Midazolam nose drops for outpatient echocardiography sedation in infants

Latson, Larry; Cheatham, John P.; Gumbiner, Carl Herbert; Danford, David A.; Hofschire, Philip J.; Honts, Judy

doi:10.1016/0002-8703(91)90981-m

Cited by 41 publications

(17 citation statements)

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“…The maximum time for onset of sedation was between 8 and 15 minutes, with most cases occurring within 10 minutes of administration irrespective of fasting. This is comparable to earlier studies [30–32] which reported that the average time to peak plasma concentration was 10 minutes. Nasal administration of a sedative has the advantage of rapid absorption of the drug directly into the systemic circulation, with greater accuracy than oral administration since it diffuses directly into the vessels, due to the rich vascularity of the nasal mucosa rather than being transported via the portal vein, as is the case in per rectal or oral administration [24].…”

Section: Discussionsupporting

confidence: 91%

Intra‐nasal midazolam in conscious sedation of young paediatric dental patients

Al-Rakaf

Bello

Turkustani

et al. 2001

Int J Paed Dentistry

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Section: Discussionsupporting

confidence: 91%

Intra‐nasal midazolam in conscious sedation of young paediatric dental patients

Al-Rakaf

Bello

Turkustani

et al. 2001

Int J Paed Dentistry

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“…The present results obtained in the rat may indicate that nasal application of diazepam in man would result in a higher concentration of diazepam in the carotid blood compared to the concentration obtained in parallel samples from a peripheral artery. Nasal application of midazolam has actually been found to be effective in children undergoing echocardiography or to control acute seizures (Latson et al 1991;O'Regan et al 1996).…”

Section: Discussionmentioning

confidence: 99%

Local Transfer of Diazepam, but Not of Cocaine, from the Nasal Cavities to the Brain Arterial Blood in Rats

Einer‐Jensen

Larsen

2000

Pharmacology & Toxicology

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Nasal administration to rats of small molecules (tritiated water, tyrosine, and propanol) results in a higher concentration in the brain arterial blood than in other arteries. The preferential distribution is based on a counter current transfer, which takes place between nasal vein blood and brain arterial blood in the cavernous sinus -carotid artery complex. The present experiments attempt to document that drugs may also be transferred by this system. Groups of 10 large male rats were anaesthetised and intubated. Two catheters were inserted into the same carotid artery, one tip pointing towards the head, the other towards the heart. Parallel blood samples were obtained every 30 sec. for 10 min. after nasal administration of radioactively labelled diazepam or cocaine, and the plasma radioactivity measured. Control groups received the drugs intravenously. The uptake of diazepam was rapid, while cocaine uptake was slow. The average ratio between the radioactivity of parallel samples (R: ''Head'' plasma/''Heart'' plasma) in rats treated with nasal diazepam was 1.12∫0.04, 181 (average∫S.E.M., n) for the whole 10 min. period and 1.20∫0.05, 96 for the second half of the sampling period. The increase of 12 and 20% is highly significant. The intravenous ratio for diazepam and both R's for the cocaine groups were not significantly different from 1.00. The present experiments show that nasal administration of diazepam induces a relatively higher concentration in the brain arterial blood than in parallel samples obtained from another artery. A preferential, first-pass distribution to the brain after nasal administration of diazepam may thus exist.

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“…Midazolam given intranasally as an anaesthetic agent has been shown to be safe and effective in children undergoing various diagnostic studies and minor surgical procedures 10 – 13. Intransal midazolam also suppresses epileptic activity and improves the background of electroencephalograms in children with epilepsy 14…”

Section: Introductionmentioning

confidence: 99%

Comparison of intranasal midazolam with intravenous diazepam for treating febrile seizures in children: prospective randomised study

Lahat

2000

BMJ

270

169

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Objective To compare the safety and efficacy of midazolam given intranasally with diazepam given intravenously in the treatment of children with prolonged febrile seizures. Design Prospective randomised study. Setting Paediatric emergency department in a general hospital. Subjects 47 children aged six months to five years with prolonged febrile seizure (at least 10 minutes) during a 12 month period. Interventions Intranasal midazolam (0.2 mg/kg) and intravenous diazepam (0.3 mg/kg). Main outcome measuresTime from arrival at hospital to starting treatment and cessation of seizures. Results Intranasal midazolam and intravenous diazepam were equally effective. Overall, 23 of 26 seizures were controlled with midazolam and 24 out of 26 with diazepam. The mean time from arrival at hospital to starting treatment was significantly shorter in the midazolam group (3.5 (SD 1.8) minutes, 95% confidence interval 3.3 to 3.7) than the diazepam group (5.5 (2.0), 5.3 to 5.7). The mean time to control of seizures was significantly sooner (6.1 (3.6), 6.3 to 6.7) in the midazolam group than the diazepam group (8.0 (0.5), 7.9 to 8.3). No significant side effects were observed in either group. Conclusion Seizures were controlled more quickly with intravenous diazepam than with intranasal midazolam, although midazolam was as safe and effective as diazepam. The overall time to cessation of seizures after arrival at hospital was faster with intranasal midazolam than with intravenous diazepam. The intranasal route can possibly be used not only in medical centres but in general practice and, with appropriate instructions, by families of children with recurrent febrile seizures at home.

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Midazolam nose drops for outpatient echocardiography sedation in infants

Cited by 41 publications

References 1 publication

Intra‐nasal midazolam in conscious sedation of young paediatric dental patients

Intra‐nasal midazolam in conscious sedation of young paediatric dental patients

Local Transfer of Diazepam, but Not of Cocaine, from the Nasal Cavities to the Brain Arterial Blood in Rats

Comparison of intranasal midazolam with intravenous diazepam for treating febrile seizures in children: prospective randomised study

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