Aim:

Catheter placement to allow video-urodynamics (VUD) to be performed can be uncomfortable and embarrassing for young people. Traditionally at our unit children requiring urethral and rectal catheter insertion for VUD were offered catheter insertion under a General anaesthetic (GA) if they had not previously catheterised at home. We describe our experience of the use of Entonox for catheter placement.

Methods:

All children over the age of 4 years requiring urethral catheterisation for VUD who were felt to be able to cooperate with Entonox inhalation and had not previously catheterised were offered Entonox for catheter insertion. We have reviewed the success of catheter placement, side effects of Entonox, analysed patient experience of this change in practice and reviewed waiting times for VUD.

Results:

310 VUD studies were performed between January 2012 and June 2013. 59 (19%) had urethral and rectal catheters inserted under Entonox. Ages 4–16 years (median 11 years) and 76% female. Catheters were successfully placed with Entonox in 90% of cases. The 6 unsuccessful attempts, 3 required GA catheter placement (mean age 6 years) and 3 without sedation. 2 patients could not tolerate Entonox, 1 refused and 2 patients experienced dizziness, no nausea or vomiting reported. 23 patients were assessed using a visual analogue score (1–10), median score of expected discomfort 6.5/10 compared with actual discomfort score of 2.9/10. 9% found catheter placement worse than they expected. Prior to change in practice our average wait for VUD was 148 days and following the introduction of Entonox the wait had reduced by 64%.

Conclusions:

Entonox is an alternative to GA in the placement of urethral catheters for video-urodynamics and is generally well tolerated. Use of Entonox has avoided the need for pre-admission clinic attendance, administration of general anaesthetic and has reduced waiting times. The availability of Entonox in the hospital setting makes it an attractive option for use during urethral catheter placement at other times.

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Abstract

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