BACKGROUND: Premedication aims at alleviating preoperative anxiety and nervousness and also at minimizing adverse effects. To our knowledge there is no study comparing efficacy and patient satisfaction of different premedications in age-adjusted dosage. METHODS: In 139 patients anxiety, sedation and adverse effects were measured at 6 consecutive perioperative time points after administration of midazolam, clonidine or a placebo. RESULTS: Midazolam showed the strongest sedative and anxiolytic effects, clonidine less and placebo none. Clonidine and midazolam reduced the risk of postoperative nausea and vomiting (PONV). Midazolam showed minimal adverse effects and the best patient satisfaction. CONCLUSION: Midazolam was the most anxiolytic, sedative and favored premedication with the least adverse effects. Most patients would choose midazolam next time.