BACKGROUND: Oral premedication is widely used in pediatric anesthesia to reduce 
preoperative anxiety and ensure smooth induction. Midazolam is currently the 
most commonly used premedicant, but good results have also been reported with 
clonidine. The aim of the present study was to compare clinical effects of oral 
midazolam and oral clonidine.
METHODS: We performed a prospective open study in 64 children who were randomly 
assigned to receive either oral midazolam 0.5 mg.kg (-1) (group M) or oral 
clonidine 4 microg.kg (-1) (group C) prior to mask induction. Drug acceptance, 
preoperative sedation and anxiolysis, quality of mask acceptance, recovery 
profile and parental satisfaction were evaluated.
RESULTS: The taste of oral clonidine was judged as significantly better; 14% of 
children rejected oral midazolam. Onset of sedation was significantly faster 
after premedication with midazolam (30+/-13.1 min) than with clonidine 
(38.5+/-14.6 min), but level of sedation was significantly better after 
premedication with clonidine. Quality of mask induction was equally successful 
in both groups. A steal-induction was performed in 66% of patients of group C, 
but none in group M. We observed a trend towards an increased incidence of 
emergence agitation after premedication with midazolam. Parental satisfaction 
was significantly higher in group C.
CONCLUSIONS: In this study, premedication with oral clonidine appeared to be 
superior to oral midazolam. Quality of mask acceptance was comparable between 
groups, but oral clonidine was better accepted by the child, produced more 
effective preoperative sedation, showed a trend towards better recovery from 
anesthesia and had a higher degree of parental satisfaction.