Background: Preoperative sedation with oral midazolam is commonly used to alleviate anxiety in children. Our current research aims to investigate influence of preoperative oral midazolam sedation on separation anxiety in pediatric individuals experiencing inguinal hernia repair. Pediatric patients suffering surgical procedures often experience separation anxiety, which can lead to increased stress and discomfort. Aim: The primary aim of our current randomized controlled research is to assess whether preoperative oral midazolam sedation reduces separation anxiety in pediatric patients scheduled for inguinal hernia repair. Additionally, we aim to assess the safety and feasibility of administering midazolam in this population. Methods: Pediatric patients aged 2 to 10 years, scheduled for elective inguinal hernia repair, were randomly allocated to either midazolam sedation group or control set. The midazolam group found an age-appropriate oral dose of midazolam one hour before surgery, whereas control group received a placebo. Anxiety levels were assessed using standardized scales, vital signs monitoring, and observations by trained healthcare providers. Adverse events and recovery times were recorded. Results: The analysis revealed the statistically substantial decrease in separation anxiety levels in midazolam sedation group associated to control group. Additionally, vital signs remained stable in both groups, and no substantial adverse events were reported in midazolam group. The recovery times were similar among the two sets. Conclusion: Preoperative oral midazolam sedation is an effective and safe intervention for reducing separation anxiety in pediatric patients undergoing inguinal hernia repair. This study provides evidence supporting the use of midazolam as an adjunctive therapy to improve the perioperative experience for children in this context. More research is necessary to discover the long-term impacts and ideal dosing regimens of midazolam in pediatric surgical settings.