Ketamine versus in total intravenous anesthetic management of children undergoing strabismus surgery: a prospective randomized controlled study

Abstract

Background Strabismus is a malalignment of the visual axes. Manipulation of the globe and traction on the extraocular muscle can elicit oculocardiac reflex (OCR). Propofol anesthesia is associated with rapid induction and recovery with minimal postoperative confusion, while ketamine anesthesia is associated with less hemodynamic changes. Thus both are preferred for anesthesia of strabismus surgery in pediatric patients. Aim The aim of this work was to compare total intravenous anesthesia (TIVA) with ketamine versus propofol in the anesthetic management of children undergoing strabismus surgery. Patients and methods This study had been carried out on 50 children with ASA I scheduled for strabismus surgery. Patients were randomized into two equal groups (25 patients in each group). Group K: received TIVA with ketamine; group P: TIVA with propofol. Heart rate and mean arterial pressure, incidence of OCR, number of patients who needed intravenous atropine, recovery time, postoperative nausea and vomiting (PONV), evaluation of postoperative pain and finally the satisfaction score of the surgeon were recorded. Results Heart rate and the incidence of PONV showed a significant decrease in group P in comparison with group K. Incidence of OCR, the need for usage of atropine and the severity of postoperative pain in group P was higher in comparison with group K. There were no significant differences between the two groups regarding satisfaction score of the surgeon Conclusion TIVA with ketamine showed significant decrease in postoperative pain and incidence of OCR owing to its hemodynamic stability in comparison with propofol, which showed more rapid onset of action with rapid recovery and decreased incidence of PONV.