Critical Appraisal of Childhood Preoperative Anxiolysis: A Study

This assignment presents a critical appraisal of a randomized prospective study titled "Childhood preoperative anxiolysis: Are sedation and distraction better than either alone? A prospective randomized study." The appraisal evaluates the study's methodology, focusing on the use of Midazolam to reduce anxiety and pain in children before and after operations. The study is analyzed in terms of its reliability, validity, and placement within the hierarchy of evidence. The report details the study's design, including the problem addressed, the stages of the study, sample size, and data analysis methods. Furthermore, it examines the study's consistency with prior research and its implications for clinical practice, highlighting the importance of evidence-based practices and the potential benefits of combining medication with distraction techniques. The appraisal also addresses any adverse events and provides a comprehensive overview of the research's contribution to the field, emphasizing the need for further studies to validate findings before widespread clinical application. The report includes the references used in APA style.

Running Head: CRITICAL APPRAISAL
Topic: Critical Appraisal: Childhood preoperative anxiolysis: Is sedation and
distraction better than either alone? A prospective randomized study

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Introduction
The current assignment provides the critical appraisal of the quantitative study ‘'
Childhood preoperative anxiolysis: Are sedation and distraction better than either alone? A
prospective randomized study''. This critical appraisal aims to investigate the cost and
effectiveness of Midazolam in reducing the anxiety and pain among children before and after
an operation. The study has been correlated with recent data to assess its reliability and
effectiveness. The results of the study have been elaborated with the implication of
medication in clinical practice both professionally and scientifically.
Q: Is this quantitative research report a case study, case-control study, cohort study,
randomized control trial or systematic review?
Ans: The quantitative study was a randomized prospective study that primarily focuses
on evidence-based practice in relieving pain among children.
Q: Where does the study fall in the hierarchy of evidence in terms of reliability and risk
of bias?
Ans: The research found to be reliable, as the large body of researches supported the
findings of the study. In contrast, a few contradictory studies provide different results.
Concerning the substantial body of researches, the current study found to be valid and
reliable. Klein, (1992) and Fazi, Kurth, Jantzen, Watcha & Rose, (2001) provided a similar
result to control the pre and post-operation pain.
Q: Why was the study done? (Define the problem and purpose.)
Ans: Pain and anxiety in a hospital or clinical setting are widespread. The children
experience substantial pain and severe anxiety before and after an operation. The pain and
anxiety are vital to reduce for getting positive post-operation results. The children should not

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get anxious in pre or post-operational state. The recent data suggested that numerous
researchers, pediatrics and doctors are working to find out the ways to reduce the pain and
anxiety among patients. The current study aimed at investigating the effectiveness of
Midazolam in the preoperative stage in controlling the postoperative pain. The results of the
study would provide evidence to control the situation in hospital settings.
Q: Where the steps of the study identified?
Ans: The current study comprised of three stages, which was mentioned in the study. In
the first stage, the pre-assessment was taken from the children. Two standardized scale visual
analog anxiety scale, Yale preoperative anxiety scale, post-operative pain scales were used to
collect the data. In the second stage, childhood midazolam, with digital viseo player,
preoperative anaxiolysis were implemented.. Lastly, the post-assessment was taken. The
significant difference in pre and post assessment was found.
Q: What was the sample size?
Ans: One thirty-five children aged 2-12 years were selected in the controlled randomized
program. The children were distributed into three sets to assess the efficiency of midazolam.
In the intervention delivery, three preventative strategies were used to investigate the results.
Q: Are the measurements of major variables reliable and valid? Explain.
Ans: The assessment of the construct was reliable as the standardized tools were used to
collect data. Such as modified visual analog anxiety scale, Yale preoperative anxiety scale,
post-operative pain, disorientation satisfaction, and the satisfaction of parentswere also
assessed.
Q: How were the data analyzed?

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Ans: The data was computed through statistical analysis of paired sample t-test. The
results of the study indicated that the three preoperative medication reduced the pre and
postoperative anxiety, and pain among patients, but no significant difference has been
observed in all three pain and anxiety management modalities.
Q: Were there any untoward events during the conduct of the study?
Ans: No, untoward events have been being found, all administration of medication to
control anxiety and pain of the patients was smooth. Rather the satisfaction of the parents
was also found to be high. In the initial stage, the children were hesitant to rate their
responses on the standardized scales, but gradually they become relax in providing the
information.
Q: How do the results fit with previous research in the area?
Ans: The results of the study found to be consistent with the literature. Klein, (1992)
concluded that the children experience anxiety before an operation. Fazi, Kurth, Jantzen,
Watcha& Rose, (2001) conducted a study to assess the effectiveness of the midazolam for
pain delivery among 4-12 years of children. The results of the current study found to
consistent with the literature and concluded that the midazolam effectively reduces the pain
and anxiety among children.
Q: What does this research mean to clinical practice?
Ans: The study has significant importance in clinical practice for multiple reasons. First,
the research provided evidence to use the medication dosage for pain relive. The research
also highlights the importance of distraction with mediation to produce better results in pain
and anxiety reduction in the clinical setting. Secondly, the research provides evidence based
on valid and reliable measures. Thirdly, the pain in a significant aspect in clinical practice,

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the current research provides an in-depth understanding of how effectively the pain can be
control among children using a controlled randomized trial.
Critical Appraisal
The study ‘'childhood preoperative anxiolysis: is sedation and distraction better than
either alone: A prospective randomized study was effective in proving evidence regarding
the benefits of the midazolam in relieving pain and anxiety among children. The current
found to be reliable as the substantial body of researches supported the findings. Klein,
(1992) and Fazi, Kurth, Jantzen, Watcha & Rose, (2001), but a few contradictory studies
raised a question on the level of evidence. The in-depth quantitative and qualitative studies
should be carried out t asses the level of evidence and efficacy. Regardless of the level of
evidence, the study was conducted effectively in a clinical setting with a controlled setting.
The question arises how much the current study is useful to practice in the clinical setting
(Melnyk & Fineout-Overholt, 2015). The results of a single study cannot be implemented in
the clinical setting. The more consistent lasts studies should be carried out before the
implementation of such practices in professional or clinical settings. More studies should be
carried out to assess the effective implementation of medication to relieve pain id pediatric
surgery ward to avoid the obnoxious consequences.

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Referenes
Fazi, L., Jantzen, E. C., Rose, J. B., Kurth, C. D., &Watcha, M. F. (2001, January). A Comparison
of oral clonidine and oral midazolam as pre-anesthetic medications in the pediatric
tonsillectomy patient.Anesthesia and Analgesia, 92 Retrieved from
http://ether.stanford.edu/asc1/documents/peds.pdf
Klein, E. R. (1992). Premedicating children for painful, invasive procedures. Journal of Pediatric
Oncology Nursing, 9(4) Retrieved from
https://journals.sagepub.com/doi/abs/10.1177/104345429200900404
Melnyk, B. M., & Fineout-Overholt, E. (Eds.). (2015). Evidence-based practice in nursing &
healthcare: A guide to best practice. Lippincott Williams & Wilkins.
Sola, C., Lefauconnier, A., Bringuier, S., Raux, O., Capdevila, X., Dadure, C. (2017. Childhood
preoperative anxiolysis: Is sedation and distraction better than either alone? A prospective
randomized study.Paediatr Anaesth. 2017 Aug; 27(8):827-834. doi: 10.1111/pan.13180.