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Rocuronium attenuates oculocardiac reflex during squint surgery in children anesthetized with halothane and nitrous oxide

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The oculocardiac reflex (OCR) may be activated during squint surgery. The aim of this study was to test whether rocuronium 0.4 mg kg−1 could reduce the frequency of OCR, and also whether a single dose of succinylcholine 1 mg kg−1 could affect the frequency of OCR during anesthesia with halothane in a nitrous oxide/oxygen mixture. Methods: 

A total of 161 ASA I children, 3–10 years old, undergoing elective surgery of the medial rectus muscle (MRM) were randomly assigned to three groups. Group R (n = 51), received 0.4 mg kg−1 of rocuronium intravenously before endotracheal intubation. Group S (n = 58) received 1 mg kg−1 of succinylcholine. Group C (controls, n = 52) received no relaxant. Oculocardiac reflex was defined as a reduction in heart rate (HR) >= 15% and/or the appearance of any other arrhythmias, during manipulation of the MRM. Analysis of variance (anova), chi-squared, Kruskal–Wallis, and Student's t-tests were used for statistical analysis; P< 0.05 was considered statistically significant. Results: 

In group R, OCR occurred in 15/51 (29%) of children, in group S in 31/58 (53%), and in group C in 23/52 (44%) (χ2 = 6.46, P = 0.049). In group R, the incidence of arrhythmias such as nodal rhythms, supraventricular and ventricular premature beats was 6%, compared with 22% in group S and 19% in group C (χ2 = 6.01, P = 0.040). However, there was no reduction in the occurrence of bradycardia (χ2 = 0.16, P = 0.924)., Conclusion: 

Rocuronium reduced the frequency of OCR, mainly by reducing the incidence of supraventricular and ventricular premature beats.

Keywords: Halothane; inhalational anesthesia; muscle relaxants; oculocardiac reflex; pediatric anesthesia; rocuronium; squint surgery; strabismus; succinylcholine

Document Type: Research Article


Affiliations: 1: Department of Anesthesiology and Intensive Care, University Hospital Split, and 2: Department of Neuroscience, University of Split Medical School, Split, Croatia

Publication date: November 1, 2004

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