Intravenous Infusion of Ketamine in Children Undergoing Strabismus Surgery - A Prospective Study

  • R Radhakrishnan Associate Professor, Department of Anaesthesiology
  • R Mala Associate Professor, Department of Anaesthesiology
  • Gowtham Ganesan Senior Resident, Department of Anaesthesiology
  • Heber Anandan Senior Clinical Scientist, Department of Clinical Research
Keywords: Ketamine, Pediatrics, Strabismus surgery

Abstract

Introduction: Strabismus surgery may be associated with significant post-operative pain. Conjunctiva is the main source of this pain.
Aim: The aim of the study was to study the effects of intravenous infusion of ketamine in children undergoing strabismus surgery.
Materials and Methods: A total of 40 patients were enrolled in the study. 20 patients were infused 1–3 mg/kg/h ketamine, (a bolus of 0.1–0.2 mg/kg and a maintenance infusion of 0.0025–0.02 mg/kg/min) after giving fentanyl 1 mic/kg and atracurium 0.5 mg/kg patient were intubated (ketamine group) and for other 20 patients after giving fentanyl 1 mic/kg and atracurium 0.5 mg/kg patient were intubated and supplemented with sevoflurane 2% (control group).
Results: The consumption of anesthetics and antiemetics, the incidence of oculocardiac reflex (OCR) in these patients was significantly low. The recovery time, Ramsay sedation score, and face pain scale were significantly lower in ketamine anesthesia.
Conclusion: The ketamine infusion is more advantageous and safer in pediatrics for strabismus surgery with an insignificant incidence of intraoperative OCR and post-operative pain, post-operative nausea and vomiting.

Author Biographies

R Radhakrishnan, Associate Professor, Department of Anaesthesiology

Chengalpattu Medical College, Chengalpattu, Tamil Nadu, India

R Mala, Associate Professor, Department of Anaesthesiology

Chengalpattu Medical College, Chengalpattu, Tamil Nadu, India

Gowtham Ganesan, Senior Resident, Department of Anaesthesiology

Regional Institute of Ophthalmology and Government Ophthalmic Hospital, Chennai, Tamil Nadu, India

Heber Anandan, Senior Clinical Scientist, Department of Clinical Research

Dr. Agarwal’s Healthcare Limited, Chennai, Tamil Nadu, India

References

1. Hahnenkamp K, Hönemann CW, Fischer LG, Durieux ME,
Muehlendyck H, Braun U, et al. Effect of different anaesthetic regimes on the oculocardiac reflex during paediatric strabismus surgery. Paediatr
Anaesth 2000;10:601-8.
2. Tramèr MR, Moore RA, McQuay HJ. Propofol and bradycardia: Causation,
frequency and severity. Br J Anaesth 1997;78:642-51.
3. Zeltzer L, Kellerman J, Ellenberg L, Dash J, Rigler D. Psychologic effects
of illness in adolescence. II. Impact of illness in adolescents--crucial issues
and coping styles. J Pediatr 1980;97:132-8.
4. Cohen MM, Duncan PG, Pope WD, Wolkenstein C. A survey of 112,000
anaesthetics at one teaching hospital (1975-83). Can Anaesth Soc J
1986;33:22-31.
5. Gilani MT, Sharifi M, Najafi MN, Mashhadi ME. Oculocardiac reflex
during strabismus surgery. Rev Clin Med 2016;3:4-7.
6. Blanc VF. Ventilation and the oculocardiac reflex. Anaesthesia
1987;42:324-6.
7. Stump M, Arnold RW. Iris color alone does not predict susceptibility to
the oculocardiac reflex in strabismus surgery. Binocul Vis Strabismus Q
1999;14:111-6.
8. Bieri D, Reeve RA, Champion GD, Addicoat L, Ziegler JB. The faces pain
scale for the self-assessment of the severity of pain experienced by children:
Development, initial validation, and preliminary investigation for ratio
scale properties. Pain 1990;41:139-50.
9. White PF, Schüttler J, Shafer A, Stanski DR, Horai Y, Trevor AJ, et al.
Comparative pharmacology of the ketamine isomers. Studies in volunteers.
Br J Anaesth 1985;57:197-203.
10. Krystal JH, Karper LP, Seibyl JP, Freeman GK, Delaney R, Bremner JD,
et al. Subanesthetic effects of the noncompetitive NMDA antagonist,
ketamine, in humans. Psychotomimetic, perceptual, cognitive, and
neuroendocrine responses. Arch Gen Psychiatry 1994;51:199-214.
11. Thorp AW, Brown L, Green SM. Ketamine-associated vomiting: Is it doserelated?
Pediatr Emerg Care 2009;25:15-8.
12. Oh JN, Lee SY, Lee JH, Choi SR, Chin YJ. Effect of ketamine and
midazolam on oculocardiac reflex in pediatric strabismus surgery. Korean J
Anesthesiol 2013;64:500-4.
Published
2021-10-05