Background & objectives: Children are more anxious and fearful due to their limited cognitive capabilities, lack of understanding of health care system and lack of self control. It becomes an important concern for an anaesthesiologist to relieve their pre-operative anxiety. Midazolam is frequently used as premedication agent in children. New drugs such as the alpha-2 agonists have also been introduced as alternatives for premedication in pediatric patients. The present study was planned to compare intranasal Dexmedetomidine with intranasal Midazolam as a preanaesthetic medication in children with the primary objectives of assessing preoperative sedation & ease of child parent separation and secondary objectives of assessing analgesia in the postoperative period. Materials and methods: Seventy children, aged between 2-6 years of either sex,belonging to ASA Grade I & II and weighing between 10-16kg were enrolled in this prospective,single blinded, randomized and comparative clinical study. The children were divided into two groups of 35 each. Forty five minutes before induction, Group-D(n=35)-received intranasal Dexmedetomidine 1mcg/kg and Group M(n=35) –received intranasal midazolam 0.3mg/kg. Results: Children who were premedicated with intranasal dexmedetomidine had lower sedation (MOAA/S Scale) scores (P<0.0001), and easier child-parent separation than children who received intranasal midazolam. Postoperatively, less number of patients required rescue analgesia in the dexmedetomidine group. Conclusion: Intranasal Dexmedetomidine can be used effectively and safely as a preanaesthetic medication in children undergoing minor surgical procedures under General anaesthesia.

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General anaesthesia with muscle relaxants using controlled ventilation involves laryngoscopy and tracheal intubation, which is associated with haemodynamic changes in the form of tachycardia and hypertension due to increased sympathoadrenal activity and are probably of no consequence in healthy individuals, but they may be hazardous to those with Myocardial Insufficiency and cerebrovascular disease. The objective of the present study was to compare the effect of two different doses of fentanyl with etomidate as an induction agent in attenuating haemodynamic stress response during laryngoscopy and endotracheal intubation. A randomised control trial was carried out on 60 adult patients (ASA I, II, III) undergoing elective surgery under general anaesthesia requiring endotracheal intubation. The patients were randomly allocated into two groups of 30 each i.e. group F2.5 and group F5 receiving fentanyl 2.5μg/kg and 5 μg/kg intravenously five minutes before intubation respectively. The pulse rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure and rate pressure product were recorded at various time intervals up to ten minutes after intubation. The study showed that both the doses were equally effective in blunting the pulse rate response, but the 5μg /kg proved significantly effective in blunting the blood pressure response. The rate pressure product, a measure of cardiac O2 consumption was found to be significantly lower in fentanyl 5μg/kg compared to fentanyl 2.5μg/kg. Hence, we conclude that fentanyl in 5 mcg/kg dose is more effective in attenuating hemodynamic responses to intubation as compared to 2.5 mcg/kg.

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