Intranasal Fentanyl and Midazolam for Procedural Analgesia and Anxiolysis in Pediatric Urgent Care Centers

Abstract

Objectives Intranasal fentanyl and midazolam use is increasing in the acute care setting for analgesia and anxiolysis, but there is a lack of literature demonstrating their use, alone or in combination, at pediatric urgent care centers. Methods This retrospective study investigated intranasal fentanyl and midazolam use at an urgent care center located within Le Bonheur Children's Hospital and 2 affiliated off-site centers from September 22, 2011, to December 30, 2015. Data collected included patient demographics, initial fentanyl dose, initial midazolam dose, type of procedure, and serious adverse drug reactions. Results Of the 490 patients who met the inclusion criteria, 143 patients received intranasal fentanyl alone, 92 received intranasal midazolam alone, and 255 received fentanyl in combination with midazolam. The overall patient population was 50% male with a median (range) age of 4.5 (0.2–17.9) years, and most patients were black at 57.1%. The median (range) initial intranasal fentanyl dose was 2.02 (0.99–4.22) μg/kg, and the median initial (range) intranasal midazolam dose was 0.19 (0.07–0.42) mg/kg. In cases where fentanyl and midazolam were administered in combination, the median (range) initial fentanyl dose was 2.23 (0.6–4.98) μg/kg and median (range) initial midazolam dose was 0.2 (0.03–0.45) mg/kg. There were no serious adverse drug reactions reported. Conclusions Intranasal fentanyl and midazolam when administrated alone and in combination can provide analgesia and anxiolysis for minor procedures in pediatric patients treated in the urgent care setting.

Evaluation of Intranasal Midazolam for Pediatric Sedation during the Suturing of Traumatic Lacerations: A Systematic Review

“…The nasal burning produced by midazolam is mild and lasts only a few seconds [1], but is continuous if the drug is administered via nasal drops. When drops are used, more time is required for administration, and a portion of the dose may drain into the oropharynx and be absorbed enterally [6,32].…”

“…To determine the necessary dose of a nasal spray, the 0.1 mL dead space of the device must be taken into account [10,14]. According to various studies, the ideal intranasal volume is 0.2 to 0.5 mL per nostril, with a maximum recommended volume of 1 mL per nostril [2,13,14,32].…”