الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Anxiolysis and smooth parental separation are important components of pediatric preoperative preparation as preoperative anxiety and parental deprivation is a traumatic time for young children and may lead to postoperative maladaptive behaviors, such as new onset enuresis, feeding difficulties, apathy, withdrawal and sleep disturbances. Studies have indicated that up to 60% of all children undergoing surgery may present with negative behavioral changes at 2 weeks postoperatively (14). The ideal premedication should have rapid onset, short duration of action, be simple to administer, accepted by patients and should also have minimal side effects (154). The nasal route of drug administration bypasses the enterohepatic circulation, which leads to better bioavailability and avoids the bitter taste of the drug compared to orally administered drugs (119). Nebulizer creates small particulate forms of the drug, creating a thin layer around the buccal, nasal, and respiratory mucosa. The inhaled drugs administered through nebulization were comparatively more effective, quicker onset, and safer than oral or intranasal routes for pediatric premedication (5). Dexmedetomidine acts on α-2 adrenergic receptors of the locus coeruleus, resulting in quicker onset of sedation, like natural sleep with less respiratory depression. Dexmedetomidine sedation is characterized by easy arousability without affecting the orientation and cooperation of the patient (154). Ketamine acts on the N-methyl-D-aspartate receptor and produces a state of dissociative anesthesia. Ketamine has been a popular drug for premedication in pediatric patients administered through various routes(120). The aim of this study was to compare the effectiveness of nebulized dexmedetomidine and nebulized ketamine as a premedication to general anesthesia in pediatric surgeries. This prospective double-blind randomized controlled study was carried out in Tanta University Hospitals in Anesthesia Department for 6 months from June 2021 to November 2021 on sixty pediatric patients between 3 -10 years undergoing surgeries. The patients were randomly classified into three groups; 20 patients in each group. group D: the patients in this group received nebulized dexmedetomidine (3 mcg/kg) (Precedex Hospira , USA) over 10-15 min before surgery. group K: the patients in this group received nebulized ketamine (3 mg/kg) (Ketalar Sigma Tec, Egypt) over 10-15 mins before surgery. group C: the patients in this group received nebulized normal saline without drug over 10-15 mins before surgery (control group). In all groups: The drugs were prepared in 0.9% normal saline to a final volume of 3ml. Nebulization was performed using a wall nebulizer and wall oxygen source on 4 l/min. Patients received nebulized drug almost over 10-15 mins through nebulizer facemask for pediatric and nebulization was stopped when the nebulizer began to sputter. The patient was transferred to operation room after 30 mins from end of nebulization. Tools for administration of supplemental oxygen, ventilation support and drugs of resuscitation kept readily available. The results of our study can be summarized as following: 1- There was no statistically significant difference between the three groups as regard to demographic data which included (age, gender, weight, ASA, type of surgery and duration of surgery). 2- As regard to Ramsay sedation scale, sedation was better in dexmedetomidine group than Ketamine group after 30 min from the end of nebulization session. 3- As regard to Hemodynamic parameters, there was statistically significant decrease in heart rate before induction of anesthesia in dexmedetomidine group compared to ketamine group and control group while there was no other statistically significant difference between the three studied groups in heart rate at the remaining time interval, MAP or SPO2. 4- As regard to parental separation and face mask acceptance, there was better parental separation and mask acceptance in dexmedetomidine group than ketamine group and control group. 5- As regard to recovery time and discharge time, there was no statistically significant difference between the three groups. 6- As regard to incidence of adverse events, the use of nebulized ketamine increases incidence of hypersalivation as compared to nebulized dexmedetomidine. Conclusion: It can be concluded from the present study that nebulized dexmedetomidine can be used with advantage compared to nebulized ketamine for preoperative sedation in pediatric surgeries. Limitation of the study: 1- Use of the facemask with nebulizer didn’t deliver accurate dose of the drug as it wasn’t tightly fitted to patient so it is better to use mouth piece if available. 2- Parent satisfaction, analgesia, onset of sedation and peak of sedation were not measured. 3- Sample size was small and may need further studies with increasing the the sample size. Recommendations: 1. The concurrent study recommends using nebulized dexmedetomidine in pediatric surgery. 2. It can be recommended for further studies to evaluate increasing total volume of nebulized drug instead of 3 ml with the same dose of drug to decrease loss of drug in dead space. 3. Also further studies using measurement of plasma concentration of nebulized drug to detect accurate dose with good sedation and less complication.