The The Effect of Pre-Emptive Dose of Intravenous Ketamine on Oculocardiac Reflex in Pediatric Strabismus Surgery: A Randomized Clinical Trial
a randomized clinical trial
- To evaluate the effect of pre-emptive dose of intravenous ketamine on Oculocardiac reflex (OCR) in pediatric strabismus surgery. 60 children with age between 2 to 8 years old candidate for strabismus surgery were randomly divided into two groups of 30 participants. After induction of anesthesia, in one group, pre-emptive dose of ketamine (0.15 mg/kg) was given intravenously (ketamine group), while the other group was given the same volume of normal saline (control group). During the surgery, OCR was recorded if the heart rate had decreased 20% or more from the baseline. In the recovery room, the incidence of nausea and vomiting, bronchospasm, laryngospasm, hallucination and recovery nurse satisfaction score were recorded. The incidence of OCR in total participants was 31 (51.7%). In control group 21 (70%) patients had OCR during surgery while this incidence was 10 (33.3%) in ketamine group which was significantly lower (P:0.004). the incidence of postoperative nausea and vomiting and the mean of recovery nurse satisfaction score in recovery room were not significantly different between two groups. The hallucination was not seen in any cases of two groups after surgery. The pre-emptive dose of ketamine (0.15 mg/kg) can reduce incidence of OCR in the pediatric strabismus surgery.
2. Oh JN, Lee SY, Lee JH, Choi SR, Chin YJ. Effect of ketamine and midazolam on oculocardiac reflex in pediatric strabismus surgery. Korean journal of anesthesiology. 2013 Jun 1;64(6):500-4.
3. Choi SH, Lee SJ, Kim SH, Kim JH, Kwon HH, Shin YS, Lee KY. Single bolus of intravenous ketamine for anesthetic induction decreases oculocardiac reflex in children undergoing strabismus surgery. Acta anaesthesiologica scandinavica. 2007 Jul;51(6):759-62.
4. Chung CJ, Lee JM, Choi SR, Lee SC, Lee JH. Effect of remifentanil on oculocardiac reflex in paediatric strabismus surgery. Acta Anaesthesiologica Scandinavica. 2008 Oct;52(9):1273-7.
5. Mizrak A, Erbagci I, Arici T, Avci N, Ganidagli S, Oner U. Dexmedetomidine use during strabismus surgery in agitated children. Medical Principles and Practice. 2011;20(5):427-32.
6. Mizrak A, Erbagci I, Arici T, Ozcan I, Ganidagli S, Tatar G, Oner U. Ketamine versus propofol for strabismus surgery in children. Clinical ophthalmology (Auckland, NZ). 2010;4:673.
7. Hahnenkamp K, HÖNEMANN CW, Fischer LG, Durieux ME, Muehlendyck H, Braun U. Effect of different anaesthetic regimes on the oculocardiac reflex during paediatric strabismus surgery. Pediatric Anesthesia. 2000 Nov;10(6):601-8.
8. Choi SR, Park SW, Lee JH, Lee SC, Chung CJ. Effect of different anesthetic agents on oculocardiac reflex in pediatric strabismus surgery. Journal of anesthesia. 2009 Nov 1;23(4):489-93.
9. Woolf CJ, Chong MS. Preemptive analgesia—treating postoperative pain by preventing the establishment of central sensitization. Anesthesia & Analgesia. 1993 Aug 1;77(2):362-79.
10. Espahbodi E, Sanatkar M, Sadrossadat H, Vafsi ME, Azarshahin M, Shoroughi M. Ketamine or atropine: which one better prevents oculocardiac reflex during eye surgery? A prospective randomized clinical trial. Acta Medica Iranica. 2015;53(3):158-61.
11. Alletag MJ, Auerbach MA, Baum CR. Ketamine, propofol, and ketofol use for pediatric sedation. Pediatric emergency care. 2012 Dec 1;28(12):1391-5.
12. Green SM, Johnson NE. Ketamine sedation for pediatric procedures: part 2, review and implications. Annals of emergency medicine. 1990 Sep 1;19(9):1033-46.
13. Tweed WA, Minuck M, Mymin D. Circulatory responses to ketamine anesthesia. Anesthesiology. 1972 Dec 1;37(6):613-9.