Background: An increased risk of dangerous emergence agitation (EA) has been linked to the use of sevoflurane.

Objectives: This study aims to compare the the use of preoperative ketamine, midazolam or Oral Dextromethorphan for reducing sevoflurane emergence agitation among preschool children undergoing adenotonsillectomy.

Methods: This randomized controlled double-blinded study was carried out at Zagazig University Hospitals on 56 children who were divided into 4 equal groups; 14 patients in each: Group (C): received 10ml oral placebo (clear fluid) 1 hour before the general anesthesia induction. Group (D): Patients received at a dose of 0.5mg/kg 1 hour from oral dextromethorphan before the general anesthesia induction. Group (K): received a dose of 0.5mg/kg 1 hour of oral ketamine before the general anesthesia induction. Group (M): received a dose of 0.5 mg/kg 1 hour of oral Midazolam before the general anesthesia induction.

Results: Regarding heart rate (HR); group (K) was significantly highest compared to other groups. (p<0.001). The postoperative agitation incidence >4 was significantly lowest in the ketamine group in comparison to the other groups (p=0.02). Group M was found to be significantly lowest in post-operative pain occurrence in comparison to the other groups (p=0.02). Group K was found to be significantly lowest in the amount of fentanyl consumption in comparison to the other groups (p=0.004).

Conclusion: Ketamine premedication is more effective for EA prevention among children during the early emergence time after sevoflurane c ompared to midazolam and dextromethorphan anethesia.