Introduction: Preoperative anxiety in children leading to postoperative negative changes and long-term behavioral problems needs better preanesthetic sedation. Across the world, midazolam is the most commonly used premedicant in pediatric patients. The fact that no single route has achieved universal acceptance for its administration suggests that each route has its own merits and demerits. Aim of the Study: This study compares oral midazolam syrup and intranasal midazolam spray as painless and needleless systems of drug administration for preanesthetic sedation in children. Materials and Methods: The study was in Government Stanley hospital Chennai. Period of the study was between 2012-2013. Seventy pediatric patients belonging to ASA physical status I & II scheduled for elective minor surgical procedures were included in the study. Children belonged to the age group of 2 to 8 years of both sexes. The children were randomly allocated into 2 groups with 35 patients in each group. (Group N & Group O). Demographic data including age, weight, and sex of the children were recorded. The children were given premedication 30 minutes before surgery orally or nasally. The reaction of the children to the premedication was noted. Group – N – received intranasal midazolam at a dose of 0.2 mg/kg using. Insideatomizer midazolam Nasal spray containing 100 microliters/ metered dose which delivers 0.5 mg/dose. Results: The median behavior score and sedation score were further analyzed with the children divided into different age groups age 2–5 and age 7–9yr. The median behavior scores at baseline, at separation from a parent, and at induction were not different among the children from groups N and 0 in all age groups. The median sedation scores of group D were significantly different from group M at separation from parent and at induction in children of age 2–5 yr. In age Group 2–5 yr, the median sedation scores at separation from the parent were 6 and 2 from group N and 0 respectively (p - 0.001). For the same age group, the median sedation scores at induction of anesthesia were 6 and 2 for group N and 0, respectively (p - 0.001). Conclusion: In conclusion, Intranasal midazolam when used as premedication in children, in a dose of 0.2 mg/kg hasa more rapid onset of action with satisfactory sedation and anxiolysis than oral midazolam. The rapid onset of action of nasal midazolam makes it an ideal route for premedication in children.