Comparative Study between Atropine and Ketamine for Prevention of Oculocardiac Reflex in Children Undergoing Strabismus Surgery

Abstract
Background: Oculucardiac Reflex (OCR) is the most common side effect during the strabismus surgeries. OCR is defined as a trigemino-vagal reflex, which may cause brady-cardia, arrhythmias, and cardiac arrest after manipulating orbital structures.
Aim: Our aim is to compare the effect of atropine versus ketamine as a protector against oculocardiac reflex during strabismus surgery.
Material and Methods: This study was carried out on 111 children, 2-12 years, ASA I-II, scheduled for elective strabis-mus surgery under general anesthesia. Patients were rand-omized into three equal groups (37 patients in each group): Group C: Control Group (CG): Patient received 1mg/kg propofol, 1mic/kg fentanyl and 0.15mg/kg cis-atracurium for induction of anesthesia. Group A: Atropine group (AG): 0.01 mg/kg atropine, 1mg/kg propofol, 1mic/kg fentanyl and 0.15 mg/kg cis-atracurium. Group K: Ketamine Group (kG): 1mg/kg ketamine, 1mic/kg fentanyl and 0.15mg/kg cis-atracurium. The following parameters were compared between the 3 groups: Intraoperative hemodynamics, incidence & severity of Oculocardiac Reflex (OCR), lenght of stay in post anesthesia care unit using modified aldert score, postoperative agitation using behavior score and incidence of Post-Operative Nausea & Vomiting (PONV) using neumeric rank score.
Results: Incidence & severity of OCR and behavior score showed a significant decrease in groupK than group A &C, while the mean arterial blood pressure showed insignificant difference at different tybe of operation. Lenght of stay in post Anesthesia Care Unit and post-operative nausea & vom-iting showed a significant increase in groupK than group A & C.
Conclusions: In pediatric patients undergoing strabismus surgery, induction of anesthesia using 1mg/kg ketamine showed significant decrease in incidence of OCR owing to its heamo-dynamic stability in comparison with atropine & control groups which showed significant decrease in PONV.