Inclusion Criteria:  Children (age 1-7 years) of American Society of Anaesthesiologists physical status (ASA) I-II Elective cleft palate repair ± cleft lip surgery under general anesthesia.  Exclusion Criteria:  Ventriculo-peritoneal shunt Suspected meningitis Congenital hydrocephalus Clinical signs of suspected increased intracranial pressure On treatment for seizures or metabolic diseases Children with developmental delay Hypersensitivity to dexmedetomidine or nalbuphine