Intranasal lidocaine and midazolam for procedural sedation in children

Chiaretti, Antonio; Barone, Giuseppe; Rigante, Donato; Ruggiero, Antonio; Pierri, Filomena; Barbi, Egidio; Barone, Giovanni; Riccardi, Riccardo

doi:10.1136/adc.2010.188433

Cited by 86 publications

(62 citation statements)

References 27 publications

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“…6 One method of preventing nasal irritation is to administer intranasal lidocaine 60 seconds before midazolam using a mucosal atomization device. Chiaretti and colleagues 18 found a single 10-mg dose of atomized lidocaine prior to a 0.2 to 0.5 mg/kg dose of intranasal midazolam to be effective at reducing nasal irritation, but the children in this study were given midazolam for conscious sedation rather than for seizures. This may be a viable option in the future if development of a premixed lidocaine/midazolam solution is feasible, but the delay in midazolam administration that would occur from giving lidocaine first is not ideal and could lead to patient harm.…”

Section: Safetymentioning

confidence: 79%

Treatment of Acute Seizures: Is Intranasal Midazolam a Viable Option?

Humphries

Eiland

2013

The Journal of Pediatric Pharmacology and Therapeutics

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Seizures in the pediatric population commonly occur, and when proper rescue medication is not administered quickly, the risk of neurologic compromise emerges. For many years, rectal diazepam has been the standard of care, but recent interest in a more cost-effective, safe alternative has led to the investigation of intranasal midazolam for this indication. Although midazolam and diazepam are both members of the benzodiazepine class, the kinetic properties of these 2 anticonvulsants vary. This paper will review available data pertaining to the efficacy, safety, cost, and pharmacokinetics of intranasal midazolam versus rectal diazepam as treatment for acute seizures for children in the prehospital, home, and emergency department settings.

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Section: Safetymentioning

confidence: 79%

Treatment of Acute Seizures: Is Intranasal Midazolam a Viable Option?

Humphries

Eiland

2013

The Journal of Pediatric Pharmacology and Therapeutics

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“…A notable downside to intranasal delivery is the potential for nasal mucosal irritation, which would likely be more poorly tolerated in neonates than in adults. It has been suggested that lidocaine could be coadministered with any intranasal drugs in neonates and children to help mitigate this issue [119].…”

Section: Intranasalmentioning

confidence: 99%

Challenges Associated with Route of Administration in Neonatal Drug Delivery

et al. 2015

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The administration of drugs to neonates poses significant challenges. The aim of this review was to provide insight into some of these challenges and resolutions that may be encountered with several of the most commonly used routes of administration and dosage forms in neonatal care, including oral, parenteral, transdermal, intrapulmonary, and rectal. Important considerations include fluctuations in stomach pH hours to years after birth, the logistics of setting up an intravenous infusion, the need for reduced particle size for aerosol delivery to the developing neonatal lung, and variation in perirectal venous drainage. Additionally, some of the recently developed technologies for use in neonatal care are described. While the understanding of neonatal drug delivery has advanced over the past several decades, there is still a deficiency of technologies and formulations developed specifically for this population.

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“…Intranasal citrate has been used as a model for intranasal midazolam in volunteers, predosing the nares with lidocaine, or mixing lidocaine with the citrate to reduce the discomfort [16]. Nasal pre-dosing with lidocaine has been shown to reduce the discomfort [34], although lidocaine itself gives a rather unpleasant taste.…”

Section: Buccal Sedationmentioning

confidence: 99%