Objective : To compare the recovery parameters by achieving time to reach Aldrete score of 8 , sedative effect of dexmedetomidine versus midazolam by Modified Ramsay`s Score,the hemodynamic stability of both groups,the maintenance dose of ketamine in both groups and  the side–effects in both groups.

Methodology : This prospective randomized double blind comparative study was conducted at our institution. After ethical committee approval and informed consents from parents, 80 pediatric patients of ASA I, II and aged 2–12 years, who were scheduled for Extracorporeal shock wave lithotripsy (ESWL) and were enrolled in the study and randomly divided into two equal groups The patients were premedicated with inj. Glycopyrrolate 0.004mg/kg and the patients in  group D received inj.dexmedetomidine 1μg/kg over the period of 10 minutes and  in group M received inj.midazolam 0.05mg/kg over the period of 10 minutes.Induction with inj. Ketamine 1mg/kg bolus slowly in both groups. Maintained with inj.ketamine (0.5mg/kg) as and when required till end of procedure. HR,BP ,SpO2 were recorded. Need of ketamine in both group was noted. Ramsay sedation score and modified aldrete score were observed postoperatively.

Results:statistically significant difference in intra–operative heart rate seen at 1min,5min and 10min where p value was <0.05 after the dose of dexmedetomidine as compared to midazolam. The time to reach an Aldrete recovery score of 8 was significantly longer in group D than group M. Demand for ketamine after the loading dose in dexmedetomidine group was less(49.30±18.77mg) than midazolam group(61.81±17.26mg)which was statistically significant(p<0.01). Time to reach modified sedation score of 3 was significantly more in group M than group D.

Conclusion : Combination of dexmedetomidine and ketamine may be a newer and better alternative agent for sedation than combination of midazolam and ketamine, in the paediatric population undergoing ESWL