Evaluation of the effects of sedation administered via three different routes on the procedure, child and parent satisfaction during cystometry

Abstract

PurposeIn this study, we retrospectively investigated case reports with and without midazolam administration via oral, intranasal and rectal before cystometry procedure. We aimed to compare the data to evaluate the effects of sedation before cystometry on the pediatric patients and parents’ satisfaction.MethodsA total of 124 ASA I-II pediatric cases aged 5–14 years were retrospectively investigated from the hospital records. One of the three administration routes was chosen; oral midazolam at a dose of 0.5 mg/kg and nasal or rectal midazolam at a dose of 0.3 mg/kg (maximum 15 mg). Heart rate, blood pressure, oxygen saturation, the Wisconsin Hospital of Children Sedation Scale (CHWSS) score and the Groningen Distress Rating Scale (GDRS) score were recorded. Cystometry measurement values, diagnoses of the cases and procedure durations were recorded from the urodynamic laboratory records.Results80 female, 44 male cases were evaluated. The CHWSS score at the 10th and 20th minutes after the drug administeration was higher in the oral group than the others (p = 0.001). The duration between the administration of the drug and the start of the procedure was shorter in the nasal group (p = 0.01). Parents satisfaction for sedation was 77 % when comparison of the cystometry with and without sedation. Comparison of the cystometry results with or without sedation no significant difference was found between all parameters (p > 0.01).ConclusionWe believe that sedation with midazolam administered through all three routes is a safe, effective and convenient option during cystometry, especially in the young age group.

Effects of Rectal Midazolam Sedation on Cystometric Parameters in Children

“…Midazolam is a benzodiazepine with a rapid effect of short duration and enables quick recovery. It provides great flexibility in terms of drug administration options, especially in pediatric cases, since it can be administered via various routes such as oral, intranasal, sublingual, rectal, intramuscular and intravenous (7). Its nasal or oral use can be difficult in children due to the nasal irritation it causes and the unpleasant taste leading to spitting the drug out.…”

“…It is therefore sometimes not possible to perform a cystometric urodynamic study in these patients. Methods such as having the parents present, the use of lidocaine gel during catheterization, distraction techniques, warm infusion fluids and hypnosis have been recommended because they decrease the pain and anxiety that occur due to the catheterization during the procedure (7,(10)(11)(12)(13). However, some children continue to show serious stress despite these methods and sedation becomes inevitable in such cases.…”

“…It is a valuable drug as it enables the patient to stay awake and cooperate for cystometry, has a rapid onset of action and short duration of effect without any serious side effects, causes partial anterograde amnesia, can be administered easily, and can be administered effectively through the intramuscular, intravenous, intranasal, rectal, oral or sublingual routes (2,3,(5)(6)(7) . Its nasal or oral use can be difficult in children due to the nasal irritation it causes and the unpleasant taste leading to spitting the drug out.…”

Effects of parental holding on pain response in young children during cystometry: A randomized controlled trial

“…Therefore, this method should be selected carefully. 1,8,9 Additionally, applying lidocaine gel to reduce pain during urethral catheter insertion did not significantly reduce pain compared with applying a general lubricant. 10 Therefore, medical staff should consider nonpharmacological management, as well as pharmacological management, to reduce procedural pain in children.…”

“…These drugs may affect lower urinary tract function and have side effects of medications. Therefore, this method should be selected carefully 1,8,9 . Additionally, applying lidocaine gel to reduce pain during urethral catheter insertion did not significantly reduce pain compared with applying a general lubricant 10 .…”