Ocular vagal reflex (OVR) is the most common complication in ophthalmic surgery. Intraoperative OVR occurs frequently and is unavoidable in children with narrow strabismus correction, which further exposes the extraocular muscles and the maximum oblique angle of view. There is a heart rate dependence of cardiac output in pediatric patients, so bradycardia in pediatric patients has a greater impact on the organism than tachycardia and is of more concern. Especially in the pediatric population, where vagal excitability is higher than in adults, sympathetic nerve development is incomplete and can easily lead to significant vagal hyper-radiation. The serious and dangerous consequences have been reported in the literature with varying incidence and severity, causing cardiac arrest at a ratio of 2200:1. 3 deaths due to OVR in 20,000 ophthalmic surgeries. Ghai et al. reported a sudden drop in heart rate from 80 to 90 beats/min to 30 beats/min and subsequent cardiac arrest when the superior rectus muscle was pulled during orbital surgery. Therefore, this complication must be given high priority during strabismus surgery. In order to investigate the relationship between OVR and the operator’s operation and morbidity factors, we observed the incidence of OVR in different operators during pediatric strabismus correction surgery under general anesthesia and the methods of prevention, which are reported below. 1.1 Data and methods 1.1 General data 200 cases of pediatric strabismus, 124 males and 76 females, aged 3 to 14 years, with normal preoperative electrocardiogram and other systemic examinations, were collected and selected from March to November 2008 at the Tianjin Eye Hospital of ASA (American Standards Association) classification grade I. 1.2 Type of surgery and grouping Strabismus correction, monocular strabismus, except for those with one eye muscle correction and recurrent correction, and binocular strabismus with only the first operated eye. The surgery was divided into 5 groups according to the main surgeon, and the surgery was performed by a physician with the title of deputy director or above and a fixed assistant, with 40 cases in each group. 1.3 OVR criteria The operation was suspended if the heart rate dropped instantaneously by more than 10 beats/min due to the surgical operation, and below 40 beats/min. 1.4 Monitoring items PHILIPS monitor (MP50) ECG, non-invasive arterial pressure, and oxygen saturation. The number of cases of OVR in each group, the number of occurrences per case, the severity of bradycardia, and the number of operations stopped due to severe OVR were recorded. 1.5 Anesthesia method Pre-operative fasting for 6-8 h and 3-4 h. 30 min before anesthesia, intramuscular injection of Valium 0.1 mg/kg and Valtrex 0.015 mg/kg. 4 mg/kg of intramuscular ketamine for uncooperative patients and 1 mg/kg of intravenous ketamine for cooperative patients. 1 mg of midazolam, 1 mg/kg of ketamine and 1 mg/kg of propofol were used for anesthesia induction. Induction. The laryngeal mask was placed when the jaw was relaxed, and ketamine 100mg, midazolam 2mg and propofol 200mg were injected at a constant rate with intravenous anesthesia, and spontaneous breathing was preserved during the operation, which was adjusted according to the depth of anesthesia. 1.6 Statistical methods Quantitative data were expressed as mean±standard deviation ( ±s) by q-test (Newman-Keuls method) using one-way ANOVA with two comparisons of 5 sample means, and qualitative data were expressed as percentages (%) by x2 test, α=0.05, P0.05), see Table 1.