الفهرس 
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Abstract
The preanesthetic management of infants and children can be a challenge for the anesthesiologist. Inadequate handling of an uncooperative child preoperatively and children who are extremely anxious during the induction of anesthesia are more at risk of developing postoperative behavior problems compared with children who appear calm during the induction process
In children preanesthetic medications are frequently administered as pharmacological adjunctions to help alleviate the stress and fear of surgery as well as to ease child parental separation and promote a smooth induction.
This study was designed to compare intranasal dexmedetomedine, midazolam and ketamine as premedication for pediatric surgeries and their role in alleviating parental separation anxiety, anxiety associated with the introduction of the anesthesia face mask and the incidence of postoperative behavioral disorders.
This work was conducted on 90 children patients of both sexes, of ASA physical status I & II, age group ranged between 2-6 years admitted to Suez Canal University hospital after approval which obtained from the research ethics committee of anesthesia and critical care department, Suez Canal University. They were scheduled for elective lower an abdominal surgical operation in which general anesthesia with endotracheal intubation was indicated.
Children were randomly assigned by a computer-generated assignment to receive via the nasal route, in a double blind manner one of the three medications:
Group D (30 children): received intranasal dexmedetomedine 1μ/kg
Group M (30 children): received intranasal midazolam 0.2 mg/kg
Group K (30 children) : received intranasal ketamine 3 mg/kg
Sedation score in different times was assessed (2.5min) and (5min) after intranasal drug administration measuring onset of sedation and peak sedative effect as well as parental separation score, quality of mask acceptance and postoperative sedation score.
Evaluation and reaction to intranasal drugs were assessed too beside emergence time, recovery time and quality of recovery from general anesthesia and postoperative behavior changes by POBQ
Assessment of agitation and postoperative pain by MOPD score were also evaluated and demonstrated that premedication with intranasal dexmedetomidine resulted in significantly better immediate postoperative analgesia compared to intranasal midazolam and intranasal ketamine. Dexmedetomidine administration was associated with decreased postoperative negative behavior changes especially sleep disturbances which happened dramatically less in children who received dexmedetomidine than in children who premedicated by midazolam or ketamine.
Dexmedetomidine administration was also associated with decreased postoperative agitation. The incidence of postoperative complications of sedation e.g., shivering, postoperative nausea and vomiting and emergence delirium were significantly less after dexmedetomidine. Patients in the dexmedetomidine group had significantly lower levels of MAP and HR, during both the intra- and postoperative periods. The decreases in heart rate and systolic blood pressure were of modest clinical interest and did not warrant corrective action with vasoactive drugs.