Effect of intranasal dexmedetomidine versus intranasal ketamine on emergence agitation after sevoflurane anesthesia in myringotomy patients: a randomized clinical trial.

Preoperatively, all patients will be assessed by detailed medical and surgical history, complete clinical examination and routine laboratory investigations and will be allocated randomly into two groups; Group I (intranasal ketamine group = 45 children): Children of this group will receive ketamine intranasal in a dose 5 mg/kg. Group II (Intranasal dexmedetomidine group = 45 children): Children of this group will receive dexmedetomidine intranasal in a dose 1 microgram/kg. A preoperative fasting period of 6 hours. No premedication will be taken. Induction of general anesthesia will done 15 minutes after study drug administration with sevoflurane which will be titrated with increments of 1% at each breath up to 8% in oxygen 100%. Once an appropriate depth of anesthesia will be obtained an IV cannula and a suitable laryngeal mask will be inserted (its position will be confirmed by capnography) and sevoflurane concentration will be reduced to an end tidal concentration of 3% in 100% oxygen. Spontaneous breathing will be allowed provided ETCO2 remained below 50 mm Hg; if ETCO2 exceeded 50 mm Hg, the patient will be excluded from the study and ventilation will be assisted. No muscle relaxant or narcotic will be administered during the procedure. The patients will be monitored continuously for heart rate, oxygen saturation, respiratory rate, end tidal CO2 and mean arterial blood pressure. Sevoflurane will be discontinued immediately after insertion of the T-tube, and the laryngeal mask will be removed 60 seconds later and the patient will be transported to the post-anesthesia care unit (PACU) in a quiet and warm environment without any stimulus. Parents will be allowed to be at the child’s bedside in the PACU.