Sedation during voiding cystourethrography: comparison of the efficacy and safety of using oral midazolam and continuous flow nitrous oxide.
OBJECTIVE
We compare the efficacy and safety profile of oral midazolam and continuous flow 50% nitrous oxide (N(2)O) for alleviating anxiety and pain during voiding cystourethrography (VCU) in children.


METHODS
This prospective, randomized clinical trial study was conducted in the radiology unit of a tertiary care center. Children older than 3 years scheduled for VCU were given either 0.5 mg/kg midazolam orally or continuous flow 50% N(2)O. Main outcomes were degree of anxiety and pain as assessed by the attending nurse and radiologist performing the test using a behavioral anxiety score, a distress score and an overall satisfaction score, side effects and recovery profile.


RESULTS
The study included 47 children (89% girls) with a mean age of 6 years (range 3 to 15). There were 24 subjects in the midazolam group and 23 in the N(2)O group. Midazolam and N(2)O provided adequate anxiety and pain relief to perform the examination, yet children given N(2)O required less restraining and experienced a significantly shorter recovery time (29 +/- 10 vs 63 +/- 25 minutes, p <0.001).


CONCLUSIONS
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.
Keidan
Ilan
I
Department of Pediatric Anesthesia, The Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel. ilankeid@sheba.health.gov.il
Zaslansky
Ruth
R
Weinberg
Margalith
M
Ben-Shlush
Aviva
A
Jacobson
Jeffrey M
JM
Augarten
Arie
A
Mor
Yoram
Y
D000280:Administration, Inhalation; D000284:Administration, Oral; D000293:Adolescent; D018685:Anesthetics, Inhalation / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation / Q000379:methods*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D008297:Male; D008874:Midazolam / Q000008:administration & dosage*; D009609:Nitrous Oxide / Q000008:administration & dosage*; D011446:Prospective Studies; D011859:Radiography; D018709:Statistics, Nonparametric; D014555:Urination Disorders / Q000000981:diagnostic imaging*
D018685:Anesthetics, Inhalation; D006993:Hypnotics and Sedatives; D009609:Nitrous Oxide; D008874:Midazolam