EVIDENCE LIBRARY
Parental presence and midazolam had different anxiety effects in a pediatric anesthesia meta-analysis
A 24-study review distinguished parental presence from midazolam premedication and found no statistically significant added benefit from combining them at induction.
A 24-study review distinguished parental presence from midazolam premedication and found no statistically significant added benefit from combining them at induction.
Four comparisons answered different questions
The review included randomized and quasi-randomized studies of parental presence during induction of general anesthesia in children. It compared parental presence with absence, parental presence with sedative premedication, the combination with medication alone, and parental presence with other non-drug interventions.
These comparisons should remain separate. Showing improvement relative to no parent does not establish equivalence to a medicine. Similarly, a combination can be helpful relative to no intervention without adding a measurable benefit over medication already given.
The midazolam comparisons
Parental presence alone was less effective than midazolam on the pooled induction-anxiety endpoint, with a standardized mean difference of 1.06 and a p value of 0.022. The analysis of change from baseline to induction also favored midazolam, with a standardized difference of 2.15 and a p value of 0.004. These are standardized scale differences, not differences in the proportion of children who completed surgery.
Adding parental presence to midazolam did not significantly improve induction anxiety compared with midazolam alone: the standardized difference was −0.40, with a p value of 0.402. A nonsignificant result does not prove the approaches are identical or exclude benefit in particular children.
Certainty and scope
Only five included studies were rated high quality, and evidence certainty ranged from low to moderate. Differences in children, anxiety measures, procedures, and how parents participated constrained the pooled interpretation. A familiar-looking intervention was not necessarily delivered identically across studies.
The review assessed perioperative anxiety, not benzodiazepine concentrations, impairment thresholds, or long-term psychological outcomes. It supports matching the comparison to the question being asked. For an individual anesthesia record, the child’s baseline distress, parental participation, medication timing, and observed response remain more informative than assuming one pooled result determines every case.
Source paper
Original analysis of the supplied journal article, identified as PMC13037229.