PREMEDICATION WITH ORAL MIDAZOLAM FOR VOIDING CYSTOURETHROGRAPHY IN CHILDREN - SAFETY AND EFFICACY

OBJECTIVE. Midazolam is a relatively short-acting water-soluble benzod iazepine that provides anxiolysis and anterograde amnesia and can be g iven orally with few adverse effects. We evaluated the benefit and saf ety of oral midazolam for sedation of young children during voiding cy stourethrography or nuclear cystography. SUBJECTS AND METHODS. For 3.5 years, a highly selected group of 98 children, ages 23 months to 9 ye ars (mean, 4 years), were given oral midazolam 0.6 mg/kg 20-30 min bef ore cystourethrography or nuclear cystography These children either ha d been frightened by a previous catheterization (39%) or seemed partic ularly frightened during an examination of their genitals in the offic e (61%). A control group of 25 children, similar in age to the study g roup, did not receive midazolam before cystourethrography. Parents wer e interviewed to assess their child's recollection of the procedure. V oiding 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 ox ygen saturation was observed in any child. In the control group, 24 (9 8%) of 25 children remembered the cystographic examination (p < .01). Behavioral side effects occurred in 12% of the children receiving mida zolam and consisted primarily of combative behavior as the medication was wearing off. Ninety-five percent of the parents indicated that the y would want their child to have midazolam again if the cystography ne eded to be repeated. Of the children receiving midazolam, 76% had litt le or no residual urine after voiding, compared with 72% of the contro l group (no significant difference). CONCLUSION. In children who have been or are likely to be excessively frightened during cystourethrogra phy or nuclear cystography, midazolam usually provides satisfactory am nesia and anxiolysis with few side effects or adverse impact on voidin g dynamics.