Pediatric Radiology

, Volume 37, Issue 7, pp 678–684 | Cite as

Sedation with nitrous oxide compared with no sedation during catheterization for urologic imaging in children

  • Judith L. Zier
  • Kathryn A. Kvam
  • Stephen C. Kurachek
  • Marsha Finkelstein
Original Article

Abstract

Background

Various strategies to mitigate children’s distress during voiding cystourethrography (VCUG) have been described. Sedation with nitrous oxide is comparable to that with oral midazolam for VCUG, but a side-by-side comparison of nitrous oxide sedation and routine care is lacking.

Objective

The effects of sedation/analgesia using 70% nitrous oxide and routine care for VCUG and radionuclide cystography (RNC) were compared.

Materials and methods

A sample of 204 children 4–18 years of age scheduled for VCUG or RNC with sedation or routine care were enrolled in this prospective study. Nitrous oxide/oxygen (70%/30%) was administered during urethral catheterization to children in the sedated group. The outcomes recorded included observed distress using the Brief Behavioral Distress Score, self-reported pain, and time in department.

Results

The study included 204 patients (99 nonsedated, 105 sedated) with a median age of 6.3 years (range 4.0–15.2 years). Distress and pain scores were greater in nonsedated than in sedated patients (P < 0.001). Time in department was longer in the sedated group (90 min vs. 30 min); however, time from entry to catheterization in a non-imaging area accounted for most of the difference. There was no difference in radiologic imaging time.

Conclusion

Sedation with nitrous oxide is effective in reducing distress and pain during catheterization for VCUG or RNC in children.

Keywords

Voiding cystourethrography Radionuclide cystography Nitrous oxide Children 

References

  1. 1.
    Stashinko EE, Goldberger J (1998) Test or trauma? The voiding cystourethrogram experience of young children. Issues Compr Pediatr Nurs 21:85–96PubMedCrossRefGoogle Scholar
  2. 2.
    Phillips D, Watson AR, Collier J (1996) Distress and radiological investigations of the urinary tract in children. Eur J Pediatr 155:684–687PubMedCrossRefGoogle Scholar
  3. 3.
    Merritt KA, Ornstein PA, Spicker B (1994) Children’s memory for a salient medical procedure: implications for testimony. Pediatrics 94:17–23PubMedGoogle Scholar
  4. 4.
    Elder JS (2005) Imaging for vesicoureteral reflux – is there a better way? J Urol 174:7–8PubMedCrossRefGoogle Scholar
  5. 5.
    Akil I, Ozkol M, Ikizoglu OY et al (2005) Premedication during micturating cystourethrogram to achieve sedation and anxiolysis. Pediatr Nephrol 20:1106–1110PubMedCrossRefGoogle Scholar
  6. 6.
    Stokland E, Andréasson S, Jacobsson B et al (2003) Sedation with midazolam for voiding cystourethrography in children: a randomised double-blind study. Pediatr Radiol 33:247–249PubMedGoogle Scholar
  7. 7.
    Elder JS, Longenecker R (1995) Premedication with oral midazolam for voiding cystourethrography in children: safety and efficacy. AJR 164:1229–1232PubMedGoogle Scholar
  8. 8.
    Krauss B, Green SM (2000) Sedation and analgesia for procedures in children. N Engl J Med 342:938–945PubMedCrossRefGoogle Scholar
  9. 9.
    Jones RD, Visram AR, Kornberg JP et al (1994) Premedication with oral midazolam in children: an assessment of psychomotor function, anxiolysis, sedation and pharmacokinetics. Anaesth Intensive Care 22:539–544PubMedGoogle Scholar
  10. 10.
    Merguerian PA, Corbett ST, Cravero J (2006) Voiding ability using propofol sedation in children undergoing voiding cystourethrograms: a retrospective analysis. J Urol 176:299–302PubMedCrossRefGoogle Scholar
  11. 11.
    Zelikovsky N, Rodrigue JR, Gidycz CA et al (2000) Cognitive behavioral and behavioral interventions help young children cope during a voiding cystourethrogram. J Pediatr Psychol 25:535–543PubMedCrossRefGoogle Scholar
  12. 12.
    Phillips DA, Watson AR, MacKinlay D (1998) Distress and the micturating cystourethrogram: does preparation help? Acta Paediatr 87:175–179PubMedCrossRefGoogle Scholar
  13. 13.
    Salmon K, McGuigan F, Pereira JK (2006) Brief report: optimizing children’s memory and management of an invasive medical procedure: the influence of procedural narration and distraction. J Pediatr Psychol 31:522–527PubMedCrossRefGoogle Scholar
  14. 14.
    Butler LD, Symons BK, Henderson SL et al (2005) Hypnosis reduces distress and duration of an invasive medical procedure for children. Pediatrics 115:e77–e85PubMedGoogle Scholar
  15. 15.
    Webb MD, Moore PA (2002) Sedation for pediatric dental patients. Dent Clin North Am 46:803–814PubMedCrossRefGoogle Scholar
  16. 16.
    Michaud L, Gottrand F, Ganga-Zandzou PS et al (1999) Nitrous oxide sedation in pediatric patients undergoing gastrointestinal endoscopy. J Pediatr Gastroenterol Nutr 28:310–314PubMedCrossRefGoogle Scholar
  17. 17.
    Annequin D, Carbajal R, Chauvin P et al (2000) Fixed 50% nitrous oxide oxygen mixture for painful procedures: a French survey. Pediatrics 105:e47PubMedCrossRefGoogle Scholar
  18. 18.
    Luhmann JD, Kennedy RM, Porter FL et al (2001) A randomized clinical trial of continuous-flow nitrous oxide and midazolam for sedation of young children during laceration repair. Ann Emerg Med 37:20–27PubMedCrossRefGoogle Scholar
  19. 19.
    Burnweit C, Diana-Zerpa JA, Nahmad MH et al (2004) Nitrous oxide analgesia for minor pediatric surgical procedures: an effective alternative to conscious sedation? J Pediatr Surg 39:495–499PubMedCrossRefGoogle Scholar
  20. 20.
    Fauroux B, Onody P, Gall O et al (2004) The efficacy of premixed nitrous oxide and oxygen for fiberoptic bronchoscopy in pediatric patients: a randomized, double-blind, controlled study. Chest 125:315–321PubMedCrossRefGoogle Scholar
  21. 21.
    Fishman G, Botzer E, Marouani N et al (2005) Nitrous oxide-oxygen inhalation for outpatient otologic examination and minor procedures performed on the uncooperative child. Int J Pediatr Otorhinolaryngol 69:501–504PubMedCrossRefGoogle Scholar
  22. 22.
    Schmit P, Sfez M (1997) Management of anxious and painful manifestations in pediatric uroradiology. J Radiol 78:367–372PubMedGoogle Scholar
  23. 23.
    Keidan I, Zaslansky R, Weinberg M et al (2005) Sedation during voiding cystourethrography: comparison of the efficacy and safety of using oral midazolam and continuous flow nitrous oxide. J Urol 174:1598–1600PubMedCrossRefGoogle Scholar
  24. 24.
    Kanagasundaram SA, Lane LJ, Cavalletto BP et al (2001) Efficacy and safety of nitrous oxide in alleviating pain and anxiety during painful procedures. Arch Dis Child 84:492–495PubMedCrossRefGoogle Scholar
  25. 25.
    Frampton A, Browne GJ, Lam LT et al (2003) Nurse administered relative analgesia using high concentration nitrous oxide to facilitate minor procedures in children in an emergency department. Emerg Med J 20:410–413PubMedCrossRefGoogle Scholar
  26. 26.
    American Academy of Pediatrics Committee on Drugs (1992) Guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures. Pediatrics 89:1110–1115Google Scholar
  27. 27.
    Tucker CL, Slifer KJ, Dahlquist LM (2001) Reliability and validity of the brief behavioral distress scale: a measure of children’s distress during invasive medical procedures. J Pediatr Psychol 26:513–523PubMedCrossRefGoogle Scholar
  28. 28.
    Wong DL, Baker CM (1988) Pain in children: comparison of assessment scales. Pediatr Nurs 14:9–17PubMedGoogle Scholar
  29. 29.
    Houpt MI, Limb R, Livingston RL (2004) Clinical effects of nitrous oxide conscious sedation in children. Pediatr Dent 26:29–36PubMedGoogle Scholar
  30. 30.
    Gall O, Annequin D, Benoit G et al (2001) Adverse events of premixed nitrous oxide and oxygen for procedural sedation in children. Lancet 358:1514–1515PubMedCrossRefGoogle Scholar
  31. 31.
    Wilson S (2000) Pharmacologic behavior management for pediatric dental treatment. Pediatr Clin North Am 47:1159–1175PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Judith L. Zier
    • 1
    • 4
  • Kathryn A. Kvam
    • 2
  • Stephen C. Kurachek
    • 1
  • Marsha Finkelstein
    • 3
  1. 1.Pediatric Critical CareChildren’s Hospitals and Clinics of MinnesotaMinneapolisUSA
  2. 2.University of Michigan Medical SchoolAnn ArborUSA
  3. 3.Center for Care Innovation and ResearchChildren’s Hospitals and Clinics of MinnesotaMinneapolisUSA
  4. 4.Children’s Respiratory and Critical Care SpecialistsMinneapolisUSA

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