Background: Spinal anesthesia is safer than general anesthesia during lower limb operations; many studies have been concerned about prolonging the duration of spinal anesthesia by adding different adjuvants.Objective: To compare the efficacy of intrathecal dexmedetomidine versus intrathecal dexamethasone in prolonging duration of spinal anesthesia, and postoperative analgesia, safety and hemodynamic stability.Patients and methods: Our study was carried out on 60 patients of American Society of Anesthesiologists (ASA) physical status I or II, scheduled for orthopedic operation under spinal anesthesiadivided into A, B and C from March 2020 to November 2020. They were divided into 3 equal groups: Group A received 2ml bupivacaine (0.5%) and 10μg dexmedetomidine in 1ml normal saline intrathecal, Group B received 2ml bupivacaine (0.5%) and 4 mg dexamethasone in 1 ml normal saline intrathecal and Group Creceived 2ml bupivacaine (o.5%) and 1ml normal saline Intrathecal. The study was carried out at Al-Azhar University Hospitals (Al-Hussein and Sayed Galal Hospitals). Results:The present study showed statistically significant difference (P-value <0.001) between the three groups according to time of motor and sensory regression. The regression time of block (both sensory and motor) were prolonged in A (sensory 359.50±20.32, motor 319.00±21.06) and B (sensory 199.75±18.22, motor 170.00±20.00) when compared to the C group (sensory 149.55±10.83, motor 141.00±22.09). However, the duration was longest in A group among the three groups. According to amount of analgesic consumption postoperatively, there was significant decrease in amount in A group in comparison to B and C groups. The amount is insignificantly decreased in B group in comparison to C group. Regarding safety and hemodynamic stability there was no statistically significant difference between the three groups. Conclusion:Dexmedetomidine had prolonging the duration of spinal anesthesia more than dexamethasone and control group with statistically significant difference between the three groups and provided prolonged postoperative analgesia compared to dexamethasone and control group.

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Background: Emergence agitation (EA) in children is increased after sevoflurane anesthesia. Nalbuphine and midazolam have been used for prophylactic treatment. It is characterized by mental confusion, irritability, disorientation, crying, and increased recovery time in the post anesthesia recovery room, increasing parents' concern and anxiety with respect to the clinical condition of their children. It can also lead to possible injury, damage to surgical dressings, lost intravenous catheters, and disconnected cables and monitoring instruments and source of dissatisfaction for parents, nurses, and others taking care of these children. Objectives:The aim of the present study was to compare the effect of nalbuphine and midazolam before termination of sevoflurane-based anesthesia on the incidence and severity of EA in children as a primary outcome and post-operative pain, comparison of alertness and spontaneous behavior according to 3 step scales, adverse effects in both groups, and intraoperative hemodynamics as a secondary outcome. Patients and Methods:This prospective double-blind randomized studyon 90 children between 4 and 8 years of age and of American Society of Anesthesiologists I undergoing adenotonsillectomy under sevoflurane-based anesthesia was enrolled in the study. Children were randomly allocated to one of the two equal groups: group (N) received nalbuphine 0.1 mg/kg and group (M) received midazolam 0.03 mg/kg. The study drugs were administered 5 min before the end of surgery. In the postanesthesia care unit, the incidence of EA was assessed with Aonos four-point scale. Severity of EA was assessed with the pediatric anesthesia emergence delirium scale upon admission (T0), after 5 min (T5), 10 min (T10), 15 min (T15), and 30 min (T30). Results:The incidence and severity of EA were lower in group (N) as compared with group (M) at T0, T5, and T10.Conclusion: Nalbuphine 0.1 mg/kg was more effective compared with midazolam 0.03 mg/kg in decreasing the incidence and severity of EA, when administered 5 min before the end of surgery in children undergoing adenotonsillectomy under sevoflurane anesthesia.

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