Abstract: Objective： To observe the clinical efficacy of esketamine combined with intranasal dexmedetomidine or oral midazolam for preoperative sedation. Methods： A total of 120 children with groin surgery in the Department of Pediatrics of the Children's Hospital of Dali Bai Autonomous Prefecture were selected and randomly divided into 3 groups. The control group received oral doses of 0.3 mL/kg of rock sugar snow pear juice before operation； intranasal group received esketamine 0.5 mg/kg + intranasal dexmedetomidine 2 μg/kg）； oral group received esketamine 1.5 mg/kg + oral midazolam 0.5 mg/kg. Preoperative sedative effects， vital signs， drug acceptance satisfaction， the ease of child-parent separation， propofol-induced acceptance and post-wake agitation were observed before and after administration. Results： Compared with the control group， the parent-child separation score， the propofol acceptance score and the agitation score during recovery were significantly different between intranasal group and oral group （P<0.05）. The drug acceptance satisfaction score of intranasal group was significantly lower than those of the other two groups， and the difference was statistically significant（P<0.01）. During 10 to 30 minutes after administration， the sedation conditions of  oral and  intranasal groups were significantly different from those before administration（P<0.01）. There was no respiratory depression in the three groups during the monitoring time， and the vital signs were stable. There were no statistical differences in the incidence of adverse reactions before and after the operation among the three groups（P>0.05）. Conclusion：Esketamine combined with intranasal dexmedetomidine or oral midazolam is effective in sedation， making the perioperative period safer and more comfortable for children.

Key words: esketamine, dexmedetomidine, midazolam, preoperative sedation