Allaying anxiety and providing calm children in the operating room is a challenging task for anesthesiologists. This study was designed to compare the use of nebulized dexmedetomidine and ketamine for premedication in pediatric patients under general anesthesia. Methods: Seventy patients, aged 2 to 8 years of both sexes, with American Society of Anesthesiologists physical status I/II scheduled for hernia repair surgery under general anesthesia, were randomized to two equal groups using a computer-generated random number table. Patients in group D received dexmedetomidine (2 µg/kg), and patients in group K received ketamine (2 mg/kg) by a jet nebulizer before the induction of anesthesia. The study’s primary objective was comparing the level of sedation, which was achieved at 30 min after a study drug administration using the Ramsay sedation scale, between the two groups. The secondary objectives were the two-group comparison of parental separation anxiety scale, acceptance of the mask, hemodynamic variables, recovery time, incidence of emergence agitation, and adverse events. Results: The median Ramsay sedation scale at 30 min was 3 (1–4) in group D and 3 (1–3) in group K (P = 0.002). Patients in group D had a more acceptable parental separation anxiety scale (P = 0.001) and a satisfactory mask acceptance scale (P = 0.042). Conclusions: Nebulized dexmedetomidine (2 µg/kg) provided better sedation along with smooth parental separation and satisfactory mask acceptance during induction of anesthesia with a similar emergence agitation profile and adverse reactions compared to nebulized ketamine in pediatric patients.

Introduction: Stroke is a common cause of mortality and morbidity and has an increasing prevalence across the world.1 Bilirubin is now being considered an antioxidant which increases in response to diseases associated with increased oxidative stress. Hence the present observational study was undertaken to assess the bilirubin levels with the outcome of acute ischemic stroke. Methods: This observational study was conducted from January 2018 to December 2018 on 64 ischemic stroke patients admitted at KLE’S Dr. Prabhakar kore hospital at Belagavi, Karnataka. All adult patients above 18 years of age presenting with cerebrovascular accident and proved as ischemic stroke on CT scan or MRI scan were included. The patients were empirically divided into different Groups based on the bilirubin level. They were then analysed with their NIHSS scores for assessing stroke severity. Results: A total of 64 patients were included in the final analysis. The mean total bilirubin level in the patients was 0.68±0.34 mg/dl ( mean±SD). 34.3% (22) of ischemic stroke patients in the study had serum total bilirubin levels 0.7 mg/dl or more. Mean NIHSS Score for Group 1(Low) total bilirubin group was 9.37 and for Group 2(High) bilirubin group was 10.9, which was statistically not significant. This indicates that there was no significant correlation between total bilirubin and severity of symptoms at the time of admission.There was no statistically significant correlation between NIHSS and direct bilirubin levels Conclusion: The current study has documented no association between the bilirubin levels and stroke severity and prognosis.