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Effects of atracurium and pancuronium on the oculocardiac reflex in children
J Loewinger1, I Friedmann-Neiger, M Cohen
1Department of Anesthesia and Intensive Care, Beilinson Medical Center, Petah-Tiqva, Israel.
Insights
Pancuronium is safer than atracurium for strabismus surgery in children. Atracurium use led to more bradycardia, dysrhythmias, and atropine use during eye muscle surgery.
Area of Science:
- Anesthesiology
- Pediatric Ophthalmology
- Pharmacology
Background:
- The oculocardiac reflex (OCR) can cause bradycardia during strabismus surgery.
- Muscle relaxants are used during pediatric strabismus surgery.
- Comparing the effects of different muscle relaxants on OCR-induced bradycardia is important for patient safety.
Purpose of the Study:
- To compare the effects of atracurium and pancuronium on bradycardia during strabismus surgery in children.
- To evaluate the incidence of dysrhythmias and need for atropine in children receiving either atracurium or pancuronium.
Main Methods:
- A randomized study involving 30 children undergoing strabismus surgery.
- Children were divided into two groups, receiving either atracurium or pancuronium.
- Heart rate, rhythm, and atropine administration were monitored throughout the surgery.
Main Results:
- The atracurium group showed a significantly higher incidence and severity of bradycardia compared to the pancuronium group.
- Dysrhythmias and the need for atropine were significantly greater in the atracurium group.
- Pancuronium was associated with a more stable heart rate during the procedure.
Conclusions:
- Pancuronium is associated with a lower incidence and severity of oculocardiac reflex-induced bradycardia in pediatric strabismus surgery compared to atracurium.
- Pancuronium may be a safer choice for muscle relaxation in this patient population.
- Further research could explore optimal dosing and monitoring strategies for both agents.
Abstract:
The authors compare the effect of two muscle relaxants, atracurium and pancuronium, on the bradycardia resulting from the oculocardiac reflex during eye surgery for strabismus in children. Two groups, each composed of 15 children, received either pancuronium or atracurium during strabismus operations. Heart rate and rhythm were observed at several points during the operations, and the changes that occurred in the two groups were compared. We found that the incidence and severity of the bradycardia, the incidence of dysrhythmias, and the need for atropine administration were significantly greater in the atracurium group than in the pancuronium group.