Abstract
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.]
- 1.Emhardt JD, Haider KM, Plager DA, Grundhoefer DL. Intraoperative apnea in children after buffered 5% povidone-iodine site sterilization for strabismus surgery. Paediatr Anaesth. 2015; 25(2):193–195.
10.1111/pan.12476 Crossref Medline, Google Scholar - 2.Powell MB, Ahlers-Schmidt CR, Engel M, Bloom BT. Clinically significant cardiopulmonary events and the effect of definition standardization on apnea of prematurity management. J Perinatol. 2017; 37(1):88–90.
10.1038/jp.2016.167 Crossref Medline, Google Scholar - 3.Behne M, Wilke HJ, Harder S. Clinical pharmacokinetics of sevoflurane. Clin Pharmacokinet. 1999; 36(1):13–26.
10.2165/00003088-199936010-00002 9989340 Crossref Medline, Google Scholar - 4.Ridder WH, Oquindo C, Dhamdhere K, Burke J. Effect of povidone-iodine 5% on the cornea, vision, and subjective comfort. Optom Vis Sci. 2017; 94(7):732–741.
10.1097/OPX.0000000000001091 28609415 Crossref Medline, Google Scholar - 5.Oakley C, Allen P, Hooshmand J, Vote BJT. Pain and antisepsis after ocular administration of povidone-iodine versus chlorhexidine. Retina. 2018; 38(10):2064–2066.
10.1097/IAE.0000000000001800 Crossref Medline, Google Scholar - 6.Goudarzi M, Yaghooti AA, Marashi S. Comment to “Intraoperative apnea in children after buffered 5% povidone-iodine site sterilization for strabismus surgery.”Paediatr Anaesth. 2017; 27(9):975.
10.1111/pan.13192 28772013 Crossref Medline, Google Scholar - 7.Tucker NA, Codère F. The effect of fluorescein volume on lacrimal outflow transit time. Ophthal Plast Reconstr Surg. 1994; 10(4):256–259.
10.1097/00002341-199412000-00006 7865446 Crossref Medline, Google Scholar - 8.Havidich JE, Beach M, Dierdorf SF, Onega T, Suresh G, Cravero JP. Preterm versus term children: analysis of sedation/anesthesia adverse events and longitudinal risk. Pediatrics. 2016; 137(3):e20150463.
10.1542/peds.2015-0463 26917674 Crossref Medline, Google Scholar - 9.Robison JG, Wilson C, Otteson TD, Chakravorty SS, Mehta DK. Increased eustachian tube dysfunction in infants with obstructive sleep apnea. Laryngoscope. 2012; 122(5):1170–1177.
10.1002/lary.22473 22344711 Crossref Medline, Google Scholar - 10.Lee CH, Hsu WC, Chang WH, Lin MT, Kang KT. Polysomnographic findings after adenotonsillectomy in obese and non-obese children: a systematic review and meta-analysis. Clin Otolaryngol. 2015; 41:498–510.
10.1111/coa.12549 Crossref, Google Scholar - 11.Schuitema K, Holm B. The role of different facial areas in eliciting human diving bradycardia. Acta Physiol Scand. 1988; 132(1):119–120.
10.1111/j.1748-1716.1988.tb08306.x 3223302 Crossref Medline, Google Scholar - 12.Meuwly C, Leibundgut G, Rosemann T, Schaller B. Sinus arrest with prolonged asystole due to the trigeminocardiac reflex during application of local anaesthetic in the nasal mucosa. BMJ Case Rep. 2018; 2018:bcr-2018-226427. doi:
30333200 Medline, Google Scholar - 13.Kane SM, Davis J. Cardiac arrest and death attributable to the “diving response” triggered during incision and debridement of an abscess of the forehead. J Craniofac Surg. 2018; 29(5):e507–e509. doi:
29608477 Crossref Medline, Google Scholar - 14.Nicholson D, Kossler A, Topping K, Stary CM. Exaggerated oculocardiac reflex elicited by local anesthetic injection of an empty orbit: a case report. A A Case Rep. 2017; 9(12):337–338.
10.1213/XAA.0000000000000609 28767475 Crossref Medline, Google Scholar
