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Chronic hepatic patients are especial category causing distress to nursing for cannulation and preparation before follow up procedures as they have fragile veins or fibrosed in addition to difficult cannulation ,the bad clinical condition for day case procedures and the psychic trauma they had. Aim In this study we aim to assess the effect of nebulized Dexmedetomidine on sedation, face mask acceptance, emotional separation scores before upper endoscopy.sixty eight children aged 4-16 years were randomly allocated into two equal groups to be premedicated with either nebulized dexmedetomidine (Group D) 2μg /kg-, or saline 0.9 same volume (Group S). The primary outcome was a five-point sedation score; parental separation anxiety scale; and mask acceptance scales on arrival in the endoscopy room 30 min after end of study drug administration. Secondary outcomes included: Emotional separation anxiety scale; and mask acceptance scales, secondary outcomes includes heart rate; time to discharge ;and Propofol dose.