Evaluating Clinical Effectiveness and Pharmacokinetic Profile of Atomized Intranasal Midazolam in Children Undergoing Laceration Repair

Mellion, Sarah A.; Bourne, David W. A.; Brou, Lina; Brent, Alison; Adelgais, Kathleen; Galinkin, Jeffrey L.; Wathen, Joseph

doi:10.1016/j.jemermed.2017.05.029

Cited by 13 publications

(13 citation statements)

References 28 publications

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“…Vomiting, agitation, hypoxia, and apnea are common adverse effects of sedation with midazolam that were reported in some studies with different rates. [ 31 32 ] Our results showed that lower than one-quarter of the patients suffered from adverse effects, which was similar between the two groups. This finding is consistent with the results of the study conducted by Klein et al .…”

Section: Discussionsupporting

confidence: 68%

Intranasal midazolam sedation as an effective sedation route in pediatric patients for radiologic imaging in the emergency ward: A single-blind randomized trial

Mayel¹,

Nejad

Khabaz

et al. 2020

Turk J Emerg Med

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OBJECTIVES: Prevention and reduction of pain, anxiety, and fear during medical procedures is one of the most important factors that should be considered in pediatric emergencies. The aim of this study was to compare the efficacy of oral versus intranasal midazolam in sedation during radiologic imaging in the largest province of Iran, Kerman. MATERIALS AND METHODS: Eighty children were enrolled in this single-blind clinical trial based on convenience sampling and were divided into two groups receiving 0.5 mg/kg midazolam in oral route administration and 0.2 mg/kg midazolam in intranasal route administration. Finally, 75 patients remained for evaluating medication acceptability, sedation level, onset time of sedation, additional sedative dose, adverse effects of sedation, and provider satisfaction. RESULTS: Children in the intranasal group accepted medication more easily (89.8% vs. 36.9%; P ≤ 0.001), while these children received a lower sedation dose, but the sedation level in both methods was similar ( P = 0.72). Our findings showed that children in the intranasal sedation group had a faster onset of sedation compared to the oral group (17.94 ± 8.99 vs. 34.50 ± 11.45; P ≤ 0.001). The frequency of midazolam side effects had no difference between the groups (29.7% vs. 15.8%; P = 0.15). CONCLUSION: Intranasal midazolam with a lower sedation dose induces a faster onset and better acceptance. Intranasal midazolam can be used as an effective sedative method for pediatric patients, especially in emergency wards.

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Section: Discussionsupporting

confidence: 68%

Intranasal midazolam sedation as an effective sedation route in pediatric patients for radiologic imaging in the emergency ward: A single-blind randomized trial

Mayel¹,

Nejad

Khabaz

et al. 2020

Turk J Emerg Med

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“…Also, patients receiving procedural sedation usually have a longer LOS and higher costs [18]. For safe and effective anxiolysis during laceration repair, intranasal midazolam can be used [19] in addition to the topical anesthetic which provides analgesia.…”

Section: Discussionmentioning

confidence: 99%

Applying Topical Anesthetic on Pediatric Lacerations in the Emergency Department: A Quality Improvement Project

Sawaya

Faris

Mrad

et al. 2021

Preprint

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Background Caring for pediatric lacerations in the Emergency Department (ED) is typically painful because of irrigation and suturing. To improve this painful experience, we aimed to increase the use of a topical anesthetic, Eutectic Mixture of Local Anesthetics (EMLA) on eligible pediatric lacerations with an attainable, sustainable, and measurable goal of 60%. Local Problem The baseline rate of applying topical anesthetic to eligible lacerations was 23% in our ED. We aimed to increase the use of topical anesthetics on eligible pediatric lacerations to a measurable goal of 60% within 3 months of implementing our intervention. Methods We conducted a prospective, single center, interrupted time series, ED quality improvement project from November 2019 to July 2020. A multidisciplinary team of physicians and nurses performed a cause-and-effect analysis identifying two key drivers: early placement of EMLA and physician buy-in on which we built our Plan, Do, Study, and Act (PDSA) cycles. We collected data on number of eligible patients receiving EMLA, as well as patient and physician feedback via phone calls within 2 days post encounter. Balancing measures included ED length of stay (LOS), patient and physician satisfaction with EMLA, and side effects of EMLA. Results We needed 3 PDSA cycles to reach our goal of 60% in 3 months, which was also maintained for 5 months. PDSA cycles used educational interventions, direct provider feedback about non-compliance and patient satisfaction results obtained via phone calls. Balancing measures were minimally impacted: 75% good patient satisfaction, No adverse events but an increase in LOS of patients who received EMLA compared to those who did not (1.79 +/- 0.66 VS 1.41 +/- 0.83 hours, p<0.001). The main reasons for dissatisfaction for physicians were the increased LOS and the preference for procedural sedation or intranasal medications. Conclusion With a few simple interventions, our aim of applying EMLA to 60% of eligible pediatric lacerations was attained and maintained.

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“…3,[7][8][9][10][11] Other intranasal benzodiazepines such as midazolam have been shown to produce similarly rapid onset of sedation and time to peak serum concentrations. 4,12 However, we chose to administer lorazepam instead of midazolam to treat our patient's severe agitation because of lorazepam's longer duration of action.…”

Section: Discussionmentioning

confidence: 99%

Intranasal Lorazepam for Treatment of Severe Agitation in a Pediatric Behavioral Health Patient in the Emergency Department

Bregstein

Wagh

Tsze

2020

Annals of Emergency Medicine

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The treatment of severe agitation, aggression, and violent behavior in behavioral health patients who present to the emergency department (ED) often requires the intramuscular administration of a sedative. However, administering an intramuscular sedative to an uncooperative patient is associated with the risk of needlestick injuries to both patients and health care providers, and times to onset of sedation range from 15 to 45 minutes. Intranasal absorption is more rapid than intramuscular, with sedatives such as lorazepam reaching peak serum concentrations up to 6 times faster when administered intranasally. We present the first report of using intranasal lorazepam as a needle-free method of providing rapid and effective sedation to treat severe agitation in a pediatric behavioral health patient presenting to the ED.

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Evaluating Clinical Effectiveness and Pharmacokinetic Profile of Atomized Intranasal Midazolam in Children Undergoing Laceration Repair

Cited by 13 publications

References 28 publications

Intranasal midazolam sedation as an effective sedation route in pediatric patients for radiologic imaging in the emergency ward: A single-blind randomized trial

Intranasal midazolam sedation as an effective sedation route in pediatric patients for radiologic imaging in the emergency ward: A single-blind randomized trial

Applying Topical Anesthetic on Pediatric Lacerations in the Emergency Department: A Quality Improvement Project

Intranasal Lorazepam for Treatment of Severe Agitation in a Pediatric Behavioral Health Patient in the Emergency Department

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