Background: While several studies assessed the effects of variant sedative premedication for pediatrics to decrease anxiety and fearing of parental separation, but the conclusions were various. We aimed to compare intranasal dexmedetomidine with midazolam using mucosal atomization device (MAD) for preschool children scheduled for magnetic resonance imaging (MRI) as a sedative premedication.

Methods: This prospective randomized controlled double blind trial included 93 children who underwent MRI. They were randomly allocated into 3 groups (31 children in each one), Control group; intranasal 1ml 0.9% normal saline was given, Dexmedetomidine; group 2µg/kg dexmedetomidine was given intranasally and Midazolam group; 0.2 mg/kg midazolam was given intranasally using (MAD) in the three groups. After intra-nasal drug (IND) giving all patients were observed for 30 minutes before MRI and the sedation score 10,20,30 minutes following IND administration (primary outcome), , parental separation anxiety scale, acceptance of venous cannulation and adverse events were assessed.

Results: Regarding sedation score, there was significant difference among the studied groups (lower in dexmedetomidine group) with the difference is significant among each two individual groups 10, 20 and 30 minutes after IND administration (P=0.001). There were statistically significant difference among the studied groups regarding parental separation anxiety scale & acceptance of venous cannulation (better among dexmedetomidine group). The difference was significant between each two individual groups (P=0.001). . No adverse events.

Conclusion: Intranasal dexmedetomidine compared to intranasal midazolam given via MAD for sedative premedication for preschool children undergoing MRI, has a better sedation score, an easier parental separation and venous cannulation.