I work in a pediatric same day surgery center in OH. We do inhalation induction N2O/ O2 70%/ 30% and after a minute start Sevo 2% and double % every 4-5 breaths. When heart rate starts to slow cut off N2O back off sevo and start IV.Then depending on airway of choice for surgery IV meds administered and LMA or ETT secured.About only time we dont start IV are mask ventilation cases such as BMT's and frenulectomies. Has anyone ever experiencedpatient ceasing spontaneous respirations when eyeball is prepped with betadine? We've been doing rectus recessions and other eye muscle cases with LMA's, regaining spontaneous rspirations quickly after insertion, and when eye prep is done spontaneous respers stop for a brief period requiring assits. Any clues why this should occur?

work at same day pediatric surgery center. We have a child-life professional who conducts pre-surgery tours of O.R. and also talks with child in preop to go over inhalation induction, shows them mask and resp. bag. They get to choose what flavor lip balm we put in mask. She will accompany the more anxious one back into O.R. and remain with them till we breathe them down. She is our Versed. We like to start out with O2/N2o 30/70% for a minute which greatly attenuates the response to Sevo, which we start at 2% and double every 4 breaths.When adequately deep (no response to nibp) start iv go to 100% O2. Most of our T&A's are done in under 25 minutes so we use .4mg/kg rocuronium , 0.05 glyco, 4-10 mgs decadron 0.1 mg/kg morphine  (to start and repeat after extubation) odanesteron .1 mg/kg (up to 4 mg) intubate return to 70/30 n2o/o2 2.5 sevo ( depending on what surgeon determines when we turn off sevo, 1 surgeon is usually so quick  i literlly turn it off after only 2 minutes. revrse with neo/glyco ( glyco dose reduced by 0.05 ) extubat at around >3 sevo and 100% O2 and after good deep suction midline.If resp effort is adequate this is when I give additinal dose of morphine. If pt has sevo delirium I will give incremental doses of 5 to 10 mg propofol for transport and additiolnal dose if needed in recovery.There are very few children are inconsolable post-op but htey are out there and you can't win them all but this technique is highly successful. For the severe OSA,severely obese, severe asthma and those under 2 years old we fall back on old reliable fentanyl 1-2 mcgs/kg at start and maybe incremental 5 mcgms boluses after extubation if resp effort is adequate.  An aside, we do eyes with LMA's, get them back spontaneous asap after insertion, we have noticed that when they are spontaneous, when eyeball is prepped with betadine their resp stop, requiring us to assist for a minute or two till spontaneous effort returns, any comments on to why this occurs?