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Premedication with oral midazolam for voiding cystourethrography in children: safety and efficacy
1Division of Pediatric Urology, Rainbow Babies and Childrens Hospital, Cleveland, OH 44106, USA.
Insights
Oral midazolam effectively reduces anxiety and memory of procedures in young children undergoing cystography. This safe sedation option for pediatric imaging significantly improves the child
Area of Science:
- Pediatric Sedation
- Radiology
- Pharmacology
Background:
- Oral midazolam is a water-soluble benzodiazepine known for anxiolysis and amnesia.
- It can be administered orally with a favorable safety profile in children.
- Pediatric cystography often causes significant fear and distress.
Purpose of the Study:
- To evaluate the efficacy and safety of oral midazolam for sedating young children during voiding cystourethrography (VCUG) or nuclear cystography.
- To assess the impact of midazolam on children's recollection and experience of the procedure.
Main Methods:
- A cohort of 98 children (ages 23 months to 9 years) received oral midazolam (0.6 mg/kg) before cystography.
- Children were selected due to prior catheterization fear or apparent distress.
- A control group of 25 children did not receive midazolam; parental interviews and voiding dynamics were assessed.
Main Results:
- 60% of midazolam-treated children had no recollection of the procedure; 31% recalled it without negative experience.
- No significant changes in vital signs or oxygen saturation were observed.
- Behavioral side effects (combative behavior) occurred in 12% as medication wore off; 95% of parents would use it again.
Conclusions:
- Oral midazolam provides effective amnesia and anxiolysis in frightened children undergoing cystography.
- The medication is associated with few adverse effects and does not negatively impact voiding dynamics.
- Midazolam is a beneficial option for managing pediatric anxiety during these imaging procedures.
Objective:
Midazolam is a relatively short-acting water-soluble benzodiazepine that provides anxiolysis and anterograde amnesia and can be given orally with few adverse effects. We evaluated the benefit and safety of oral midazolam for sedation of young children during voiding cystourethrography or nuclear cystography.
Subjects And Methods:
For 3.5 years, a highly selected group of 98 children, ages 23 months to 9 years (mean, 4 years), were given oral midazolam 0.6 mg/kg 20-30 min before cystourethrography or nuclear cystography. These children either had been frightened by a previous catheterization (39%) or seemed particularly frightened during an examination of their genitals in the office (61%). A control group of 25 children, similar in age to the study group, did not receive midazolam before cystourethrography. Parents were interviewed to assess their child's recollection of the procedure. Voiding dynamics were assessed by evaluating the postvoiding radiograph.
Results:
Of the midazolam-treated patients, 60% had no recollection of the study, and 31% remembered part or all of the study but did not have a negative experience. No significant change in vital signs or oxygen saturation was observed in any child. In the control group, 24 (96%) of 25 children remembered the cystographic examination (p < .01). Behavioral side effects occurred in 12% of the children receiving midazolam and consisted primarily of combative behavior as the medication was wearing off. Ninety-five percent of the parents indicated that they would want their child to have midazolam again if the cystography needed to be repeated. Of the children receiving midazolam, 76% had little or no residual urine after voiding, compared with 72% of the control group (no significant difference).
Conclusion:
In children who have been or are likely to be excessively frightened during cystourethrography or nuclear cystography, midazolam usually provides satisfactory amnesia and anxiolysis with few side effects or adverse impact on voiding dynamics.