Choi S H, Lee S J, Kim S H, Kim J H, Kwon H H, Shin Y S, Lee K Y
Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea.
Acta Anaesthesiol Scand. 2007 Jul;51(6):759-62. doi: 10.1111/j.1399-6576.2007.01329.x. Epub 2007 May 4.
Oculocardiac reflex (OCR) is a major complication of pediatric strabismus surgery. The aim of the present study was to determine whether a single bolus of intravenous (i.v.) ketamine for anesthetic induction can decrease OCR in children undergoing strabismus surgery.
One hundred and twenty healthy children undergoing strabismus surgery were allocated to three groups using double-blind randomization. Anesthesia was induced with propofol 3 mg/kg in Group P, ketamine 1 mg/kg in Group K1, or ketamine 2 mg/kg in Group K2. Anesthesia was maintained with 3% sevoflurane in 50% N(2)O/O(2) in all patients. The baseline heart rate was obtained 30 s prior to the first traction of the extraocular muscle (EOM). OCR was defined as a development of arrhythmia or a decrease of more than 20% of the baseline heart rate during EOM traction.
The incidence of OCR was significantly lower in the ketamine groups (4/40 and 1/40 in Group K1 and K2, respectively) compared with the propofol group (14/40).
A single bolus of i.v. ketamine 1 or 2 mg/kg for anesthetic induction results in a lower incidence of OCR than propofol when combined with sevoflurane for maintenance in children undergoing strabismus surgery.
眼心反射（OCR）是小儿斜视手术的主要并发症。本研究的目的是确定麻醉诱导时单次静脉注射氯胺酮是否能降低斜视手术患儿的眼心反射。
120例接受斜视手术的健康儿童采用双盲随机法分为三组。P组用丙泊酚3mg/kg诱导麻醉，K1组用氯胺酮1mg/kg，K2组用氯胺酮2mg/kg。所有患者均用3%七氟醚加50%氧化亚氮/氧气维持麻醉。在首次牵拉眼外肌（EOM）前30秒记录基础心率。眼心反射定义为牵拉眼外肌期间出现心律失常或心率较基础心率降低超过20%。
氯胺酮组（K1组4/40，K2组1/40）的眼心反射发生率明显低于丙泊酚组（14/40）。
在接受斜视手术的儿童中，麻醉诱导时单次静脉注射1或2mg/kg氯胺酮与七氟醚维持麻醉联合应用时，眼心反射的发生率低于丙泊酚。
