The effect of ketofol anesthesia on intraocular pressure in pediatric strabismus surgery

Abstract

Background/Aim: Keeping intraocular pressure (IOP) within normal limits is an important goal in the anesthetic management of pediatric strabismus surgery. While propofol is commonly used as an induction agent since it provides smooth laryngeal mask insertion, it has the undesirable side effect of dose-dependent cardiorespiratory depression. On the other hand, ketamine acts as a sympathetic cardiorespiratory stimulant; however, its effect on IOP is controversial. The aim of this study was to determine the effect of the combination of ketamine and propofol (ketofol) on IOP in pediatric strabismus surgery compared to propofol alone. Methods: Participants included patients aged between 2 and 18 years who underwent strabismus surgery. They were divided into two groups according to type of anesthesia induction: propofol and ketofol. Patient characteristics, surgical data, hemodynamic parameters, oculocardiac reflex (OCR), and IOP were compared between the two groups. Results: Forty-five children with a mean age of 7.7 years were enrolled in the study. The patients were assigned into two groups: propofol alone (n=26) and ketofol (n=19). The groups were similar in patient characteristics, surgical data, and hemodynamic parameters (P<0.05 for each). IOP was measured at four points: before anesthesia, at 1 minute following induction, at 3 minutes following laryngeal mask airway (LMA) insertion, and at the end of surgery. All IOP values were within normal limits. No significant differences in mean IOP values were found between the groups (P>0.05 for each). There was also no significant difference in OCR between the groups (P=1.000). Conclusions: Compared to propofol alone, ketofol had a similar effect on IOP, OCR, and hemodynamic parameters. These results suggest that ketofol can be safely used in the induction of anesthesia in pediatric patients undergoing strabismus surgery.