Instillation of 5% Povidone-Iodine Ophthalmic Drops Decreases the Respiratory Rate in Children Undergoing Strabismus Surgery: A Randomized Controlled Trial

• Published in: Journal of pediatric ophthalmology and strabismus Vol. 56; no. 6; pp. 378 - 382
• Main Authors: Rovner, Michelle S, Wolf, Bethany Jacobs, Rubin, Melanie, Ritter, Alexandra, Heine, Christopher L, Wester, Tracy E, Furse, Cory M
• Format: Journal Article
• Language: English
• Published: United States Slack, Inc 01.11.2019; SLACK INCORPORATED
• Subjects: Adolescent; Age; Airway management; Anesthesia; Anesthesia, General - methods; Anti-Infective Agents, Local - administration & dosage; Blood pressure; Carbon dioxide; Child; Child, Preschool; Female; Heart rate; Humans; Instillation, Drug; Iodine; Laboratories; Male; Ophthalmic drugs; Ophthalmic Solutions; Ophthalmologic Surgical Procedures; Patients; Pediatric anesthesia; Povidone-Iodine - administration & dosage; Premature birth; Preoperative Care - methods; Respiration; Respiratory Rate - drug effects; Single-Blind Method; Strabismus; Strabismus - drug therapy; Strabismus - physiopathology; Strabismus - surgery; Surgery; Treatment Outcome; Vision disorders in children
• ISSN: 0191-3913; 1938-2405
• DOI: 10.3928/01913913-20190923-01

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. 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. 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. 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.].