Critical Appraisal of Oral Midazolam Sedative Agent in Dental Practice

This report presents a critical appraisal of a meta-analysis investigating the efficacy of oral midazolam as a sedative for children undergoing dental treatment. The study reviewed various databases, including Embase, Medline, and others, to gather relevant research articles. The appraisal assesses the methodology, data extraction, and validity of the findings, highlighting inconsistencies with existing literature regarding midazolam's effectiveness in reducing anxiety and pain. The report also discusses the limitations of the study, such as the lack of recent data and a limited number of included articles. While acknowledging the study's potential contributions in providing unique results, it also points out the weak evidence supporting midazolam's effectiveness, especially considering the potential variability in patient responses. The conclusion suggests that further studies are needed to assess the implications and significance of the current findings and to validate the results in clinical practice, considering individual patient differences and responses to the medication.

Running Head: CRITICAL APPRAISAL
Title: Weak Evidence that Oral Midazolam is an Effective Sedative
agent for Children undergoing Dental Treatment

CRITICAL APPRAISAL 2
Introduction
The sedative medication has become a necessity in clinical practice
to reduce the pain and anxiety among patients. In particular, the
pediatrics experience substantial fear, anxiety before dental treatment,
and express noncompliance behavior. The current study provides a critical
appraisal of a meta-analysis to investigate the effect of midazolam
medication to reduce the anxiety and pain among children.
The meta-analysis was carried out to assess the effect of
midazolam in pediatrics before dental treatment. The results were found
to be trustworthy as the recognized journals were approached to explore
the answer such as Embase, SIGGLE, the WorldWideWeb, Medline, and
Community of Science Database. Thirty-eight studies were chosen from
the latest researches published in the recognized journals of Embase,
SIGGLE, the WorldWideWeb, Medline, and Community of Science
Database. The accuracy of completeness of the data was assured
through the data extraction process. The articles that were found to be
highly relevant and fluffing the criteria were included in the study. The
irrelevant articles with unambiguous results were excluded from the
study. The results were found to be valid according to the literature that
has been included in the study. According to studies conducted by Kim et
al. (2016) and Linares et al. (2014), the results were found to be
consistent with the literature.
The implications of the research have not been stated, but it
increased the insight regarding the dire needs of the sensitive situation

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before dental treatment. Also, it has increased the understanding of how
to much medication dose should be given to the patients before dental
treatment to avoid pain and anxiety.
The results of the study were plausible, as the substantial data
supported the fact that oral midazolam decreases the pain, agitation, and
anxiety before surgery among children (Kim et al., 2016: Linares et al.,
2014). A large body of research suggested that sedative medication such
as midazolam is effective for pediatric to reduced the anxiousness and
pain (Fazi, Kurth, Jantzen, Watcha & Rose, 2001; Klein, 1992).
The results of the study indicated that the literature has weak
evidence regarding the effectivity of midazolam use before dental
treatment among children. The research approach was not much
accurate for the study due to a lack of recent data, and the least number
of articles were included in the study.
The researcher identified the study approach through literature,
and the data collection approach was not accurate. The data extraction
has not been made for several reasons. The data collection approach was
accurate as the researcher approached high ranked journals, but he did
not primarily focus on the recent data; rather, he included studies from
1966 to onward. The researcher should include lasts five or above years
of articles to provide the updated information to enhance the implication
and validity of the research.
The significance of the study was mentioned, as the current study
provided substantial information regarding the effectiveness of the
midazolam does not reduce pain and anxiety among patients (Melnyk &

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Fineout-Overholt, 2015). The findings of the current study contradict with the
literature as according to the literature, midazolam reduces anxiety and
pain among children undergoing surgical treatment. The potential
contribution of the study was to provide contradictory and unique results.
The sampling of participants and articles were clear and according
to the need of the study but the selection of sample found to be least
effective. The sample size and composition were reflecting the needs of
the study. As far as the phenomenon of human experience is concerned,
the constructs were identified in terms of experimental and plausible
effects. The sources of data collection and verifying data were clear, and
the role of the researcher and activities were explained thoroughly.
Almost 28 oral and nitrous oxide has been used in the current study to
investigate the effects.
The data analysis procedures were well described and provided the
direction of guidance. The thirty articles were reported to be at the high
risk of bias, and six were found to be at a low risk of bias. The
standardized mean difference was carried out to assess the average
outcome with the 95%CL 1.58, P< 0.001, and I2 found to be equal 91%.
The weak evidence from five trails found to be at high risk of bias, which
indicates the weak relationship between midazolam and cooperative
behavior for treatment or reduction of anxiety or pain.
The data finding has been presented in the qualitative and
descriptive form. The writing of the articles effectively promoted
comprehension regarding the concerned phenomenon. The detailed
description has been given for each step, but unfortunately, no conclusion

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can be drawn from the study which sedative provide the high results to
control the behavior, anxiety, and pain.
The results were found to be the least valid and reliable in terms of
clinical practice. Still, the finding would help me in providing the best care
to my patients understanding the needs and desire of the patient. The
result could vary in the situation as a few patients might get an advantage
after taking midazolam pill, while some other might get no effect. The
results were moderately relevant to patient values and circumstances.
However, the results may be applied to clinical practice in terms of
individual difference. Each case and child is unique and reacts differently
to the medication. The low mg of midazolam can work effectively for some
patient; in contrast, the high dosage might be effectless. The study
provided an understanding of how the literature provides a substantial
difference in the effect of midazolam.
Conclusion
The Meta-analysis provided a detailed description of the effectivity
of midazolam for dental treatment. The study was found to have a few
gaps that would be covered in further studies to assess the implication
and significance of the current study. Further studies should also be
overviewed to assess the validity of the current study.

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References
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.
Kim, K. M., Lee, K. H., Kim, Y. H., Ko, M. J., Jung, J. W., & Kang, E. (2016).
Comparison of effects of intravenous midazolam and ketamine on
emergence agitation in children: Randomized controlled trial. The
Journal of international medical research, 44(2), 258–266.
doi:10.1177/0300060515621639.
Klein, E. R., (1992). Premedicating children for painful, invasive procedures. Journal of
Pediatric Oncology Nursing, 9(4) Retrieved from
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Linares, S. B., Garcia, C. M., Ramirez, C. I., Guerrero, R. J., Botello, B.,
Monroy, T. R., & Ramirez, G. X. (2014, January). Pre-anesthetic
medication with intranasal dexmedetomidine and oral midazolam as
an anxiolytic. A clinical trial. A Pediatr (Barc).
http://dx.doi.org/10.1016/j.anpedi.2013.12.006
Melnyk, B. M., & Fineout-Overholt, E. (Eds.). (2015). Evidence-based practice in nursing &
healthcare: A guide to best practice. Lippincott Williams & Wilkins.