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Comparison of Intranasal Dexmedetomidine with Intranasal Clonidine as a Premedication in Surgery. OBJECTIVES: To compare effectiveness of intranasal dexmedetomidine and clonidine as anxiolytics and sedatives in pediatric patients undergoing various surgeries. METHODS: This double blind randomized placebo controlled study was conducted on 105 surgical patients of American Society of Anesthesiologist (ASA) physical status І-ІІ, aged between 2 and 9 y in a tertiary-care hospital (February 2014 to September 2015). Participants were randomly allocated to three groups to receive either intranasal dexmedetomidine 2 μg/kg (Group І) or intranasal clonidine 3 μg/kg (Group ІІ) or intranasal saline 0.5 ml (Group ІІІ). The primary outcome measure was proportion of patients with satisfactory anxiolysis and sedation at 30 min after drug administration. Secondary outcome measures included time taken to achieve Aldrete score of 9 and number of doses of rescue analgesia required in 12 h after surgery. RESULTS: Satisfactory anxiolysis was achieved by 88.5% in Group І vs. 60% in Group ІІ (p = 0.001) and satisfactory sedation by 57.1% in Group І vs. 25.7% in Group ІІ (p = 0.001) 30 min after premedication. Rescue analgesia requirement was significantly less in Group І as compared to Group ІІ (p = 0.001) while time taken to achieve Aldrete score was comparable between the study groups (p = 0.185). CONCLUSIONS: Intranasal dexmedetomidine is a better anxiolytic and sedative as compared to clonidine. Postoperative analgesic requirement was also significantly decreased after intranasal dexmedetomidine. Thus, it can be preferred as compared to clonidine for premedication in pediatric surgical patients.