Materials and method: In this prospective, double-blinded, randomized study, 80 patients (aged one month to 12 years, ASA PS I and II) with a foreign body in the esophagus at the cricopharynx level undergoing endoscopic foreign body removal were randomly allocated into groups A and B, with 40 patients each. In the preoperative area, Group A received 3 mcg/kg dexmedetomidine intranasally, and Group B received 3 mcg/kg intravenously over 10 minutes. Sedation onset was assessed using the Ramsay Sedation Scale (RSS), aiming for an RSS score of 3+ before transferring to the operation theater. Propofol was administered (2 mg/kg) for induction. The Parent Separation Scale was used to evaluate anxiolytic effects. Perioperative pain, heart rate (HR), oxygen saturation (SpO2), ECG, and blood pressure (BP) were monitored throughout. 

Results: Group A's mean time to the operation theater (33.8 ± 5 minutes) was significantly longer than Group B's (10.7 ± 2.1 minutes, p = 0.001). Group B achieved higher RSS at 10 and 20 minutes. Group B had lower pain scores at 10 minutes (2.2 ± 1.4, p ≤ 0.001), but Group A experienced longer postoperative pain relief (1.35 ± 0.94 for 120 minutes, compared to 1.94 ± 0.35 in Group B, p = 0.002). Group B showed sharp hemodynamic decreases, while Group A's changes were gradual and persistent.

Conclusion: Intranasal dexmedetomidine is a safer, more effective sedation method for removing esophageal foreign bodies at the cricopharynx level in pediatric patients, providing stable hemodynamic parameters and prolonged postoperative pain relief compared to intravenous administration.