RSNA 2008 – McCormick Place, Chicago, IL

Wed Dec 03 2008 3:20PM - 3:30PM ROOM N230

Anxiolysis with Oral Midazolam for Pediatric Voiding Cystourethrography (VCUG): Experience at a Community Hospital

 C L Kalbhen, MD, FACR, Arlington Heights, IL; L Criscione, RT; J Barry, RN; P Jacobson, RN

PURPOSE

To evaluate a community hospital VCUG anxiolysis program, with specific regard to examination quality, family satisfaction and patient safety.

METHOD AND MATERIALS

We evaluated the first 245 consecutive pediatric outpatients (184 girls, 61 boys) referred for VCUG at a 400 bed community hospital following implementation of a dedicated anxiolysis protocol. All families received an anonymous satisfaction survey to be completed following the examination. The parents of the 151 children (132 girls, 19 boys) aged 1 year and older (mean, 4.8 years) were given the option of having their children receive PO midazolam (0.5 mg/kg) prior to VCUG. Examination indications in these 151 children were urinary tract infection (n= 111), follow-up known vesicoureteral reflux [VUR] (n=28), hydronephrosis (n=5), enuresis (n=4), hematuria (n=2) and sibling history of VUR (n=1). In addition to evaluating for VUR, the ability of the children to void on the fluoroscopy table and the degree of bladder emptying were assessed. The children were monitored, with any and all adverse events (eg, the need for supplemental oxygen) to be documented. 

RESULTS

116 (76.8%) of the children aged 1 year and older received anxiolysis (Group A), and 35 (23.2%) did not (Group B). For the Group A patients, VUR was identified in 42 (36.2%), voiding images could not be obtained in 17 (14.7%) and a measurable post-void urinary bladder residual was present in 13 (22.8%). For the Group B patients, the corresponding data were 2 (5.7%), 6 (17.1%) and 8 (50%), respectively. No adverse events were observed. 95 family surveys were completed and returned (response rate, 38.8%), with the VCUG experience rated as very good in 89 (93.7%), good in 4 (4.2%), fair in 2 (2.1%), poor in 0 (0%) and very poor in 0 (0%).

CONCLUSION

The majority of parents wish to provide anxiolysis to their children when VCUG is performed, and the families' experiences with our particular program were overwhelmingly positive. Anxiolysis did not hinder making the diagnosis of VUR, and the children who received midazolam were no less likely to void on the fluoroscopy table or completely empty their bladders than those who did not. Most importantly, no adverse events occurred.

CLINICAL RELEVANCE/APPLICATION

VCUG is often a stressful examination for pediatric patients and their families. The use of anxiolysis remains controversial, but it has the ability to minimize the unpleasantness of the experience.