N. Marković, S. Kelić, V. Dolinaj, G. Rakić, D. Turanjanin, R. Zdravković

ntroduction Preoperative anxiety is a common and clinically signifi- cant problem in pediatric anesthesia. Oral midazolam has traditionally been used for premedication, however, it is associated with variable efficacy and potential adverse effects. Inhalational dexmedetomidine is increasingly be- ing considered as a safer and promising alternative for pediatric premedication. The aim of this study was to compare the efficacy and safety of inhalational dexme- detomidine and oral midazolam in terms of sedation qual- ity, hemodynamic and respiratory stability, as well as the child’s cooperation during premedication. Methods This prospective randomized study included 60 children aged 2–12 years, ASA physical status I–II, undergoing abdominal or urological surgical procedures. The partic- ipants were divided into two groups: the dexmedetomi- dine group (group D) received inhalational dexme- detomidine at a dose of 2 μg/kg, while the midazolam group (group M) received oral midazolam at a dose of 0.3 mg/kg. Vital parameters and sedation levels were moni- tored 10, 20, and 30 minutes after drug administration. Cooperation was assessed during intravenous Sad, Faculty of Medicine, Novi Sad, Serbia. cannulation, separation from parents, and acceptance of the anesthesia mask during induction of general anesthe- sia. Results After 10 minutes, a statistically significant difference in sedation level was observed in favor of group M (p = 0.003). After 20 and 30 minutes, no statistically signifi- cant differences between the groups were observed (p > 0.05). During intravenous cannulation, no statistically significant difference was found (p = 0.061), although a clear trend favored group D. Successful separation from parents was comparable between groups (p > 0.05), whereas mask acceptance was more effective in group M (83.3%) compared with group D (53.3%; p = 0.033). He- modynamic parameters remained stable, with transient bradycardia observed only in group D. No significant res- piratory adverse effects were recorded. Conclusion Inhalational dexmedetomidine demonstrated comparable efficacy to oral midazolam with a favorable safety pro- file, making it a suitable alternative for premedication in pediatric anesthesia.