History and Objectives: Due to the importance of calmness and not having anxiety on entry to operation room in children and its known effect and the present problems with the administration of premedications and in order to define the effect of Midazolam administration in Iran, this study was carried out to compare intranasal Midazolam with oral atropine as premedication in pediatric anesthesia in referrers to Mofid children hospital during 1375 and 1376.

Materials and Methods: A double blind experimental clinical trial was performed on 100 children whom were classified by random sampling into 2 groups. Intranasal Midazolam and oral atropine were administrated to 50 patients and another 50 patients were premedicated by intramuscular morphine half an hour before separation from their parents. The calmness and/or the anxiety of the child were evaluated in three stages: First, on separation from parents second, at the time of induction of anesthesia and third, at the time of recovery.

Results: Age, sex, weight and blood pressure of the two groups were similar in these 100 patients. In the Midazolam group, there was a better toleration of separation from their parents, easier anesthesia induction and a shorter recovery time. The prevalence of lack of even slight degrees of anxiety was 28% and 76% in the control and case groups respectively (P<0.001). Nausea, vomiting and airway secretions were more common in the morphine group than the Midazolam one. Flushing was slightly more common in the Midazolam group than the morphine one.

Conclusion: Intranasal Midazolam and oral Atropine are recommended as appropriate premedication in pediatric anesthesia.