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Background: This study was designed to compare the effects of anesthetic methods used recently on emergence delirium in pediatric strabismus surgery. Methods: Two hundred and thirty two children, aged 2-10 years, undergoing strabismus surgery, were randomly assigned to one of eight groups; ketamine-desflurane (n = 30), ketamine-sevoflurane (n = 30), ketamine-propofol (n = 30), ketamine-remifentanil (n = 27), midazolam-desflurane (n = 28), midazolam-sevoflurane (n = 30), midazolam-propofol (n = 27), and midazolam-remifentanil (n = 30). Anesthesia was induced with ketamine 1.0 mg/kg or midazolam 0.15 mg/kg. Laryngeal mask airway (LMA) was placed with rocuronium 0.5 mg/kg. Anesthesia was maintained with desflurane 5-6 vol%, sevoflurane 2-3 vol%, propofol 7-8 mg/kg/hr, and remifentanil 0.5μg/kg/min under N2O 66% in O2. Ventilation was controlled to maintain normocapnia. The status of emergence delirium (ED) was evaluated by a blinded observer until discharge from postanesthetic care unit. Results: There was no differences in age, sex, weight, height, anesthetic time, and recovery time among the eight groups. ED occurred in 54 children (23.3%), but severe ED needed treatment was not occurred. Compared with ketamine group, midazolam group showed less incidence of ED. Propofol and remifentanil groups showed less incidence of ED compared with desflurane and sevoflurane groups. ED group was more younger and more temperamental compared with nonED group. Conclusions: Propofol or remifentanil anesthesia provided less incidence of ED compared with desflurane and sevoflurane in pediatric strabismus surgery. (Korean J Anesthesiol 2007; 52: 138~42)