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

Authors: Kumar D et al.

Cureus 18(2): e103239, February 08, 2026 10.7759/cureus.103239

Summary

This prospective randomized controlled trial compared two doses of intranasal atomized dexmedetomidine (1 µg/kg vs 2 µg/kg) for preoperative anxiolysis in children undergoing elective surgery.

Preoperative anxiety in pediatric patients is strongly associated with:

• Difficult parental separation

• Poor mask acceptance

• Increased perioperative distress

• Higher emergence agitation

• Potentially worse postoperative pain outcomes

Study Design

Fifty children (ages 1–6 years), ASA I–II, scheduled for elective surgery under general anesthesia were randomized into:

Group I: 1 µg/kg intranasal dexmedetomidine
Group II: 2 µg/kg intranasal dexmedetomidine

The medication was administered 30 minutes prior to induction.

Measured outcomes:

• Sedation Score (SS)

• Parental Separation Anxiety Score (PSAS)

• Mask acceptance

• Hemodynamic parameters

• Postoperative pain (FLACC scale)

• Emergence Agitation Scale (EAS)

Key Findings

1. Sedation
   The 2 µg/kg group demonstrated significantly deeper and more satisfactory sedation at 30 minutes (p < 0.001).

2. Parental Separation
   Group II had significantly lower anxiety scores and smoother separation from parents.

3. Mask Acceptance
   Children receiving 2 µg/kg showed improved cooperation during mask induction.

4. Emergence Agitation
   Higher dose was associated with significantly lower emergence agitation scores.

5. Postoperative Pain
   FLACC scores were lower in the 2 µg/kg group, suggesting enhanced perioperative comfort.

6. Hemodynamics
   Both doses maintained stable heart rate and blood pressure.
   No significant adverse effects were reported.

Clinical Interpretation

Intranasal dexmedetomidine at 2 µg/kg provided:

• Better anxiolysis

• Improved sedation quality

• Smoother induction process

• Reduced postoperative agitation

• Reduced early postoperative pain

without compromising cardiovascular stability.

What You Should Know

• Intranasal dexmedetomidine is a noninvasive and effective pediatric premedication.

• 2 µg/kg appears superior to 1 µg/kg for separation anxiety and perioperative conditions.

• Hemodynamic safety profile remained acceptable at the higher dose.

• Reduced emergence agitation may improve PACU workflow and parental satisfaction.

• Particularly useful in anxious toddlers and preschool-aged children.

Key Points

• RCT of 50 children aged 1–6 years.

• Compared 1 µg/kg vs 2 µg/kg intranasal dexmedetomidine.

• 2 µg/kg provided superior sedation and perioperative conditions.

• Improved mask acceptance and lower emergence agitation.

• No clinically significant adverse events.

Thank you to Cureus for publishing this randomized trial evaluating dose optimization of intranasal dexmedetomidine for pediatric premedication.