الفهرس 
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Abstract
Surgery is a stressful and fearful event that the child face every day and the children cannot deal with such situations, they have a lot of issues and concerns about the surgical procedure, OR, strange peoples and environment, needles and syringes, the children have after that a very bad experience and it may let psychological impact on them, and this fear and anxiety may obstruct the anesthesia induction or may prolong it, may make the procedure of cannulation is very difficult in addition to the stress and anxiety at parents and their bad experience also.
The modern anesthesia practice developed many techniques to alleviate or decrease stress and anxiety starting from parent and child education, preoperative clinic visits, reassurance from anesthesiologist to parents and child, distraction techniques, use of sedatives and anxiolytics in the preoperative period via intramuscular route, oral route and finally by intranasal application of drugs by instillation of the drug directly in the nasal cavity.
Intranasal route is a very effective route of administration as nasal cavity highly vascularized and bypasses the hepatic metabolism and provides high serum levels of drug to attain a higher degree of sedation and anxiolysis if sedative drug given through it and also it is easy, safe route of administration and well tolerated by most of pediatrics, so many of drugs are given through the intranasal route and in this study we are in concern about the effectiveness of sedative drugs to be given through the intranasal route and comparing their effect and pharmacological action.
Dexmedetomidine is a highly selective α2-adrenergic agonist. Its sedative effect is dose dependent and characterized by being easily arousable. It also has an analgesic and anxiolytic effect without causing respiratory depression. The intranasal application of dexmedetomidine is an effective and well tolerated choice for children premedication.
Ketamine a phencyclidine derivative can produce a state of sedation, anesthesia, immobility, analgesia, and amnesia through blocking N-methyl D-aspartate receptors is used widely in pediatric patients due to its hypnotic, analgesic and amnesic effect. Ketamine is safe and effective by intranasal drug route for moderate sedation of anxious and uncooperative pediatric patients.
This study compared the effect of intranasal application of dexmedetomidine versus ketamine and compared their sedative and anxiolytic actions on pediatric patients undergoing adenotonsillectomy, after application of each drug vital signs assessed every 10 minutes pre, intra and postoperative, modified Ramsay sedation scale also applied preoperative and postoperative, response to cannulation was assessed by Groningen distress rating scale, response of child to parental separation and degree of satisfaction of parents or guardians.
This study was done on 76 pediatric patients undergoing adenotonsillectomy, the patients was ranging from 3 to 6 years old and divided into two groups each group consisting of 38 patients, first group received 2 micrograms/kg intranasal dexmedetomidine and the second group received 5 milligrams/kg intranasal ketamine.
This study revealed that both drugs produce effective and favorable sedation level, the difference between both groups was statistically significant but clinically insignificant with superiority to dexmedetomidine in sedation scores, time of onset of sedation and also there was little decrease in heart rate and MAP which is favorable during such surgeries, also there was accepted level of cannulation and parental separation scores denoting that there was smooth insertion of cannula, smooth and easy separation from guardians or caregivers, finally the parents from both groups especially dexmedetomidine group was highly satisfied with the procedure and was grateful for us due to alleviating stress and anxiety from them and from their children.