Anxiety in Children Undergoing VCUG: Sedation or No Sedation?
Table 1
Studies comparing a sedative against another sedative, placebo, or standard treatment
for VCUG. Design and interventions. (NSD: no significant difference; VCUG: voiding cystourethrogram; RNC: radionuclide cystography; VUR: vesicoureteric reflux; SD: standard deviation).
Authors; year; country
Title
Patients
Intervention and comparison
Nonpharmacological cointervention
Time of follow-up and differences (if any)
I. Akil, M. Ozkol,O. Y. Ikizoglu, M. Polat, O. Y. Tuncyurek, O. Taskin, H. Yuksel; 2005; Turkey [41]
“Premedication during micturating cystourethrogram to achieve sedation and anxiolysis”
53 (39F;14M), >6 m, median age of 6 y (range from 7 m to 11.1 y); first VCUG 98%
Oral midazolam of 0.6 mg/kg (max. of 15 mg) versus chloral hydrate
of 25 mg/kg (max. of 500 mg) versus Placebo; 15–30 min prior to VCUG
Parents informed about MCUG and permission granted for sedative drug and making child nil
by mouth for 3 h, parental presence not stated
Until they were allowed to drink clear liquids, usually 1 h after completion of the procedure
“Premedication with oral midazolam for voiding cystourethrography in children: safety and efficacy”
98 children previously distressed by VCUG (38) or appeared shy (79F;19M), mean age of 4.4 (range from 23 m to 9 y); 25 controls (21F : 4M),
mean age of 4.6 (range not stated); first VCUG 61%
Oral midazolam of 0.6 mg/kg (max. of 15 mg), 20–30 min prior to VCUG or NUC
versus standard care
Parents of intervention group-contacted prior with purpose of midazolam and expected effects, parents
are allowed to be present
Phone call at 48 h
D. W. Herd, K. A. McAnulty, N. A. Keene, D. E. Sommerville; 2006; New Zealand [45]
“Conscious sedation reduces distress in children undergoing voiding cystourethrography and
does not interfere with the diagnosis of vesicoureteric reflux: a randomized controlled study”
Children of 1–14 y (eligible); 139 randomised, 117 completed VCUG on the day (84F : 33M), 8 had VCUG
completed later, age >1 y, mean ages of 3.6 y (SD1.8) and 3.4 y (SD2.1), ASAI-II
Oral midazolam of 0.5 mg/kg (max. of 15 mg), 30 min prior to catheter insertion
versus placebo
All offered play therapy (visit to department, doll catheterised), four-page pamphlet,
only the treatment group fasted for 6 h with solids and 4 h with liquid (i.e., control group was allowed to eat),
parent/caregiver present, skilled nurse did all catheters
60–90 min after medication
I. Keidan, R. Zaslansky, M. Weinberg, A. Ben-Shlush, J. M. Jacobson, A. Augarten, Y. Mor; 2005;
Israel [47]
“Sedation during voiding cystourethrography: comparison of the efficacy and safety of using oral
midazolam and continuous flow nitrous oxide”
47 (42F : 5M), age of 3–16 y, ASAI and II, mean age of 6 (range
from 3 to 15)
Oral midazolam of 0.5 mg/kg (max. of 15 mg), 20 min
prior to procedure versus continuous flow 50% nitrous oxide
Both groups fasted with solids for 6 h, and liquids for 2 h, parents were encouraged
to accompany the children throughout the procedure, flavoured nasal mask was used for nitrous oxide
24 h follow-up by telephone, recovery time of 63 min (SD 25) in midazolam group,
29 min (SD 10) in the N2O group ()
P. A. Merguerian, S. T. Corbett, J. Cravero; 2006; USA [48]
“Voiding ability using propofol sedation in children undergoing voiding cystourethrograms:
a retrospective analysis”
544 charts, 287 selected ages from 2 to 8 (preselected), mean age of 51 m (244F : 43M),
first VCUG 75%
Sevoflurane induction followed by propofol infusion on its own (historical controls)
Not reported
E. Stokland, S. Andréasson, B. Jacobsson, U. Jodal, B. Ljung; 2003; Sweden [52]
“Sedation with midazolam for voiding cystourethrography in children: a randomised double-blind study”
Children of 0.5 to 9 y (eligible), 95 enrolled (70F : 20M), gender stratified,
median age of 2.2 y, midazolam, 3.2 placebo
Intranasal midazolam of 0.2 mg/kg (max. of 5 mg), 3–5 min
prior to bladder catheter versus placebo
Oral and written information
Follow-up questionnaire and phone call at 48 h
J. L. Zier, K. A. Kvam, S. C. Kurachek, M. Finkelstein; 2007; USA [59]
“Sedation with nitrous oxide compared with no sedation during catheterization for urologic imaging
in children”
Children of 4–18 y selected by investigator undergoing VCUG or RNC, enrolled
204 (165F : 39M) out of 389, mean age nonsedated: 6.4 (range of 4–15.2),
sedated: 6.3 (range of 4–14.9)
Continuous flow 70% nitrous oxide until catheterisation is complete versus standard care
All patients fasted for 4 h
To time of discharge, longer in sedated group, 85 min versus 33 min ()
