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Mucosal atomization device (MAD) was designed to increase the bioavailability of intranasal medications by facilitating absorption, the present study aimed to evaluate and compare the sedation effects of intranasal dexmedetomidine delivered as drops versus sprays on pediatric responses to intravenous cannulation.One hundred and six pediatric patients (aged from 2 to 5 years) scheduled for elective ophthalmic surgery were intranasally received a dose of 2 μg/kg in 20 μl/kg of dexmedetomidine for sedation to reduce response to venous cannulation. The patients were randomized into syringe group and MAD group in which dexmedetomidine was delivered as drops or sprays via syringe or MAD respectively. The primary outcome was the response to peripheral vein cannulation assessed by the FLACC scores (faces, legs, activity, cry and consolability) 30 min after intranasal administration of dexmedetomidine. The secondary outcomes included acceptance for intranasal medication, sedation onset time, and needle insertion times and any adverse event at the preoperative holding area.The FLACC scores in MAD group were significantly decreased than that treated by drops (P = 0.021). The acceptance for intranasal administration between both groups was comparable (P > 0.05), the onset time and the incidences in two and more times of needle insertion did not differ significantly between syringe and MAD groups (all P > 0.05). None of patients were required to clinically intervene in heart rates reduction and none suffered respiratory depression after administrations of dexmedetomidine in either group.Intranasal dexmedetomidine by sprays offers better sedation effects to reduce responses to venous cannulation than drops.