Anxiety in Children Undergoing VCUG: Sedation or No Sedation?
Table 2
Studies comparing a sedative against another sedative, placebo, or standard treatment for VCUG. Outcomes,
results, and follow-up. (NSD: no significant difference; VCUG: voiding cystourethrogram; RNC: radionuclide cystography; VUR: vesicoureteric reflux; SD: standard deviation).
Authors; year; country
Sedation score outcome and results
Distress outcome(s) and results
Urological outcome(s) and results
Safety outcome(s) and adverse events
I. Akil, M. Ozkol, O. Y. Ikizoglu, M. Polat, O. Y. Tuncyurek, O. Taskin, H. Yuksel; 2005; Turkey [41]
Breitkopf and Buttner classification of emotional status [87], 1.87
(SD0.72) in midazolam versus 1.35 (SD0.49) in control (), duration
of sedation is 68 min (midazolam), 28 min (chloral),
Frankl behaviour rating score [88] NSD; Spielberger's state
anxiety inventory [41] NSD; Houpt behaviour scale [88]
of 4.93 (SD1.12) in midazolam group versus control of 4.12 (SD 1.05) in chloral group, all NSD
Postvoid residual volume, VCUG grading, no difference found
None found, defined as drop in PaO2/Sats by 5%, systolic blood pressure drop of 15 mm Hg,
drop in pulse to 60 bpm
Phone call at 48 h, recall, behavioural side effects; parental wishes, 97 out of 98
contacted, 56 children (60%), no recall of VCUG, 19 (21%) recalled parts, 10 remembered the procedure
without negative experience, 9 recalled a negative experience, 12 out of 97 children had
behavioural side effects reported after the study, 92 out of 97 (95%) parents of sedated children
would request the use of midazolam again
Postvoid residual volume (Bis and Slovis method [89]), no residual
volume in 74% of midazolam group and 72% of control group; NSD
Saturation decrease by 10%, systolic BP drop by 15 mm Hg, respective rate down to
8/min, HR down to 60/min, one child had a transient decrease in saturation requiring no intervention
D. W. Herd, K. A. McAnulty, N. A. Keene, D. E. Sommerville; 2006; New Zealand [45]
None
Independent observer Groningen distress rating scale [90]; nursing
GDRS; heart rate; parent-child interaction, 61% of placebo group experienced serious or severe distress
(GDRS of 3 or 4); 26% of midazolam group had the same distress; number needed for treatment was
2.9 (95%CI 1.9–5.5)
VUR grade; volume infused, no difference in volume infused (), no difference in
VUR grading (), a priori power of 90%
Oxygen requirement (Sats <94%), two children in midazolam group had transient desaturations
to less than 94% and were given oxygen
I. Keidan, R. Zaslansky, M. Weinberg, A. Ben-Shlush, J. M. Jacobson, A. Augarten, Y. Mor; 2005;
Israel [47]
AVPU (alert, responds to voice, responds to pain, unresponsive)
FLACC (face, legs, activity, crying, consolability) score for pain [91];
anxiety score (observer scale of behavioural distress) [92]; no
difference between midazolam and nitrous oxide, number of children requiring physical restraint is 10/24 in
midazolam and 2/23 for N2O ()
Time to micturition 7.2 (SD2.5) min for midazolam and 15.3 (SD 17.3),
Oxygen saturation <93%, alteration in heart rate or BP by 15% from baseline, oversedation
defined as “U” on the AVPU scale
P. A. Merguerian, S. T. Corbett, J. Cravero; 2006; USA [48]
Not reported
None
Void to completion; sedated children (55%) could void to completion compared to 89%
nonsedated ()
Not reported
E. Stokland, S. Andréasson, B. Jacobsson, U. Jodal, B. Ljung; 2003; Sweden [52]
None
VAS from 0 mm to 100 mm (severe problems); nurse observation VAS NSD, parent VAS,
administration of midazolam more uncomfortable (), catheter,
and overall procedure more uncomfortable with placebo ();
parent follow-up questionnaire at 12, 24, and 48 h of “reactions,” NSD
VUR grade; volume infused; ability to void; NSD
Not defined, none reported
J. L. Zier, K. A. Kvam, S. C. Kurachek, M. Finkelstein; 2007; USA [59]
None
Brief behavioural distress score (BBDS) for VCUG, median age of 44 (range of 11–100)
nonsedated, 11 (range of 0–67) sedated (),
patient self-reported Wong-Baker FACES pain rating scale, 6 after catheter in
nonsedated, 0 in sedated ()
Time to bladder emptying; NSD
One patient in sedated group experienced nausea, no desaturations
