Anxiety In Children Undergoing VCUG: Sedation Or No Sedation?

Main Category: Pediatrics / Children's Health
Also Included In: Urology / Nephrology
Article Date: 17 Oct 2008 - 3:00 PDT

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UroToday.com - A manuscript by David W. Herd examined studies of voiding cystourethrograms (VCUGs) and anxiety in children as evaluated in previously published articles about VCUGs. Pub Med, EMBase, and Cochrane databases were utilized. His Med Line search found 17 papers to be considered of interest while the EMBase search found an additional 8 papers of interest out of a total of 650 manuscripts. When these 25 studies were reviewed, the bibliographies identified another 39 papers of interest. Four of these papers were focused on anesthesiology for VCUGs and were also included in the discussion.

The study determined that the best way to avoid the stresses of VCUG is to not perform the procedure at all. The sedation utilized for VCUGs were analgesics, anxiolytics and amnesia agents. The study showed that sedation does have a cost, and opinions varied as to which method was the most appropriate for individual patients.

It appeared from this study that many children did not actually experience stress during the VCUG study. This could be related to a previous experience and other coping mechanisms - especially parental influence and staff experience. Ages of the patients and developmental considerations were very important in determining who might need sedation. Also previous experience would play a role if the child had had a bad experience during an earlier VCUG study. The other consideration was whether the sedation affected the ability of the VCUG to diagnose reflux. According to this meta-analysis there was no difference in VUR grading between the sedated groups and the non-sedated groups.

The study concluded that sedation reduces the stress of VCUG studies in children. Midazolam, which has an excellent safety profile, is the agent most studied and utilized. Continuous flow nitrous oxide also appears promising. Voiding cystourethrograms are distressing for children and parents. Non-pharmacological methods reduce distress. Pharmacological interventions for VCUG focus on sedation as well as analgesia, anxiolysis, and amnesia. Sedation has cost, time, and safety issues. Which agents and route should we use? Are we sure that sedation does not influence the ability to diagnose vesicoureteric reflux? Midazolam reduces the VCUG distress, causes amnesia, and does not appear to interfere with voiding dynamics. Midazolam combined with simple analgesia is an effective method to reduce distress to children undergoing VCUG.

Herd DW

Adv Urol. 2008:498614
10.1155/2008/498614

Written by UroToday.com Medical Editor Pasquale Casale, MD

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