This study is being done to find out which of three medications-dexmedetomidine, ketamine, or midazolam-is best at reducing anxiety and breathing problems in children having surgery to remove their tonsils and adenoids. These medicines will be given as nose drops before anesthesia. Anxiety before surgery can cause stress and lead to problems like trouble breathing during or after surgery. The study will include 148 children aged 4 to 8 years. Each child will get one of the three medicines or a placebo (saline). Researchers will observe the children for signs of anxiety before surgery and for breathing problems, such as laryngospasm, after they wake up. The goal is to find the safest and most effective medicine to help children feel calmer and breathe safely during surgery.
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Measurement of the vital signs mean blood pressure
Timeframe: From 30 minutes pre-induction to 30 minutes post-extubation (approximately 1 hour total)
Measurement of the heat rate
Timeframe: From 30 minutes pre-induction to 30 minutes post-extubation (approximately 1 hour total)
Measurement of respiratory
Timeframe: From 30 minutes pre-induction to 30 minutes post-extubation (approximately 1 hour total)
Scoring the incidence and severity of post-extubation laryngospasm
Timeframe: First 30 minutes after extubation
Assessment of the sedation level done by Ramsay sedation score
Timeframe: First 30 minutes post-extubation
Assessment of the sedation level done by Ramsay sedation score
Timeframe: From baseline to 20 minutes after surgery (approximately 1 hour total)
Assessment of distress associated with potentially painful event using Groningen distress scale at time of canulation.
Timeframe: During intravenous cannulation before anesthesia induction
Time to achieve discharge readiness from PACU
Timeframe: From arrival at PACU until Modified Aldrete Score >9 is achieved, up to 2 hours postoperatively.