Sedation During Voiding Cystourethrography: Comparison of the Efficacy and Safety of Using Oral Midazolam and Continuous Flow Nitrous Oxide

Abstract

Continuous flow 50% nitrous oxide and oral midazolam are comparably safe and effective in reducing anxiety and distress during VCU in children older than 3 years. However, N(2)O provides a more rapid onset of sedating effect and has a shorter recovery time.

Non-Intravenous Sedatives and Analgesics for Procedural Sedation for Imaging Procedures in Pediatric Patients

“…The most common agent evaluated was PO midazolam. [7][8][9][10][11][12][13][14][19][20]22 Table 4 provides a summary of dosing information and adverse events reported in the included studies.…”

“…Seven studies included a comparator group; all with a relatively small sample size, making it difficult to draw conclusions. 4,7,[13][14][19][20]22 Three studies compared PO or IN midazolam to PO chloral hydrate. 4,13,19 It should be noted that chloral hydrate is no longer commercially available, although some institutions may compound a solution.…”

“…Eight studies provided details for preparation of PO midazolam; all 8 studies used the IV midazolam solution in a sweetened drink. [7][8][9][10][11][12][13][14][19][20]22 Oral midazolam syrup is now commercially available, which is considered more tolerable. TM dexmedetomidine with the IV formulation was said to be well tolerated because of bland taste and minimal volume required, and no children refused it in the study by Lami et al 6 IN midazolam was administered using the IV product delivered by dropper or MAD.…”

“…Ten studies and 1 case report included in this report describe sedation during VCUG. [8][9][10][11][12][13][14][15][16][17][18] Midazolam was the medication most widely studied for VCUG. Elder and colleagues 8 were the first to evaluate the safety and efficacy of PO midazolam.…”

Sedation and the VCUG

“…The patients achieve sedation but are awake and able to respond to questions and to void [8][9][10][11][12].…”