Preoperative anxiety is commonly seen in children coming for surgery with an incidence of at least 60%. Relieving pre and postoperative anxiety is an important concern for the paediatric anaesthesiologist.  Dexmedetomidine is a highly selective alpha 2-adrenergic receptor agonist and possesses sedative, analgesic, perioperative sympatholytic, anaesthetic-sparing, and hemodynamic-stabilizing properties, but lacks respiratory depression,  making it a useful and safe adjunct in diverse clinical applications. Midazolam, a γ-amino-butyric acid (GABA) receptor inhibitor, is the most commonly used sedative drug for premedication in children. Midazolam is a water-soluble benzodiazepine with rapid onset and short duration of action. It provides effective sedation, anxiolysis, and varying degrees of anterograde amnesia.

Sublingual route has an advantage of mucosal absorption directly into the systemic circulation with no first pass hepatic metabolism due to the rich blood supply of oral mucosa, is easy to administer, has rapid action, reliable predictable effect and the drug is not destroyed by the gastrointestinal enzymes.

A mucosal atomiser device (MAD) delivers medications via a fine spray over a broad surface area. Higher drug serum levels are achieved when a drug is given in its atomized form, due to a more extensive distribution of the medication across the mucosa and increased bioavailability of the drug.  From the perspective of patient acceptance, administration of atomized spray has also been shown to produce significantly less aversive behaviour in young children, making it a practical option. 

The aim of this study is to compare the ease of child-parent separation between sublingual atomized dexmedetomidine and sublingual atomized midazolam groups.