Comparison of two doses of Dexmedetomidine for the reduction of emergence delirium in children undergoing tonsillectomy/ adenotonsillectomy with or without myringotomy: A Randomized Controlled Trail.

Adenotonsillectomy is one of the most common surgeries performed by otorhinolaryngologists in children under general anaesthesia. In addition to nausea, vomiting, severe pain and poor oral intake, emergence delirium after adenotonsillectomy is one of the main reasons for postoperative morbidity, which may delay the discharge, influence the patient ability to return to normal activity, increase the duration of hospital stay and overall medical cost. Emergence delirium causes distress among children, parents and caregivers thereby increasing dissatisfaction towards the quality of care. Postoperative agitation occurs commonly in young children, generally presenting shortly after emergence from general anaesthesia commonly with volatile agents. Studies have found that children can become agitated at any time during their stay in post anaesthesia care unit. Post operative emergence delirium can be associated with several causes including pain, anxiety, physiological compromise and anaesthetic side effect. Emergence delirium in children is frequent but a preventable complication. Many drugs have been used in practice to prevent emergence delirium in children post anaesthesia. One such drug is dexmedetomidine. Dexmedetomidine is a potent selective alpha 2 agonist which has diverse actions providing dose dependent sedation, anxiolysis, analgesia, perioperative sympatholytic action, anaesthetic sparing effects without relevant respiratory compromise. It decreases heart rate, blood pressure and cardiac output in a dose dependent manner with preservation of respiratory function. Because of its favourable sedation characteristics, hemodynamic stability and lack of respiratory depression, dexmedetomidine can be used in paediatric population. It was found that dexmedetomidine offers specific advantages over others drugs that are used for post operative agitation in children after tonsillectomy. Therefore, we plant compare two doses of dexmedetomidine in reduction of emergence delirium after adenotonsillectomy  with or without myringotomy in children in this study.