Background: Emergence agitation (EA) is a serious complication of recovery from anesthesia. This study aimed to compare the effect of adding ketamine to Dexmedetomidine versus Dexmedetomidine alone in the incidence and severity of EA in pediatric urologic surgeries under sevoflurane anesthesia.

Design: Prospective Randomized Controlled double blinded Clinical study.

Patients and methods: A total of 90 pediatric patients of ASA physical status class I and II scheduled for urological surgery were equally divided into 3 groups: Control group (group C) (30 patients) received 10 ml saline; Dexmedetomidine group (group D) (30 patients) received 0.5µg/kg Dexmedetomidine; Ketodex group (group KD) (30 patients) received combination of 0.3µg/kg Dexmedetomidine and 0.15 mg/kg ketamine. Studied drugs were given intravenously 10 minutes before end of anesthesia.

Results: Dexmedetomidine group and ketodex group had decrease the incidence of emergence agitation it was (23.3%) in dexmedetomidine group, and (13.3%) in ketodex group, and on other hand (73.3%) in control group and the number of patients requiring midazolam was (16.7%) in dexmedetomidine group and (6.7%) in Ketodex group compared to (60%) in control group. The three groups' respective occurrences of medication side effects were negligible and similar.

Conclusion: adding ketamine to dexmedetomidine was similar to dexmedetomidine alone in reducing the incidence and severity of emergence agitation in pediatrics urological surgeries under sevoflurane.