BACKGROUND: This study evaluated the hemodynamic response and recovery profile of remifentanil-N₂O anesthesia, compared with sevoflurane-N₂O anesthesia in pediatric strabismus surgery. METHODS: Fifty-seven healthy children aged 1-9 years undergoing strabismus surgery were randomly assigned to two groups, group R or group S. None of the children was premedicated with an anticholinergic agent. Anesthesia was induced with intravenous ketamine 1.0 mg/kg. A laryngeal mask airway (LMA) was placed with rocuronium 0.4 mg/kg. Anesthesia was maintained with sevoflurane 2.0-3.0 vol% and N₂O 66% in group S, and with remifentanil 0.75 µgram/kg over 1 min followed by remifentanil 0.5 µgram/kg/min and N₂O 66% in group R. At the end of surgery, the anesthetic agents were discontinued, and the early emergence, recovery, and side effects were assessed. RESULTS: During anesthesia, the heart rate and blood pressure were lower in group R (P < 0.05). The incidence of an oculocardiac reflex was similar in both groups. The times to spontaneous ventilation and the removal of LMA were similar in the two groups. The times from eye opening to command, orientation and full recovery were faster in group R (P < 0.05). The incidence of postoperative nausea and vomiting was similar in both groups. The incidence of coughing was lower in group R (P < 0.05). Mild pruritus developed in 17.2% of patients in group R. CONCLUSIONS: In pediatric strabismus surgery, remifentanil provided similar hemodynamic stability, and an earlier and smoother recovery, compared with sevoflurane anesthesia.