الفهرس 
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Abstract
A
denotonsillectomy in children is one of the most common surgeries performed by otorhinolaryngologists. In addition to nausea, vomiting, severe pain and poor oral intake, emergence agitation (EA) after tonsillectomy is the main reason for postoperative morbidity, which may delay the discharge and influence the patient’s ability to return to normal activity.
Emergence agitation or delirium (ED) is a frequent phenomenon in children recovering from general anesthesia (GA). Postoperative emergence agitation occurs commonly in young children, generally presenting shortly after emergence from general anesthesia. Studies have found that children can become agitated at any time during their stay in the Postoperative Care Unit (PACU). Postoperative emergence agitation can be associated with a number of etiologies including pain, anxiety, physiologic compromise, and anesthetics side.
Dexmedetomidine is a potent, selective α2-adrenergic agonist, providing dose-dependent sedation, analgesia, anesthetic-sparing effects and without relevant respiratory depression. Dexmedetomidine is currently approved by the US Food and Drug Administration (FDA) for intravenous (IV) administration by continuous infusion for up to 24 h for the sedation of adults during mechanical ventilation in an intensive care unit (ICU) setting. It decreases heart rate, blood pressure, and cardiac output in a dose-dependent manner. Initial experience in the pediatric population has shown the drug’s efficacy for sedation during mechanical ventilation as well as procedural sedation during noninvasive radiologic imaging.
Magnesium sulphate is a non-anaesthetic N-methyl-D-aspartate receptor (NMDA) antagonist, which is increasingly used in adults as an anaesthetic- and analgesic-sparing medication, with controversial clinical effectiveness. There is a paucity of reports describing the analogous use of magnesium sulphate in the paediatric anaesthesia literature.
The aim of this study is evaluating the efficacy and safety of dexmedetomidine versus Magnesium for reducing emergence agitation after adenotonsillectomy in children.
Secondary outcome is to reduce child needs for analgesics and to reduce their dose.
45 children, aged between 4-12 years of either sex, belonging to ASA I or II, scheduled for elective adeno- tonsillectomy were enrolled in this prospective, double blinded, randomized and comparative clinical study. The children were divided into three groups of 15 each. group A received Dex., group B received mg sulphate and group C normal saline
Our study showed that there was statistically significant difference between the three groups as regarding the HR and the blood pressure. There was a statistically significant decrease in the dexmedetomidine group regarding the heart rate and the BP at 30 min, 45min postoperative and regarding the heart rate during the postoperative period. There was no significant difference in oxygen saturation between groups.
Limitation to our study were only 15 participants each group made up the small sample size, so we advise increasing the number of participants in future research to improve the validity of the findings. The single-centre study design might have compromised the study’s objectivity. Also recording but not analysing the intraoperative data as our main target is the agitation caused by many factors and how to be treated.
CONCLUSION
D
exmedetomidine offers some advantages compared with magnesium sulphate in controlling of emergence agitation in children. In order to lessen postoperative agitation in children having an adenotonsillectomy under general anaesthesia, it can be used as an anaesthetic medicine in a safe and effective manner. In limited resources countries, magnesium sulphate could be used but will not provide same efficacy as dexmedetomidine.