A randomized comparative study of intranasal atomized dexmedetomidine versus ketamine as a premedication in children undergoing adenotonsillectomy in general anaesthesia at SMS Medical College Jaipur

Paediatric  patients present a unique set of challenges to the anaesthetist as preoperative anxiety in children leads to a difficulty in parental separation, i.v. cannulation, induction of anaesthesia, greater analgesic requirements and emergence agitation .Hence, the administration of balanced short-acting sedative agents with minimal risk of respiratory dysfunction is recommended under close monitoring of vitals. Dexmedetomidine is a selective alpha 2 agonist similar to clonidine, but with higher affinity to the alpha 2 receptor. It produces dose-dependent sedation, anxiolysis, and analgesia without respiratory depression and minimal effect on respiratory rate and tidal volume. Ketamine acts on the N methyl D aspartate receptor (NMDA R) producing a dissociative anesthesia. Ketamine is known to reduce central sensitization to pain, decrease overall opioid utilization, and produce effective sedation level. Oral administration has low bioavailability. Parenteral and intramuscular routes are invasive and painful. Intranasal application is a relatively non-invasive and easy route of administration which has the additional benefit of not requiring patient cooperation. With this background, we have planned this study to compare the efficacy of intranasal atomized dexmedetomidine versus ketamine as a premedication for anxiolysis and sedation in pediatric patients undergoing adenotonsillectomy in general anaesthesia.