Background: Following strabismus surgery under sevoflurane anesthesia children often experience emergence agitation (EA) and postoperative vomiting (POV). This study compared the effects of premedication with intranasal dexmedetomidine, midazolam, and placebo on postoperative EA and POV. Methods: 105 children (aged 1-7 years) undergoing elective strabismus surgery under sevoflurane anesthesia were randomly assigned to one of three groups (n = 35 each). Preoperatively, group D received intranasal (IN) dexmedetomidine (1 lg/kg), group M received IN midazolam (0.1 mg/kg), and group C received (1 ml) IN normal saline. Agitation scores (Pediatric Anesthesia Emergence Delirium [PAED] scale) and POV were assessed in post-anesthesia care unit (PACU). The incidence of intraoperative Oculocardiac Reflex OCR events, Time to spontaneous eye opening, Postoperative pain score, total consumption of rescue analgesia and time to discharge from PACU were also assessed. Results: 98 children completed the study. Incidence of agitation (defined as PAED score P 10) was significantly higher in the control group and the midazolam group than in the dexmedetomidine group (P = 0.014), and the number of patients who developed severe agitation requiring fentanyl (PAED score P 15) was also higher in the control group (P = 0.042). There was no significant difference between the incidence of POV in the PACU between the control group (28%) and the midazolam group (21%); however, the incidence was significantly lower in the dexmedetomidine group (15%). The number of intraoperative OCR events was significantly higher in the control group (39%) than in the dexmedetomidine (0%; P = 0.006) and in the midazolam group the incidence was higher than the dexmedetomidine (9%; 3 events) but did not reach statistical significance.

a b s t r a c tObjective: To compare the use of rocuronium with that of dexmedetomidine as an adjuvant to the local anesthetic mixture in peribulbar anesthesia for cataract surgery. Design: A double blind, prospective, randomized controlled study. Methods: Ninety patients with cataract in the age group 18-80 years of American Society of Anesthesiologists (ASA) physical status I-III scheduled for elective cataract surgery under regional anesthesia were randomly divided into three groups; Group C (control) received peribulbar anesthesia using a mixture of 4 ml lidocaine 2%, 4 ml bupivacaine 0.5%, and 1 ml normal saline. Group R received a mixture of 4 ml lidocaine 2%, 4 ml bupivacaine 0.5%, and 0.06 mg/kg rocuronium (maximum 5 mg) in 1 ml saline.Group D received a mixture of 4 ml lidocaine 2%, 4 ml bupivacaine 0.5%, and dexmedetomidine 50 lg (1 ml). Patients were assessed for onset and duration of corneal anesthesia and globe akinesia, postoperative pain using visual analog score (VAS), intraocular pressure (IOP), and sedation level using modified Ramsay sedation score (RSS). Patient and surgeon satisfaction score were also assessed. Results: Corneal anesthesia was achieved more rapidly in groups D and R than group C (P < 0.01). Akinesia was achieved more rapidly in the group R than both group D and group C. Akinesia was achieved more rapidly in group D than the control group. Intraocular Pressure was significantly lower in group D compared to both the control group and group R. Ramsay sedation score was significantly higher in group D compared to both the control group and D. Patient and surgeon satisfaction was significantly higher in group R and D compared to the control group. Conclusion: Adding 5 mg rocuronium to local anesthetic mixture provides more rapid onset of corneal and globe akinesia than 50 lg dexmedetomidine. Adding dexmedetomidine decreases IOP and provides sedation.