About 70% of all children exhibitsignificant stress and anxietybefore surgery.The perioperative period is particularly important to prepare a child posted for surgery and anaesthesiologists have a crucial role in it.An excessive stress and anxiety prior to surgery can lead to serious adverse outcomes,such as emergence delirium,maladaptive behavior,and increased postoperative pain.Sedative premedicationis one of modalities commonly used to reduce anxiety,facilitate parental separation,and promote acceptance of mask induction.Threehealthy,ASA 1 children(aged 2 years)were posted to palatoplasty in general anesthesia.Oral premedication(midazolam(M)0,5 mg/kg,ketamine(K)5 mg/kg,or clonidine(C)4 mcg/kg)was given 30 minutes before surgery.Sedation score,heart rate,respiratory rate and saturation was assessed every 5 minutes for each children.There were no significant change of heart rate,repiratory rate and saturation between those three children.After reaching adequate sedation(0 to-1),they were brought to operation room with medical personnel.Adequate sedation score was reached in 20 minutes(M),15 minutes(K),and 45 minutes(C).Induction was smoothly perfomed with sevoflurane 4-8 vol%,fentanyl 2 mcg/kg iv,atracurium 0,5 mg/kg.Anesthesia was maintained with sevoflurane 2-3 vol%,O_2 and air.During surgery,hemodynamic was stable and patient was extubated fully awake.Postoperative analgesia Paracetamol 20 mg/kg iv was given 30 minutes before surgery ends.After surgery,patients was monitored in recovery room for 2 hours.During observation,patient M experienced pain,fentanyl 1 mcg/kg iv was given as rescue.Agitation and nausea occurs in patient K and treated with propofol 1 mg/kg iv.Sedative premedication seems to be superior to parental presence or behavioral preparation program because of its predicatable effect.Many agents could be used for premedication and midazolam becomes a routine standard for premedication in pediatrics.In this case report,we compares sedation score and postoperative pain between midazolam,ketamine,and clonidine.Ketamine and clonidine shows better acceptance due to its tasteless,unlike midazolam which has a bitter taste.Fastest sedation score was achieved by ketamine(K) administration,followed by midazolam(M) and clonidine(C)(table 2).Agitation score during vein canullation and face mask acceptance was lower in M because of its amnestic effect(table 5).There were no significant hemodynamic changes after intubation and during surgery in those children,but C showed more stable blood pressure and heart rate(figure 1).Post operative pain was higher in M and has to be rescued with fentanyl.Other post operative complication,such as agitation and nausea appeared in K(table 6).Clonidine was superior to midazolam and ketamine due to its tasteless,better sedation and analgesic effect,despite of its longer onset and lack of amnestic effect.Midazolam provides amnetic effect and makes surgery a favourable event,but it has a bitter taste and no analgesic property.Ketamine,besides of its faster onset and analgesic property,is related to post operative nausea,agitation,hypersalivation and hallucination.It can be concluded that premedication should be individualized depends on the children condition and needs.Clonidine and midazolam provides better sedation compared to ketamine.Combination of ketamine and midazolamcould be used for better outcome.