Intranasal midazolam as a sedative for children during laceration repair

Yealy, Donald M.; Ellis, James H.; Hobbs, Gregory D.; Moscati, Ronald

doi:10.1016/0735-6757(92)90190-9

Cited by 49 publications

(34 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our results are consistent with those of Yearly et al [13], who studied intranasal midazolam for laceration repair. They found that 27% [confidence limits (CL) 6-60%] of children receiving 0.2 mg/kg midazolam had adequate sedation as compared with 80% (CL 52-95%) in the 0.3 mg/kg group at the end of 12 ± 4 min.…”

Section: Discussionsupporting

confidence: 95%

Atomised intranasal midazolam spray as premedication in pediatric patients: comparison between two doses of 0.2 and 0.3 mg/kg

Baldwa¹,

Padvi

Dave

et al. 2012

J Anesth

View full text Add to dashboard Cite

show abstract

Section: Discussionsupporting

confidence: 95%

Atomised intranasal midazolam spray as premedication in pediatric patients: comparison between two doses of 0.2 and 0.3 mg/kg

Baldwa¹,

Padvi

Dave

et al. 2012

J Anesth

View full text Add to dashboard Cite

show abstract

“…1-3 Intranasal administration delivers the sedative to both the highly vascularized nasal mucosa, and the olfactory tissue that is in direct contact with the central nervous system (termed the “nose-brain pathway”), thereby bypassing first-pass metabolism. 1,4 Although there are commercial products designed specifically for IN drug delivery, it is common practice in emergency departments (ED) to use parenteral formulations of a sedative for IN administration.…”

Section: Introductionmentioning

confidence: 99%

“…1,4 Although there are commercial products designed specifically for IN drug delivery, it is common practice in emergency departments (ED) to use parenteral formulations of a sedative for IN administration. 1-3,5-7 However, commonly available concentrations of these sedatives often necessitate large total volumes in order to deliver the required weight-based dose in children. In the clinical setting, this total volume is often divided into smaller aliquots, or volumes of administration (VOA), that are administered repeatedly by alternating between both nostrils, until the total volume is delivered.…”

Section: Introductionmentioning

confidence: 99%

Optimal Volume of Administration of Intranasal Midazolam in Children: A Randomized Clinical Trial

Tsze

Ieni

Fenster

et al. 2017

Annals of Emergency Medicine

View full text Add to dashboard Cite

Objectives The optimal intranasal volume of administration (VOA) for achieving timely and effective sedation in children is unclear. We aimed to compare clinical outcomes relevant to procedural sedation associated with using escalating VOA to administer intranasal midazolam. Methods We conducted a randomized, single-blinded, three-arm, superiority clinical trial. Children 1 to 7 years old undergoing laceration repair requiring 0.5 mg/kg intranasal midazolam (5 mg/mL) were block-randomized to receive midazolam using one of three VOA: 0.2mL, 0.5mL, or 1mL. Procedures were videotaped, with outcome assessors blinded to VOA. Primary outcome was time to onset of minimal sedation (i.e. score of 1 on the University of Michigan Sedation Scale). Secondary outcomes included procedural distress; time to procedure start; deepest level of sedation achieved; adverse events; and clinician and caregiver satisfaction. Results Ninety-nine children were enrolled; 96 were analyzed for the primary outcome and secondary outcomes, except for the outcome of procedural distress, for which only 90 were analyzed. Time to onset of minimal sedation for each escalating VOA was 4.7 (95% CI 3.8, 5.4), 4.3 (95% CI 3.9, 4.9) and 5.2 (95% CI 4.6, 7) minutes, respectively. There were no differences in secondary outcomes except for clinician satisfaction with ease of administration: fewer clinicians were satisfied when using a VOA of 0.2mL. Conclusions There was a slightly shorter time to onset of minimal sedation when using a VOA of 0.5mL compared to 1mL, but all three VOA produced comparable clinical outcomes. Fewer clinicians were satisfied with ease of administration using a VOA of 0.2mL.

show abstract

“…Transmucosal routes of drug administration have been used as premedicants in this age group [6,7]. Intranasal midazolam has been found to be effective in doses ranging from 0.2 to 0.6 mg.kg )1 when used for conscious sedation and as a premedicant [8][9][10]. This technique has advantages when compared with oral administration as the bioavailability of intranasally administered midazolam is approximately 55%, compared with 15% when administered orally [11,12].…”

mentioning

confidence: 99%

The use of intranasal midazolam in the treatment of paediatric dental patients*

Gilchrist¹,

Cairns²,

Leitch³

2007

Anaesthesia

View full text Add to dashboard Cite

SummaryThe aim of this study was to assess the use of intranasal midazolam in paediatric dental patients requiring extractions or simple surgical procedures who may otherwise have required a general anaesthetic. Twenty children aged between 2–9 years who required simple surgical procedures were given 0.25 mg.kg−1 midazolam, administered using a MAD® (Mucosal Atomization Device; Wolfe Tory Medical Inc., Salt Lake City, UT, USA). Compliance with the full dose was achieved in 14 patients, 13 of whom completed the treatment. One of two patients who allowed only partial administration completed the treatment and three patients did not comply. The mean time to starting treatment was 13 min (range 6–25 min) and patients were discharged after a mean of 46 min (range 25–67 min). Physiological parameters remained stable throughout with no clinically significant episodes of desaturation. One patient vomited at home postoperatively. Midazolam in a dose of 0.25 mg.kg−1 administered intranasally provided adequate anxiolysis for the majority of children, allowing them to complete their treatment.

show abstract

Intranasal midazolam as a sedative for children during laceration repair

Cited by 49 publications

References 29 publications

Atomised intranasal midazolam spray as premedication in pediatric patients: comparison between two doses of 0.2 and 0.3 mg/kg

Atomised intranasal midazolam spray as premedication in pediatric patients: comparison between two doses of 0.2 and 0.3 mg/kg

Optimal Volume of Administration of Intranasal Midazolam in Children: A Randomized Clinical Trial

The use of intranasal midazolam in the treatment of paediatric dental patients*

Contact Info

Product

Resources

About