Following approval from institutional ethical committee, informed consent and written consent will be taken from 70 patients of American Society of Anaesthesiologist (ASA) physical status class I/II undergoing laparoscopic surgeries under general anaesthesia.

Patients will be randomly allocated into 2 groups;

Group 1- DK group

Receiving Dexmedetomidine 1mcg/kg/body weight& ketamine 25mg intravenously.

Group 2- F group

Receiving Fentanyl 1mcg/kg/body weight intravenously.

Randomization will be done by another anaesthesiologist (who will not take part further in the study) using shuffled sealed envelope technique.

All the patients are evaluated on the previous day of surgery& on the morning of the surgery. Patients are shifted to operation theatre and connected with multi parameter monitor (PHILIPS intellivue MP-20) and baseline parameters like systolic blood pressure(SBP); diastolic blood pressure (DBP);mean arterial pressure(MAP) &heart rate (HR), saturation of O₂ will be noted.

    Patients belonging to DK group will receive Inj Dexmeditomidine 1mcg/kg diluted to100ml NS and infused over 10-15min before induction. Inj. Ketamine 25mg diluted to 2ml with NS will be injected before induction.

     Patients belongs to F group will receive 100 ml of NS over 10-15 min before induction and Inj Fentanyl 1mcg/kg diluted to 2 ml will be administrated iv before induction.

     The study drugs will be prepared by the same anaesthesiologist involved with randomization who will not take part further in the study and thus the observer and patient will be blinded to study.

      All the patients will be given 1.5mg/kg/body weight of IV lidocaine(preservative free) after pre-oxygenation for 3min, followed by 1% propofol till the loss of eye lash reflexes and total dose of propofol used will be noted.

All the patients will be intubated with appropriate sized ET tubes using 0.1mg/kg of vecuronium. Patients will be maintained using O₂+ N₂O (30:70) and isoflurane 0.5%. Intraoperative blood pressure (BP) and heart rate (HR) will be monitored and any increase of either BP or HR more than 20% of baseline will be managed by increasing the isoflurane to 1% and if not controlled additional boluses of 20mg of propofol will be given and number of doses of propofol will be noted. Any fall in SBP more than 30% will be treated with IV fluids and if required 6mg of ephedrine boluses & number of doses of ephedrine will be noted. Any decrease in heart rate less than 50/min will be treated with Inj. Atropine 0.6mg. Patients will be given Inj. Dexamethasone 8mg after induction and Inj. Ondansetron 4mg just before extubation. Patients are administered with inj. Paracetamol 1gm IV and Inj. Diclofenac 75mg iv intraoperatively. At end of surgery patients will be reversed with 0.05mg/kg Inj  Neostigmine and Inj Glycopyrolate 0.01mg/kg.

     Time of recovery will be noted from the time of administrating reversal drugs and patients satisfying the extubation criteria are extubated. All the patients are shifted to post anaesthetic care unit (PACU) and monitored for post-operative pain using VAS score at the interval of immediate post- operative and 2^nd  hourly for 6 hours and every 6^th hourly for 24 hours. Any patient with VAS score >4 will receive rescue analgesic Inj. Diclofenac 75mg and number of doses in 24 hours will be noted.

     Incidence of post-operative nausea and vomiting will be noted every 2^nd hourly up to 6 hours and every 6^th hourly up to 24 hours. Incidence of post-operative nausea and vomiting (PONV) will be treated with Inj. Ondansetron 4mg and the number of injections will be noted.

    The post-operative sedation will be noted based on Ramsay sedation score immediately after extubation.

Ramsay sedation score:

  Score          Definition

1              Anxious and restless or agitated or both.

2              Co-operative, oriented and tranquil.

3              Responds to commands only.

4              Brisk response to a light glabellar tap or loud auditory stimulus.

5              Slight response to a light glabellar tap or loud auditory stimulus.

6              No response to a light glabellar tap or loud auditory stimulus.