Objective To investigate the effect of intranasal dexmedetomidine on preoperative anxiety, cooperation and postoperative recovery in children undergoing strabismus surgery under general anesthesia. Methods A total of 82 children undergoing strabismus correction under general anesthesia in our hospital from January 2021 to September 2023 were selected as the research objects. According to different anesthesia methods, they were divided into control group and study group, with 41 children in each group. 30 min before anesthesia induction, the control group was given 0.02 ml/kg normal saline nasal drip, and the study group was given 2 μg/kg dexmedetomidine nasal drip. The sleep status after nasal drip, preoperative anxiety, degree of cooperation during anesthesia induction, incidence of postoperative adverse events and recovery were compared between the two groups. Results The falling asleep rate in the study group was higher than in the control group (P <0.05). The mYPAS score and the proportion of mYPAS score>40 scores on the day of operation and anesthesia induction in the study group were lower than those in the control group (P <0.05). The proportion of drowsiness in the study group was higher than that in the control group, and the proportion of restlessness was lower than that in the control group (P <0.05). There was no significant difference in the incidence of pain and nausea between the two groups (P >0.05). The PAED score of the study group was lower than that of the control group (P <0.05). Conclusion Nasal drip of dexmedetomidine 30 min before anesthesia induction in children undergoing strabismus surgery under general anesthesia is helpful to relieve preoperative anxiety, improve cooperation, reduce the risk of agitation during anesthesia recovery, and promote postoperative anesthesia recovery. It has high application value.