• Judith L Zier, Kathryn A Kvam, Stephen C Kurachek, and Marsha Finkelstein.
• Pediatric Critical Care, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA. judy.zier@childrensmn.org
• Pediatr Radiol. 2007 Jul 1;37(7):678-84.

BackgroundVarious 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.ObjectiveThe effects of sedation/analgesia using 70% nitrous oxide and routine care for VCUG and radionuclide cystography (RNC) were compared.Materials And MethodsA 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.ResultsThe 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.ConclusionSedation with nitrous oxide is effective in reducing distress and pain during catheterization for VCUG or RNC in children.

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