Aim and background: Relieving preoperative anxiety is an important concern for the pediatric anesthesiologists. Anxiety can cause aggressive reactions and increases child’s restlessness. It might even make postoperative pain management impossible. Oral midazolam has been the most frequently used premedication in children. The purpose of this study was to evaluate preoperative sedative effects and anxiety level changes  by using intra nasal dexmedetomidine compared with intra nasal midazolam in children scheduled for elective surgery.

Methods and Materials: This double blind randomized clinical trial was done on sixty 2-8 years old ،ASA I _ II children scheduled for elective surgery in academic hospitals in Rasht ،Iran. Using random blocks the children were divided into 2 equal groups (group D and group M). Group D received 1µg/kg intranasal dexmedetomidine and group M received 2 mg/kg intranasal midazolam 30 minutes before entering OR. Preoperative sedation effects ،sing the Ramsy sedation score ،anxiety level changes،and recovery time were assessed and compared in two groups using Chi square ،t-test, KS and repeated measure statistical tests.

Findings: The study was done on 49 (81.7%) boys and 11 (18.3) girls with the mean age of 4.45±1.67 years. No statistical difference was seen between the two groups in sex ،age ،asal heart rate (HR) ،blood pressure (BP) and arterial O2 saturation (SpO2).  The sedation Ramsay score before administration of the drug and when entering the OR were not different between two groups، although it was lower in both groups at the time of entering OR. (p=0.009 for group D and p=0.000 for group M) The anxiety level before administering drug was the same in two groups (p=0.911) and decreased at the time of entering OR. (p=0.000 in both group D and M) Children receiving midazolam were less anxious when entering the OR (p=0.034), but there was no difference between two groups in recovery time (p=0.947)

Conclusions: Administration of intranasal midazolam and dexmedetomidine before surgery results in less anxiety. Although midazolam is superior to dexmedetomidine in reducing anxiety, dexmedetomidine causes less respiratory depression than midazolam.