Paediatric patients often experience significant anxiety and lack of cooperation during the perioperative period, which can adversely affect anaesthetic induction and perioperative outcomes. Dexmedetomidine, a selective α2-adrenergic agonist, provides sedation and anxiolysis without causing clinically significant respiratory depression and is increasingly used as a premedicant in children. The nebulised route offers a non-invasive, painless, and well-accepted method of drug delivery; however, the optimal nebulised dose for effective premedication remains uncertain. This prospective, randomised, double-blind study was conducted to compare the efficacy and safety of two different doses of nebulised dexmedetomidine administered as premedication in paediatric patients undergoing elective surgery under general anaesthesia. Eligible children were randomly allocated into two groups to receive either a lower dose or a higher dose of nebulised dexmedetomidine prior to anaesthesia induction. The primary outcomes assessed included level of sedation, ease of parental separation, and mask acceptance at induction, while secondary outcomes included changes in heart rate, blood pressure, oxygen saturation, and the incidence of adverse effects. Sedation and behavioural responses were evaluated using standardised and validated scoring systems. Children receiving the higher dose of nebulised dexmedetomidine demonstrated significantly better sedation scores, smoother parental separation, and improved mask acceptance compared to those receiving the lower dose. Haemodynamic parameters remained stable and within clinically acceptable limits in both groups throughout the perioperative period. 

No episodes of clinically significant bradycardia, hypotension, oxygen desaturation, or excessive sedation were observed, and the nebulised administration was well tolerated with good patient compliance. The findings of this study indicate that nebulised dexmedetomidine is a safe and effective premedicant in paediatric patients, and that the higher dose provides superior sedation and anxiolysis without compromising haemodynamic stability. Nebulised dexmedetomidine may therefore serve as a useful non-invasive alternative to conventional paediatric premedication techniques. 

Swati das completed her MD in anaesthesiology in 2019 from university college of medical sciences, New Delhi. Since then, she has been working in the department of anaesthesiology and is currently associated as a assistant professor at All India Institute Of Medical Sciences Bathinda, Punjab. She is a young and emerging researcher with active academic and clinical interests in paediatric anaesthesia and obstetric anaesthesia.