الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Inhalation general anaesthesia is frequently required in children undergoing surgical or diagnostic procedures. Sevoflurane was first synthesized in 1968 and reported in 1971 and has been available for general clinical use in Japan since 1990. Sevoflurane has gained widespread acceptance in pediatric anaesthesia because of the rapidity of induction and emergence from anaesthesia, hemodynamic stability.
Concerns about quality of the emergence from sevoflurane anaesthesia remain due to increased incidence of postoperative emergence agitation characterized by mental confusion, irritability, disorientation, inconsolable crying. Most common age is preschool age and the incidence rate reported varies from 10 to 67%. It is self-limiting phenomenon with limited duration (15-30 min) and spontaneous recovery .it’s seen during the first 30 minutes after emergence from anaesthesia.
There is no clear and scientifically valid explanation for this phenomenon but many theories were suggested like interaction at the GABAA receptor level or rapid emergence from sevoflurane anaesthesia in conjunction with psychological immaturity of young children.
Several medications have been used in an attempt to decrease the incidence and severity of emergence agitation.
Ketamine is antagonist of the excitatory neurotransmitter glutamate at (NMDA) receptor sites in the CNS. It is used for induction and maintenance of aneasthesia, sedation, analgesia and treatment of bronchospasm.
Nalbuphine is a synthetic narcotic agonist-antagonist which has been administered as an analgesic supplement for conscious sedation or balanced anaesthesia and as an analgesic for postoperative and chronic pain problems.
The current study aimed at studying the effectiveness of preventing sevoflurane induced emergency agitation in pediatrics undergoing cataract surgery by using small dose of ketamine or nalbuphine administered just before discontinuation of anaesthesia.