Context: Preoperative period exposes to anxiety and stress to children and their parents resulting in emotional and psychological disturbances. To alleviate this midazolam has been found to be effective
premedication. The purpose of this study is to compare the efficacy of oral versus nasal route and acceptance by children.

Aims: To compare efficacy of oral and intranasal midazolam as premedication in children.

Settings and Design: comparartive study, observational study in tertiary health care set up.

Methods and Material: Fifty patients of age 2-5years of either gender of ASA I and II were assigned to two groups of 25 each undergoing
elective surgeries of 1.5-2 hours under general anaesthesia. In Oral group - midazolam formulation 0.5 mg/kg (preservative free plus sweetener) and in intranasal group - midazolam nasal spray as 0.2 mg/kg with half the dose in each nostril was administered 30minutes prior to surgery and were assessed for acceptance of drug, level of sedation 30minutes after premedication, behaviour at time of separation from parents and behaviour during mask acceptance at the time of induction which was by a standard intravenous technique. Intraoperatively children were monitored for heart rate and SpO2. Statistical analysis used: unpaired student t test and p value < 0.05 is significant, Statistical Package for the Social Sciences SPSS Statistics for Windows, Version 20.0 software (IBM, Bengaluru, India), Microsoft word and excel have been used to generate graphs and tables. Mean, median and standard deviation have also been used.

Results: Two routes were statistically insignificant regarding acceptance of drug, sedation after 30min and behavior during parental separation, though oral was slightly better than nasal clinically. Mask acceptance of oral midazolam was better than nasal and significant.

Conclusions: Both are safe with oral is better than nasal route for premedication in children due to significant mask acceptance.