Comparative study of 2 anesthesia techniques for pediatric refractive surgery

To compare the effectiveness of 2 anesthesia techniques for pediatric refractive surgery, propofol/fentanyl and ketamine/midazolam.

Department of Ophthalmology, Magraby Eye & Ear Center, Muscat, Oman.

This prospective clinical study was of children ranging in age range from 3 to 12 years who were followed for myopic anisometropia with amblyopia after failure of conventional correction or patients with superficial stromal corneal opacities. The children were scheduled to have refractive surgery under general anesthesia using propofol/fentanyl (P/F group) or ketamine/midazolam (K/M group). All drugs were administered intravenously.

Thirty patients were included in the study and were divided randomly into 2 equal groups. Both groups were comparable in age, weight, sex, duration of anesthesia, and duration of surgery. Time to complete recovery was significantly shorter in the P/F group. The hemodynamic changes observed in this study were not of clinical significance. Three patients in the P/F group showed arterial oxygen (O2) saturation of less than 90% and supplemental O2 was given by nasal cannula. The incidence of postoperative agitation and vomiting was significantly higher in the K/M group, while the need for jaw thrust was significantly higher in the P/F group. The difference between both groups in the ophthalmologist satisfaction score was not significant.

Propofol offered some advantages for brief procedures outside the traditional operating rooms. It is short acting, and has a rapid offset resulting in shorter postoperative monitoring and a smoother recovery profile. It has greater potential for respiratory depression than ketamine. Hence, greater vigilance and experience with the pediatric airway is recommended with its use.