الفهرس 
A NATOMICAL C ONSIDERATION (A NATOMY OF THE N ASAL C AVI TYOnly 14 pages are availabe for public view
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Abstract
ABSTRACT
Background: The immediate pre-operative period is a very stressful time for most of the individuals undergoing surgery especially the paediatric patients. So, relieving their pre-operative anxiety becomes an important concern for an anaesthesiologist. Many anaesthetic pre-medications are used to relieve this stress response. Of these pre-medications, ketamine and dexmedetomidine are effectively used as sedatives. The present study is planned to compare sedative effect of intranasal dexmedetomidine vs intranasal ketamine as a pre-anaesthetic medication in children.
Aim of the Work: To compare the sedative effects, successful child–parental separation and haemodynamic parameters of intranasal dexmedetomidine versus ketamine as a premedication in children undergoing surgery.
Patients and Methods: After Ethical Committee approval and written informed parents’ consent, this Prospective randomized controlled clinical trial was performed in Ain Shams University Hospitals, Cairo, Egypt. Ninety children were scheduled to undergo elective surgeries.
Results: ninety children, aged between 2-8 years of either sex, belonging to ASA I-II, scheduled for elective surgery were enrolled in this prospective, randomized and comparative clinical study. The children were divided into two groups of 45 each. thirty minutes before induction, Group-D (n=45) received intranasal Dexmedetomidine 1mcg/kg and group K (n=45) received intranasal ketamine 2mg/kg. Our study showed that there was no statistically significant difference between the two groups as regarding the HR and the blood pressure at 10 and 20 min after intranasal drug instillation. There was a statistically significant decrease in the dexmedetomidine group regarding the heart rate and the BP at 30 min, preoperative and during the intraoperative period. There was no significant difference in oxygen saturation between both groups. The MOAA/S scores were comparable in both groups, It was significantly lower in the ketamine group at 10 and 20 min after the administration of the drug. However, at 30min there was a statistically significant decrease in sedation score in the D group compared with group K.
Conclusion: Revealed that both drugs produce effective and favorable sedation level with superiority to dexmedetomidine in sedation scores and slight delay in onset of sedation, and there was little decrease in heart rate and MAP which is favorable during surgeries. Also, there was accepted parental separation scores denoting that there was smooth and easy separation from guardians. Thus, it can be concluded that intranasal dexmedetomidine can be used effectively and safely as a preanesthetic medication in children undergoing any surgical procedures under general anesthesia.