Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 0 0 2026 04 04 1421 1421 Kareem Nawwar Department of Anesthesia, Surgical Intensive Care, and Pain Management, Faculty of Medicine, Cairo University, Cairo, Egypt. Muhammad Ali Department of Anesthesia, Surgical Intensive Care, and Pain Management, Faculty of Medicine, Cairo University, Cairo, Egypt. Omnia Kamel Department of Anesthesia, Surgical Intensive Care, and Pain Management, Faculty of Medicine, Cairo University, Cairo, Egypt. Hany Shaukat Department of Anesthesia, Surgical Intensive Care, and Pain Management, Faculty of Medicine, Cairo University, Cairo, Egypt. Karim Girgis Department of Anesthesia, Surgical Intensive Care, and Pain Management, Faculty of Medicine, Cairo University, Cairo, Egypt Mohamed Mohammed Department of Anesthesia, Surgical Intensive Care, and Pain Management, Faculty of Medicine, Cairo University, Cairo, Egypt 2025 09 25 2025 10 29 Background: A common adverse event in pediatric patients after surgery is emergence delirium (ED), which manifests as agitation, disorientation, and changes in perception (such as hypersensitivity to stimuli) together with inconsolable crying and moaning. This study compared the efficacy of ketofol versus dexmedetomidine (DEX) in preventing ED in children undergoing squint surgeries. Methods: This prospective, randomized, clinical double-blind study enrolled 52 children aged 2–6 years, of both sexes, undergoing squint surgery. Patients were divided into two equal groups. Five minutes after securing the airway, DEX was infused at 0.2 µg/kg/h in Group D, and Ketofol (1:4 ketamine to propofol) was infused at 80 µg/kg/min propofol and 20 µg/kg/min ketamine in Group K. Results: The incidence of intraoperative bradycardia and hypotension was not substantially different between the two groups. There was no significant difference in heart rate, mean arterial blood pressure, or peripheral oxygen saturation between groups intraoperatively and postoperatively. PAED and FLACC scores were insignificantly different between the two groups. Postoperative rescue analgesia and rescue sedation showed insignificant differences between groups. Conclusion: Ketofol and DEX are equally effective in preventing emergence delirium (ED) in children undergoing squint surgery while maintaining stable hemodynamics. https://aacc.tums.ac.ir/index.php/aacc/article/view/1421