Comparison of the Efficacy of Two Doses of Intranasal Atomized Dexmedetomidine as Premedication for Parental Separation Anxiety in Children Undergoing Elective Surgery

Background Preoperative anxiety in children is a common challenge associated with adverse perioperative outcomes, including poor parental separation, difficult mask acceptance, and emergence delirium. Dexmedetomidine, an alpha-2 adrenergic agonist, is increasingly explored as a noninvasive intranasal premedication. Objective This study compared the efficacy of two intranasal doses of dexmedetomidine (1 µg/kg vs. 2 µg/kg) in reducing separation anxiety and improving perioperative conditions in children undergoing elective surgery. Methods A prospective randomized controlled trial was conducted on 50 children aged between one and six years, American Society of Anesthesiologists (ASA) I-II, scheduled for elective surgery under general anesthesia. Participants were randomly assigned to receive either 1 µg/kg (Group I) or 2 µg/kg (Group II) of atomized intranasal dexmedetomidine 30 minutes before induction. Sedation Score (SS), Parental Separation Anxiety Score (PSAS), mask acceptance, hemodynamic parameters, postoperative pain (Face, Legs, Activity, Cry, Consolability (FLACC) scale), and emergence agitation (Emergence Agitation Scale (EAS)) were assessed. Results Group II demonstrated significantly better sedation at 30 minutes, a lower PSAS, improved mask acceptance, and reduced postoperative pain and emergence agitation (p<0.001). Hemodynamics remained stable in both groups without adverse events. Conclusion Intranasal dexmedetomidine 2 µg/kg provided superior preoperative sedation, smoother parental separation, better mask acceptance, and reduced postoperative discomfort compared with 1 µg/kg, without significant side effects.