Review Article

The Effect of Rectal Midazolam on Clinical Conditions in Pediatric Dentistry: A Systematic Review Study

Abstract

Background: Before dental procedures, children often require mild to moderate sedation. This study was conducted to determine the effect of rectal midazolam on pediatric dental pain using a systematic review method.
Methods: In this systematic review study, articles published from 2000 up to the beginning of 2025 that focused on the effect of rectal midazolam on the clinical condition of pediatric patients undergoing dental services were included. The search was conducted by both authors of the article: one holding a specialization degree in pediatric dentistry and the other being a pharmacist. The search keywords included "pediatrics," "tooth," "dentistry," "dental services," "midazolam," "rectal midazolam," "children," and "clinical indicators." The search was performed across all international databases, including PubMed, Scopus, Web of Science, Embase, EBSCO, and the Google Scholar search engine. After searching for the articles, the relevant data were extracted using a checklist designed by the researchers, and the findings were reported in table format using a descriptive method.
Results: The result showed the initial search yielded 189 articles. After reviewing and evaluating the articles based on research objectives, methodology, the type of drug prescribed to patients, the method of drug administration, the manner of reporting findings, the language of publication, and the availability of the full article files, 5 articles proceeded to the systematic review stage. Also, in all extracted studies, the administration of rectal midazolam resulted in a positive effect on the clinical conditions of the patients, and the administration of this drug caused no side effects in the patients.
Conclusion: The administration of midazolam rectally has proven effective in achieving the study objectives, including maintaining stable clinical conditions for the patients and resulting in no significant clinical side effects. Therefore, the rectal administration of this drug is recommended.

[1] Gharavi M, Salem K, Ahmadi SAY, Baradaran HR. A Comparative Evaluation of Midazolam, Ketamine and Their Combination as Sedative Agents in Pediatric Dentistry: A Systematic Review and Meta-analysis. Front Dent. 2025; 22:34.
[2] Alizadeh A, Kayalha H, Heyrat B, Rastak S, Sofiabadi M. Comparison Hemodynamic Effects of Midazolam and Dexmedetomidine as a Premedication in Patients Undergoing Upper Limb Surgeries: A Double-blind Intervention. J North Khorasan Univ Med Sci. 2020; 11(4):45-51.
[3] Shetabi H, Haidari SM, Moradi FD, Bechari Z. A comparison of sedation quality with midazolam-ketamine versus propofol-ketamine during Phacoemulsification surgery. Tehran Univ Med J. 2021; 79(1):18-25.
[4] Rienhoff J, Splieth CH, Veerkamp JSJ, Krikken JB, Rienhoff S, Halsband U, et al. The Role of Ibuprofen and Midazolam in Pediatric Dentistry: A Retrospective Study and Neurophysiological Considerations. Brain Sci. 2024; 14(11):1073.
[5] Nashibi M, Mottaghi K, Faraji M, Delavari A, Taghipour H, Amiri M. Comparison of analgesic and sedative effects of ketamine-propofol (ketofol) and fentanyl-midazolam (fentazolam) combinations in outpatient orthopedic procedures. Trauma Mon. 2017; 22(5).
[6] Masoudifar M, Nazemroaya B, Rahimi Z, Khademi M. Effects of midazolam and dexmedetomidine on sedation levels, hemodynamics and, complications under brain stereotaxic surgery. Jundishapur Sci Med J. 2019; 18(3):311-7.
[7] Nazemroaya B, Masoudifar M, Rajabi Moghadam M. Comparison of dexmedetomidine versus midazolam on hemodynamic parameters, bleeding, satisfaction of surgeons and patients who Underwent laminectomy surgery by spinal anesthesia. Tehran Univ Med J. 2021; 79(5):343-50.
[8] Kamalfar S, Mousavi R, Alinaghimaddah SM. Effect of Midazolam on the Incidence of Agitation in Patients Undergoing Electroconvulsive Therapy: A Randomized Clinical Trial. Iran J Psychiatry Clin Psychol. 2023; 29(2):188-201.
[9] Gencer M, Sezen O. A study comparing the effect of premedication with intravenous midazolam or dexmedetomidine on ketamine-fentanyl sedoanalgesia in burn patients: A randomized clinical trial. Burns. 2021; 47(1):101-9.
[10] Tadler SC, Mickey BJ. Emerging evidence for antidepressant actions of anesthetic agents. Curr Opin Anaesthesiol. 2018; 31(4):439-45.
[11] Cravero JP, Beach M, Thyr B, Whalen K. The effect of small dose fentanyl on the emergence characteristics of pediatric patients after sevoflurane anesthesia without surgery. Anesth Analg. 2003; 97(2):364-7.
[12] Sanatkar M, Goudarzi M, Espahbodi E. Comparison of the efficacy of two pre-treatment medication of dexmedetomedine-fentanyl and midazolam-fentanyl in cataract surgery. Tehran Univ Med J. 2020; 78(3):155-64.
[13] Inoue T, Yamamoto T, Kishimoto N, Seo K. Comparison of Anesthetic Features in Diazepam and Midazolam for Sedation Dentistry: A Scoping Review. Cureus. 2025; 17(2):e79079.
[14] Ebrahim Soltani A, Arbabi SH, Nahvi H, Moshirian N. Rectal premedication in pediatric anesthesia: midazolam versus ketamine. Tehran Univ Med J. 2008; 66(2):113-7.
[15] Alzoubi H, Kabbani S, Taleb A, Bshara N, Altinawi MK, Almonakel MB, et al. Rectal Sedation With Ketamine and Midazolam in the Management of Uncooperative Children During Dental Treatment: A Case Series and Method Description. Cureus. 2024; 16(2):e54825.
[16] Aydintug YS, Okcu KM, Guner Y, Gunaydin Y, Sencimen M. Evaluation of oral or rectal midazolam as conscious sedation for pediatric patients in oral surgery. Mil Med. 2004; 169(4):270-3.
[17] Yoshino A, Seto M, Mano R, Kita R, Ishida S, Aoyagi N, et al. Rectal administration of midazolam plus ketamine as conscious sedation for injured paediatric patients requiring Oral surgery. J Oral Maxillofac Surg Med Pathol. 2019; 31(4):241-4.
[18] Jensen B, Matsson L. Oral versus rectal midazolam as a pre-anaesthetic sedative in children receiving dental treatment under general anaesthesia. Acta Paediatr. 2002; 91(8):920-5.
[19] Lindh-Strömberg U. Rectal administration of midazolam for conscious sedation of uncooperative children in need of dental treatment. Swed Dent J. 2001; 25(3):105-11.
[20] Sarafi M, Azimi B, Karimian M, Ebrahimisaraj G. Assessment of Clinical Characteristics of Patients with Penetrating Abdominal Trauma. Arch Anesth Crit Care. 2025; 11(4):509-12.
[21] Sarafi M, Azimi B, Vasigh A, Ebrahimisaraj G. Assessment of Chronic Postoperative Inguinal Hernia Pain (CPIP) in Children. Arch Anesth Crit Care. 2025.
[22] Borji M, Nourmohammadi H, Otaghi M, Salimi AH, Tarjoman A. Positive Effects of Cognitive Behavioral Therapy on Depression, Anxiety and Stress of Family Caregivers of Patients with Prostate Cancer: A Randomized Clinical Trial. Asian Pac J Cancer Prev. 2017; 18(12):3207-12.
[23] Shokri M, Tarjoman A, Borji M, Solaimanizadeh L. Investigating psychological problems in caregiver of pediatrics with cancer: A systematic review. J Child Adolesc Psychiatr Nurs. 2020; 33(4):229-38.
[24] Baier K, Milgrom P, Russell S, Mancl L, Yoshida T. Children's fear and behavior in private pediatric dentistry practices. Pediatr Dent. 2004; 26(4):316-21.
[25] Rabassa-Blanco J, Cahuana-Bartra P, González-Chópite Y, Rocha-Eiroa MD, Ramírez-Rámiz A, Mashala EI, et al. Efficacy of Midazolam in Outpatient Pediatric Dentistry: A Systematic Review. Spec Care Dentist. 2025; 45(5):e70107.
[26] van der Bijl P, Roelofse JA, Stander IA. Rectal ketamine and midazolam for premedication in pediatric dentistry. J Oral Maxillofac Surg. 1991; 49(10):1050-4.
[27] Roelofse JA, van der Bijl P, Stegmann DH, Hartshorne JE. Preanesthetic medication with rectal midazolam in children undergoing dental extractions. J Oral Maxillofac Surg. 1990; 48(8):791-7.
[28] Lökken P, Bakstad OJ, Fonnelöp E, Skogedal N, Hellsten K, Bjerkelund CE, et al. Conscious sedation by rectal administration of midazolam or midazolam plus ketamine as alternatives to general anesthesia for dental treatment of uncooperative children. Scand J Dent Res. 1994; 102(5):274-80.
[29] Ashley P, Anand P, Andersson K. Best clinical practice guidance for conscious sedation of children undergoing dental treatment: an EAPD policy document. Eur Arch Paediatr Dent. 2021; 22(6):989-1002.
[30] Yeo XH, Shehabi Z. Effectiveness and safety of dentist-led conscious sedation using fentanyl with midazolam in dentistry: a five-year retrospective service evaluation. Br Dent J. 2023:1-6.
[31] Zhang Y, Li C, Shi J, Gong Y, Zeng T, Lin M, et al. Comparison of dexmedetomidine with midazolam for dental surgery: A systematic review and meta-analysis. Medicine (Baltimore). 2020; 99(43):e22288.
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Keywords
Midazolam Clinical conditions Pediatric Dentistry Systematic review study

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1.
Kashefizadeh M, Jamshidi YA, Kazempour M. The Effect of Rectal Midazolam on Clinical Conditions in Pediatric Dentistry: A Systematic Review Study. Arch Anesth & Crit Care. 2026;.