Behavioral outcome of oral midazolam premedication in pediatric dental general anesthesia: A systematic review

Abstract

Aim: This systematic review explores the postoperative behavior outcomes of oral midazolam (OM) premedication in pediatric dental general anesthesia (DGA). Premedication drug assists in the reduction of negative psychological impact during the general anesthesia induction, thus influence the behavior, particularly in pediatric patients. OM is one of the common premedications given due to its efficacy and well accepted administration. Materials and Methods: This review was registered under the International Prospective Register of Systematic Reviews (PROSPERO). Studies published in the databases including PubMed Central, Cochrane, Web of Science, Google Scholar and others between January 1980 and December 2020 were analyzed using Preferred Reporting Items for Systematic Review and Meta‐analysis (PRISMA) guidelines. Risks of bias and evidence levels were determined on each selected study. Results: Seven out of 6944 studies, were scrutinized for final analysis, which involved a total of 392 children in experimental groups and 89 children in placebo groups. OM had shown both positive and negative behavior outcomes post DGA using different assessment tools, in comparison to other premedications. It also showed less side effect post consumption. Conclusions: OM premedication demonstrated very limited evidence for positive behavior outcomes in pediatric DGA. The 0.5 mg/kg body weight dosage of midazolam yields the most favorable behavior postoperatively. Based on this collective review, there is still limited evidence for positive behavior outcomes in OM premedication.