Instillation of 5% Povidone-Iodine Ophthalmic Drops Decreases the Respiratory Rate in Children Undergoing Strabismus
Insights
Topical povidone-iodine eye drops can cause respiratory pauses in children undergoing anesthesia, potentially activating the diving reflex. This finding is crucial for pediatric anesthesia safety.
Area of Science:
- Pediatric Anesthesiology
- Ophthalmology
- Physiology
Background:
- Povidone-iodine eye drops are commonly used in ophthalmic procedures.
- Apnea has been anecdotally reported with povidone-iodine use in pediatric anesthesia.
- The diving reflex is a physiological response to cold water immersion.
Purpose of the Study:
- To investigate the respiratory effects of topical 5% povidone-iodine eye drops in spontaneously breathing children under general anesthesia.
- To compare these effects with balanced salt solution eye drops.
Main Methods:
- A randomized, controlled, single-blinded study was conducted.
- Fifty children received balanced salt solution (control) and 50 received 5% povidone-iodine eye drops.
- Respiration was monitored during general anesthesia with sevoflurane via laryngeal mask airway.
Main Results:
- No significant respiratory changes were observed in the control group.
- 60% of children receiving povidone-iodine experienced respiratory slowing or pauses (median 18.5 seconds).
- Children with prior tonsillectomy/adenoidectomy or myringotomy had a 7.2x higher risk of respiratory changes.
Conclusions:
- Topical 5% povidone-iodine eye drops significantly slow or pause spontaneous breathing in most children undergoing anesthesia.
- This effect may be attributed to the activation of the diving reflex.
- Clinical vigilance is recommended during povidone-iodine administration in pediatric anesthesia.
Purpose:
To investigate the effects of topical application of ophthalmic 5% povidone-iodine eye drops, which has been reported to cause apnea in spontaneously breathing children during general anesthesia.
Methods:
The authors conducted a randomized, controlled, single-blinded study comparing the effect of balanced salt solution eye drops and povidone-iodine eye drops on respiration in spontaneously breathing children during general anesthesia with sevoflurane via a laryngeal mask airway. Fifty patients received balanced salt solution eye drops and 50 patients received 5% povidone-iodine eye drops.
Results:
None of the control patients had a significant change in respiration. Thirty of the 50 (60%) povidone-iodine patients had a slowing of respiration within the first 6 breaths after eye drop instillation (P < .001). The median time of respiratory pause in those 30 patients was 18.5 seconds (range: 4.36 to 96.2 seconds). Among the povidone-iodine patients, children with a history of a prior tonsillectomy and adenoidectomy and/or bilateral myringotomy had a 7.2 times greater chance of experiencing a change in respiration after instillation of the povidone-iodine eye drops.
Conclusions:
Topical application of 5% povidone-iodine eye drops causes a slowing and pause in spontaneous ventilation in a majority of children prior to strabismus surgery. This may represent activation of the diving reflex. [J Pediatr Ophthalmol Strabismus. 2019;56(6):378-382.].
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