Nasal premedication with midazolam and dexmedetomidine has been studied as alternatives to oral premedication and injectables with comparable results. Intranasal route is a non-invasive route well tolerated by the pediatric patient . Bioavailability is highly primarily due to rich vasculature in the nasal mucosa. Onset of action is quicker than other systemic routes. Drugs administered via the nasal route are rapidly absorbed into the systemic circulation because they do not pass through portal circulation.

Dexmedetomidine is a newer alpha 2 agonist with mopre selective alpha 2 : alpha 1 adrenoreceptor activity with a short half life. Since this drug has a neutral pH, it is virtually painless when given given intanasally and it is also tasteless and odourless. Recently, it has been recommended for procedural sedation in children. In addition to its sedative property, dexmedetomidine exerts analgesics and antiemetic effects. In comparison with other ana;lgesics and sedative agents, dexmedetomidine has minimal effects on respiration.

Midazolam is one of the most commonly used sedative premedication in pediatric anaesthesia. It is employed in a variety of surgical and non surgical procedures. Midazolam is water soluble benzodiazepine that works by inhibiting the GABA receptor. It has sedative and anxiolytic properties, which makes easier to perform any procedure. As midazolam has high hepatic clearance , avoidance of first pass metabolism offers greater systemic bioavailabilty. The beneficial effect of modazolam includes rapid sedation, anxiolytic and reduction of post operative nausea and vomiting. However, the major drawback is that atleast 50% children cry on administration because it transiently irritates nasal passage.