Methods Two hundred and eighty children, 1 to 9 years old, undergoing elective strabismus surgery, were randomly assigned to eight groups; ketamine-sevoflurane (KS), ketamine-desflurane (KD), ketamine-propofol (KP), ketamine-remifentanil (KR), midazolam-sevoflurane (MS), midazolam-desflurane (MD), midazolam-propofol (MP), and midazolam-remifentanil (MR). No premedication was given. Anesthesia was induced using ketamine 1 mg·kg−1 or midazolam 0.15 mg·kg−1 with 66% N2O in O2. Laryngeal mask airways (LMAs) were placed with rocuronium 0.5 mg·kg−1. Anesthesia was maintained with sevoflurane 2–3 vol. %, desflurane 5–6 vol. %, propofol 7–8 mg·kg−1·h−1, or remifentanil 0.75 µg·kg−1 over 1 min, followed by a continuous infusion of remifentanil 0.5 µg·kg−1·min−1 with 66% N2O in O2. Heart rate (HR) was recorded during extraocular muscle (EOM) manipulation. OCR was defined as a reduction in HR of more than 20% induced by the traction of an EOM.
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