Sedation for VCUG? - Mothering Forums

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#1 of 7 Old 03-05-2007, 04:06 PM - Thread Starter
 
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Hi. I've been reading archived posts about VCUGs but can't find anything about sedation. Has anyone used sedation for their child's VCUG? Any recommendations on whether to do it or not?

DD (26 mos) is scheduled in 2 wks for her 2nd vcug. First was at 7 months and unsedated. It was a miserable experience for everyone. We now have the option of using versed - which will cause her to have no memory of the event. It's serious enough of a drug that it has to be adminstered by a nurse anesthetist - we're doing the procedure in a hospital, so if there are any side effects, doctors will be close by.

I don't know whether the trauma of experiencing the actual procedure unsedated, or the experience of being sedated, will be worse for her. I'm trying to do the best thing for her and just don't know which way to go! I'm just doing this darn procedure so hopefully we can get off the prophylatic antibiotics. (And if we can't, we're going to start the probiotics that I've learned alot about from you all).

Thanks!
Bridget
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#2 of 7 Old 03-05-2007, 06:48 PM
 
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My dd has had one done every year (she's 4) and we've never sedated her and I don't think I would. The nurses are really great with her, and once the cath is in the worst part is over and she calms down and watches the 'pictures' of the ink inside her. No, its not fun, but I don't really see using a sedative as being necessary for us. I can understand why you'd want to, of course, and only you know your child well enough to say how she will react to the procedure and how best you can comfort her through it.
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#3 of 7 Old 07-16-2008, 01:53 PM
 
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DS is going in for his 3rd VCUG.

1st was done in Sept 07 (close to 2nd B-day) and showed stage 2 reflux in both kidneys (no sedation). This one went ok, a little discomfort, but the most part he was calm.


2nd on valentines day 08 age 2 1/2 (no sedation). It was brutal for the both of us! WE had potty training well on its way (staying dry all day) and along came this test again. I had to forcefully hold him down while the nurses worked. The whole time he cried "mommy help me!". I have never been so heartbroken in my life! The results came in a little better this time, no sign of reflux on left, still stage 2 on the right. Not to mention it took over an hour when teh first only took 30 min. DS refused to void his bladder. He is only 2 and refused to go on command!

So I called and scheduled the 3rd set for a couple weeks from now. Requested the Dr do something to help ease his distress as we are getting on track again with potty training (he is still hesitant any time his pants are off...) I requested sedation. The nurse just called back and said "we have the test scheduled", so I asked about the sedation and she said "I am asking the Dr about that still I will get back to you".

I know there are some slight risks to sedation, but I can't bear to put DS through this again! Its done at the best childrens hospital around, so I am sure they are equipped to handle the sedation. Has anyone else gone through the sedation for this procedure?
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#4 of 7 Old 07-16-2008, 02:05 PM
 
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Stage II reflux is minor. I personally wouldn't do the test. Please see these following studies discussing the issues surrounding current medical treatment of VURs.

This study indicates: Continuous antibiotic prophylaxis was ineffective in reducing the rate of pyelonephritis recurrence and the incidence of renal damage in children who were younger than 30 months and had vesicoureteral reflux grades II through IV.
Published online May 19, 2008
http://pediatrics.aappublications.or...ds.2007-2652v1

This study indicates: Probiotics prophylaxis was as effective as antibiotic prophylaxis in children with persistent primary VUR. Even after stratification by VUR grade, age, gender, phimosis, voiding dysfunction and renal scar, the incidence of recurrent UTI did not differ significantly between the two groups.
Published online: 26 May 2007
http://www.springerlink.com/content/1741p5k22284x265/


Here is a comprehensive article regarding the research studies and the debate regarding prophylaxis and VUR: http://www.pubmedcentral.nih.gov/art...?artid=2441852

Here is another invasive medical alternative which has high success at resolving VUR. It appears to be a new alternative to consider: http://blue.regence.com/trgmedpol/surgery/sur133.html

The Cochran Report is a systematic review of the quality of medical research studies. It provides a "conclusion" upon which medical professionals alter their practices. This link indicates: A recent Cochrane Review of the effectiveness of long-term antibiotics for preventing UTI concluded that most published studies to date have been poorly designed, with biases known to overestimate the true treatment effect(23). In yet another systematic analysis, the authors questioned the value of identification of VUR after a symptomatic UTI, and the effects of various interventions on the occurrence of UTI and subsequent renal parenchymal damage. The study concluded that it is uncertain whether the identification and treatment of children with VUR confers clinically important benefit and intervention, including antibiotic prophylaxis or surgery for VUR, is better than no treatment(24).
Published 2006http://www.indianpediatrics.net/feb2006/feb-111-115.htm

Efficacy of Antibiotic Prophylaxis in Children With VUR in Preventing Pyelonephritis In Pediatrics, the official journey for AAP
CONCLUSIONS:
Continuous antibiotic prophylaxis is not effective in reducing the rate of infection and the incidence of renal damage and its progression, which seems to be associated with the presence of VUR and its grade. Early and correct diagnosis and prompt treatment of episodes remain the pillars of correct case management of pyelonephritis and should be emphasized in practice guidelines.
13 June 2008
http://pediatrics.aappublications.or...rs/121/6/e1489

ETA: Spontaneous resolution of VUR occurs naturally in the majority of children, especially children given an VUR dx quite young: http://www.springerlink.com/content/u8n1771377g08l5v/
http://cat.inist.fr/?aModele=afficheN&cpsidt=17566870
http://www.news-medical.net/?id=16452

This is the most comprehensive study of the studies that I found. http://www.uptodate.com/home/content...pedineph/14681
Jan. 2008.




HTH, Pat

I have a blog.
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#5 of 7 Old 07-16-2008, 02:48 PM
 
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My DD had her third VCUG back in June. Since the first two (3 months and 13 months) were traumatic (she kicked and screamed with me holding her arms down and others holding her legs) for both of us. This time we went with the recommendation of the doctor and had the sedation. A week before the procedure I received a call from the hospital to confirm and I started to really worry. In addition to the side effect worries, I was also concerned about not feeding her during the time leading up to the procedure (6+ hrs). They told me we could decide that morning if I wanted. We ended up doing the sedation.

Overall, it turned out ok. We did a bit of roll-play up to the day of the procedure. We practiced drinking "medicine" and then she practiced putting her legs in the frog position. I waved a big shoe box over her to simulate the x-ray machine. The hospital had a good pdf of the procedure and room that they go to, designed mainly for an older child to understand.

At the hospital, she took the anesthesia from a dropper not a cup. It took about 10 minutes (which seemed like much longer) and then we went into the exam room. She couldn't talk clearly by that time and she needed me to carry her. She could sit up propped up but preferred to lay down. We entertained her with psychedelic toys as she was quite loopy. They filled her up and at that point she was very uncomfortable. What kind of potty-trained child likes to be horizontal to pee (they did have a small bedpan for her to slide onto)? She kicked and squirmed and voided about 3/4 of what was in her. Fortunately that was enough to see that there wasn't a problem. The sent us to recover and she ended up peeing all over me. She was groggy for about another 20 minutes. Then she was famished.

The anesthesia was helpful for the reason you mentioned before, she cannot remember anything about the procedure. It didn't help her from fighting us holding her down, which I thought it would. I don't think I would have done it if I was not with her the whole time.

I hope that helps. Good luck.
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#6 of 7 Old 09-01-2008, 12:04 PM
 
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wuwei thanks for the fantastic references and thank you all for these great posts! you have helped us enormously!
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#7 of 7 Old 09-02-2008, 10:28 AM
 
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We used sedation the first time and it was so great to know she wouldn't remember the procedure. She still felt the process, but didn't remember. We go for another VCUG in November with no sedation. DD is 3 and has a bladder diverticulum. The reasoning for no sedation this time is that 1) the doctor's we see now do this every day and do it quickly. 2) The body/organs act differently when child is sedated and the specialist wants to see how the bladder is working normally. I am not excited about this upcoming visit in November. DD is going to FREAK OUT!!!
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