Background: The traditional technique for foreign body removal is rigid bronchoscopy. However, fiberoptic bronchoscopy is becoming more popular for foreign body removal. Compared with rigid bronchoscopy, fiberoptic bronchoscopy is better suited for removing foreign bodies from the distal airways and upper lobe bronchi because of the smaller diameter and greater flexibility of the bronchoscope. Dexmedetomidine, a highly selective α2 adrenergic agonist, reduces preoperative anxiety, reduces the requirement for general anesthetics, and does not induce respiratory depression. The safety and efficacy of intravenous dexmedetomidine have been confirmed in patients undergoing fiberoptic bronchoscopy. Intranasal dexmedetomidine reportedly produce satisfactory sedation in children. We hypothesized that intranasal dexmedetomidine at 1 µg·kg−1 administered 25 minutes before anesthetic induction can reduce the incidence of adverse events during fiberoptic bronchoscopy under sevoflurane inhalation general anesthesia. Methods: Forty preschool-aged children (6–48 months) with an American Society of Anesthesiologists physical status of I or II were randomly allocated to receive either intranasal dexmedetomidine at 1 µg·kg−1 or normal saline at 0.01 ml·kg−1 25 minutes before anesthetic induction. The primary outcome was the incidence of perioperative adverse events. The heart rate, respiratory rate, separation score, tolerance of the anesthetic mask, agitation score, anesthetic induction time, consumption of sevoflurane, and recovery time were also recorded. Results: The incidence of laryngospasm, breath-holding, and coughing were significantly lower in patients who received intranasal dexmedetomidine than saline (15% vs. 50%, P=0.018; 10% vs. 40%, P=0.028; and 5% vs. 30%, P=0.037, respectively). Patients who received intranasal dexmedetomidine had a lower separation score (P=0.017), more satisfactory tolerance of the anesthetic mask (P=0.027), a significantly shorter anesthetic induction time (5.75±1.4 vs. 7.75±2.5 min, P=0.004), and less consumption of sevoflurane (38.18±14.95 vs. 48.03±14.45 ml, P=0.041). The recovery time was similar in both groups, and the frequency of postoperative agitation was significantly lower in patients who received intranasal dexmedetomidine (P=0.004). Conclusions: Intranasal dexmedetomidine at 1 µg·kg−1 can reduce the incidence of laryngospasm, breath-holding, and coughing during fiberoptic bronchoscopy for foreign body removal via its sedative and analgesic effects. Moreover, intranasal dexmedetomidine can reduce postoperative agitation without a prolonged recovery time.