Comparison of Intranasal Dexmedetomidine with Intranasal Midazolam as Premedication in Children Undergoing Elective Surgeries- A Randomised Controlled Trial.

After obtaining Institutional Ethics Committee clearance and explaining the study in detail, written informed consent will be procured from parents. The patients are randomized into two groups dexmedetomidine (group D) and midazolam (group M) by a computer generated randomization list prepared by an anaesthesiologist not involved in the study. The principal investigator is blinded to the computer generation of random numbers and sealed envelope method will be used during the conduct of study. The allotted patients will be kept nil per oral as per the standard fasting guideline protocol. The child is brought to the premedication room and are administered with either intranasal dexmedetomidine 1 mcg/kg or intranasal midazolam 0.2 mg/kg 30 minutes prior to the procedure on the day of surgery.  The premedication drug is prepared by a person not involved in the study, either of the drug is taken in a 2 ml syringe and is diluted to 2 ml. It is instilled into both the nostrils by the principal investigator using an atomiser. In the premedication room, the patient’s heart rate and SPO2 are monitored at 5 minutes interval. After 30 minutes, parental separation anxiety is assessed using appropriate score. The child is shifted to the operating theatre and standard ASA monitors are attached. All children are given Inhalational induction using sevoflurane followed by assessment of mask acceptance using Mask acceptance score. Tracheal intubation will be done after administration of standard non-depolarizing muscle relaxant, anaesthesia will maintained by O2 , air and sevoflurane and analgesia will provided by fentanyl and paracetamol. Ventilation will be controlled by either Jackson-Ree’s modification of Ayre’s T-piece or pediatric closed circuit. Residual neuromuscular paralysis will be reversed at the end of operation by appropriate dose of neostigmine and glycopyrrolate. In all patients heart rate, systolic blood pressure, diastolic blood pressure and mean arterial blood pressure are measured at baseline and at 5 min interval throughout the procedure.  Post extubation emergence agitation is assessed using the Cravero emergence agitation score. Hemodynamic parameters are measured postoperatively in the recovery room till the patient is shifted.