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Background: Oculucardiac Reflex (OCR) is the most common side effect during the strabismus surgeries. OCR is defined as a trigemino-vagal reflex, which may cause bradycardia, arrhythmias, and cardiac arrest after manipulating orbital structures. Aim: Our aim is to compare the effect of atropine versus ketamine as a protector against oculocardiac reflex during strabismus surgery. Material and Methods: This study was carried out on 111 children, 2-12 years, ASA I-II, scheduled for elective strabismus surgery under general anesthesia. Patients were randomized into three equal groups (37 patients in each group): Group C: Control Group (CG): Patient received 1mg/kg propofol, 1mic/kg fentanyl and 0.15mg/kg cis-atracurium for induction of anesthesia. Group A: Atropine group (AG): 0.01 mg/kg atropine, 1mg/kg propofol, 1mic/kg fentanyl and 0.15 mg/kg cis-atracurium. Group K: Ketamine Group (kG): 1mg/kg ketamine, 1mic/kg fentanyl and 0.15mg/kg cis-atracurium. The following parameters were compared between the 3 groups: Intraoperative hemodynamics, incidence & severity of Oculocardiac Reflex (OCR), lenght of stay in post anesthesia care unit using modified aldert score, postoperative agitation using behavior score and incidence of Post-Operative Nausea & Vomiting (PONV) using neumeric rank score. Results: Incidence & severity of OCR and behavior score showed a significant decrease in groupK than group A &C, while the mean arterial blood pressure showed insignificant difference at different tybe of operation. Lenght of stay in post Anesthesia Care Unit and post-operative nausea & vomiting showed a significant increase in groupK than group A & C. Conclusions: In pediatric patients undergoing strabismus surgery, induction of anesthesia using 1mg/kg ketamine showed significant decrease in incidence of OCR owing to its heamodynamic stability in comparison with atropine & control groups which showed significant decrease in PONV.

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