Intranasal Administration Of Midazolam Research Articles

Sedation and Physiologic Response to Manual Restraint After Intranasal Administration of Midazolam in Hispaniolan Amazon Parrots (Amazona ventralis)

Administration of intranasal midazolam (2 mg/kg) was evaluated for sedation and effects on cloacal temperature, respiratory rate, and heart rate in manually restrained Hispaniolan Amazon parrots (Amazona ventralis). Adult parrots (n=9) were administered either midazolam (2 mg/kg) or an equal volume of saline solution intranasally before a 15-minute manual restraint in a complete crossover study. Respiratory rate and sedation scores were recorded before and during capture and during and after 15 minutes of manual restraint. Heart rate and cloacal temperature were recorded during manual restraint. After restraint, the parrots received intranasal flumazenil (0.05 mg/kg) or an equal volume of saline solution, and the recovery time was recorded. In those birds that received midazolam, sedation was observed within 3 minutes of administration, and vocalization, flight, and defense responses were significantly reduced during capture. During manual restraint, the mean rate of cloacal temperature increase was significantly slower and remained significantly lower in birds that received midazolam compared with controls. Mean respiratory rates were significantly lower for up to 12 minutes in parrots that received midazolam compared with those receiving saline solution. Flumazenil antagonized the effects of midazolam within 10 minutes. No overt clinical adverse effects to intranasal midazolam and flumazenil administration were observed. Further studies on the safety of intranasal midazolam and flumazenil in this species are warranted.

미다졸람의 비강 내 추가투여가 소아의 경구 진정요법에 미치는 영향

Effect of supplementary intranasal midazolam on oral sedation of children The purpose of this study was to compare the cardiopulmonary parameters of two sedation regimens during dental treatment: (1) Oral chloral hydrate(CH) and hydroxyzine(HZ) with nitrous oxide-oxygen() inhalation(CH-HZ group); (2) Oral chloral hydrate(CH) and hydroxyzine(HZ) with nitrous oxide-oxygen() inhalation and supplementary intranasal(IN) midazolam administration(MIDA group). Among the patients of OO hospital who received dental treatment under sedation over the past 5 years, 44 patients were selected for each group of CH-HZ and MIDA according to their age, gender and weight. Following parameters that were recorded every 5 minutes were compared: 1) Heart rate(HR) 2) saturation 3) End tidal carbon dioxide concentration() 4) Respiratory rate(RR) 33 patients of Group MIDA who have complete data of 15 minutes before and after supplementary IN midazolam administration were selected. And measurements 15 minutes before and after midazolam administration in same patient were evaluated. The results were as follows: 1. Heart rate was significantly higher in MIDA group than in CH-HZ group, but it was within normal range. 2. Comparing HR, saturation, EtCO2, RR between before and after of supplementary IN midazolam administration in the same patient, the differences were not statistically significant.

A Comparative Evaluation of Intranasal Midazolam, Ketamine and their Combination for Sedation of Young Uncooperative Pediatric Dental Patients: A Triple Blind Randomized Crossover Trial

The purpose of this study was to evaluate and compare the efficacy and safety of intranasal (IN) administration of midazolam (M), ketamine (K) and their combination (MK) to produce moderate sedation in young, uncooperative pediatric dental patients. In this three stage crossover trial forty five uncooperative ASA type-1 children, who required dental treatment, were randomly assigned to receive one of the three drugs/combination by IN route during three subsequent visits. The efficacy and safety of the agents were assessed by overall success rate and by monitoring of vital signs, respectively. The onset of sedation was rapid with K as compared to M and MK. The difference was statistically significant (P < 0.01) between K and M. The overall success rate was 89% with K, MK was 84% and 69% with M. The difference between the overall success rates of K and M was statistically significant (P < 0.01). Vital signs were within physiological limits and there were no significant adverse effects with any medication. M, K and MK are safe and effective by IN route to produce moderate sedation for providing dental care to pediatric dental patients who have been otherwise indicated for treatment under general anesthesia.

Comparison of intranasal administration of diazepam, midazolam and xylazine in Pigeons: Clinical evaluation.

Safe and effective sedation methods are as much important for small pet birds as for the other animals not only for surgical procedures but also for safe handling and diagnostic and clinical procedures such as radiography, wound dressing, blood collection, endoscopy and fracture repair procedures. The aim of this study is comparison of sedation efficacy in intranasal administration of xylazine, diazepam and midazolam in Pigeons. Fifteen healthy adult domesticated Pigeons of both sexes, weighing 289±61.8 gram were used in this study. Xylazine (29.4±1.9 mg/kg), diazepam (6.4±0.9 mg/kg) and midazolam (6.5±1.0 mg/kg) was administered intranasaly using a micropipette. The onset time, dorsal recumbency duration time and duration of sedation time were measured and recorded. This study showed that intranasal (IN) drug administration could provide fast and reliable sedation in Pigeons and IN midazolam or diazepam can provide adequate sedation for diagnostic and minor therapeutic procedures.

Mucosal Atomization Device/MAD® for Administration of Intranasal Midazolam for Pediatric Patients Preoperatively

Mucosal Atomization Device/MAD® for Administration of Intranasal Midazolam for Pediatric Patients Preoperatively

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

We wish to congratulate Gilchrist et al. for their recent publication [1]. We agree on the efficacy and safety of midazolam in children having procedures who may otherwise have required a general anaesthetic. However in recent recommendations [2], intranasal midazolam administration in patients under the age of 12 years, is classified in the category of ‘alternative techniques’. It is important to appreciate then, that the apparent simplicity of intranasal sedation belies the potential for undesirable effects so that monitoring, discharge and supervision requirements should be the same as those for intravenous sedation [2-4]. This technique must be limited to skilled hospital personnel and it must be stressed that premature discharge to an unmonitored setting remains the weakest link in this setting [3, 4]. Indeed, the use of sedation is still a limited practice among European dentists: in Italy sedation is provided mainly by anaesthetists (94%), seldom by dentists (6%) [5]. Education is largely theoretical, and practice on patients is lacking in the majority of the European Dental Schools [6]. If the teacher of dental anaesthesia is an anaesthetist, they must be able to transfer specialist professional skills and competences to dentists, who, in turn, will gain greater autonomy. Without this autonomy, the dental profession will remain subject to the anaesthetist’s will and, consequently, deep sedation/general anaesthesia techniques will be preferred to conscious sedation techniques. This situation increases risks for patients and the expenditure for dental care, with the teaching of inappropriate competencies leading to individuals considering they are able to practice in areas that they have not been truly appropriately taught [7]. This situation has arisen in Europe, but we have the opportunity to change it, with a greater autonomy for the dentists. It is necessary to establish a clear definition of objectives, competences and limits for the modern dentist, in order to get a common professional profile and legal framework, produced by European Union Authorities [8-10]. It is impossible currently to say which is the most effective sedation technique for anxious children [11] and this absence of evidence to support current practice is indeed alarming. However, we must remember that the cornerstone of management in dentistry remains an empathic approach to the patient supported by behaviour management techniques.

Assessment of Intranasal Midazolam Administration with a Dose of 0.5 mg/ Kg in Behavior Management of Uncooperative Children

Intranasal midazolam has been used to induce conscious sedation in children with negative and aggressive behavior The main goal of this study was to determine the effectiveness of intranasal administration of midazolam (with a dose of 0.5 mg/kg) in behavior management of uncooperative children. Thirty healthy, difficult children of 3-5 years were evaluated. At the beginning of each session, ordinary techniques of behavior management to treat patients were applied. In cases of unsatisfactory responses, intranasal midazolam was immediately employed. To determine the efficacy of the drug, child behavior was evaluated before and after administration of midazolam using Houpt rating scale of general behavior. A statistically significant difference was demonstrated in the patients 'behavior before and after administration of intranasal midazolam. this drug is effective in sedation and reduction of the anxiety of children under treatment.

Community use of intranasal midazolam for managing prolonged seizures

Background Until a few years ago, rectal diazepam (RD) was the only option available to parents and carers managing prolonged seizures. However, its use in the community was limited due to the requirement for privacy, and because education staff in South Australia are not permitted to carry out invasive procedures.Method Following a literature review, a seizure management training package was developed to enhance the implementation of a trial treatment protocol for the administration of intranasal midazolam (INM). Parents, carers and education staff were later surveyed about their experiences and perceptions.Results Intranasal midazolam was administered to 131 people (51 children and 80 adults), with 96.9% control of seizures, and only one minor adverse event. Parents expressed a preference for INM over RD because of the shorter time it took to take effect and wear off, and the ability to administer it in public if necessary.Conclusion Intranasal midazolam is a safe and practical alternative to rectal diazepam for managing prolonged seizures in the community.

Sedative effects of midazolam and xylazine with or without ketamine and detomidine alone following intranasal administration in Ring-necked Parakeets

To evaluate the effects of intranasal administration of midazolam and xylazine (with or without ketamine) and detomidine and their specific antagonists in parakeets. Prospective study. 17 healthy adult Ring-necked Parakeets (Psittacula krameri) of both sexes (mean weight, 128.83+/-10.46 g [0.28+/-0.02 lb]). The dose of each drug or ketamine-drug combination administered intranasally that resulted in adequate sedation (ie, unrestrained dorsal recumbency maintained for >or=5 minutes) was determined; the onset of action, duration of dorsal recumbency, and duration of sedation associated with these treatments were evaluated. The efficacy of the reversal agents flumazenil, yohimbine, and atipamezole was also evaluated. In parakeets, intranasal administration of midazolam (7.3 mg/kg [3.32 mg/lb]) or detomidine (12 mg/kg [5.45 mg/lb]) caused adequate sedation within 2.7 and 3.5 minutes, respectively. Combinations of midazolam (3.65 mg/kg [1.66 mg/lb]) and xylazine (10 mg/kg [4.55 mg/lb]) with ketamine (40 to 50 mg/kg [18.2 to 22.7 mg/lb]) also achieved adequate sedation. Compared with detomidine, duration of dorsal recumbency was significantly longer with midazolam. Intranasal administration of flumazenil (0.13 mg/kg [0.06 mg/lb]) significantly decreased midazolam-associated recumbency time. Compared with the xylazineketamine combination, duration of dorsal recumbency was longer after midazolam-ketamine administration. Intranasal administration of flumazenil, yohimbine, or atipamezole significantly decreased the duration of sedation induced by midazolam, xylazine, or detomidine, respectively. Intranasal administration of sedative drugs appears to be an acceptable method of drug delivery in Ring-necked Parakeets. Reversal agents are also effective when administered via this route.

Intranasal midazolam as a treatment of autonomic crises in patients with familial dysautonomia

To evaluate the efficacy and safety of intranasal midazolam in the treatment of autonomic crises in children with familial dysautonomia, intranasal midazolam was administered at the hospital to six patients during nine episodes of autonomic crisis. Treatment was successful in seven of nine episodes of autonomic crisis in five of six patients, with a mean interval to response of 9.25 ± 1.25 minutes. The parents of five patients in whom the treatment was successful were instructed to use midazolam at home. At home, 16 additional episodes were treated by the parents, with successful control achieved in 14 (87%). The mean interval to response was 12.8 ± 2 minutes. No significant side effects were observed at the hospital or at home after intranasal administration of midazolam. Midazolam, given intranasally, is effective and safe in the management of autonomic crises in patients with familial dysautonomia, either in the hospital or at home by the parents after appropriate instruction.

Intranasal Midazolam in Patients With Status Epilepticus

The patient in status epilepticus presents many challenges to the emergency physician. IV access is frequently difficult to achieve, and prolonged attempts at access can jeopardize the patient and endanger the caregiver. We present two cases in which the administration of intranasal midazolam appeared to successfully terminate status epilepticus. No adverse effects were noted. Studies are needed to clarify the safety, optimal dosing, and clinical utility of this treatment modality. [Kendall JL, Reynolds M, Goldberg R: Intranasal midazolam in status epilepticus. Ann Emerg Med March 1997;29:415-417.]

The effects of intranasal midazolam on urodynamic studies in children.

To determine the influence of midazolam on the function of the lower urinary tract when used to sedate the patient. Urodynamic studies were performed on 20 patients (seven boys and 13 girls, mean age 4.04 years, range 1 day to 10 years) before and after the intranasal administration of 0.5 mg/kg of midazolam. The patients' heart rate, respiratory rate and oxygen saturation were monitored and the level of sedation recorded by an anaesthesiologist and a surgeon during the study. Heart rate and respiratory rate did not change and the percentage oxygen saturation remained stable throughout the study period. The childrens' behaviour began to change 3-5 min after the intranasal administration of midazolam. The sedation lasted 2 h and the full co-operation of the patient was assured. The difference between the initial and post-midazolam evaluation of maximal cystometric capacity, contractility, compliance, intravesical pressure, maximum flow rate, intravesical pressure at maximum flow and the amount of residual urine were statistically insignificant (P > 0.05). Electromyographic characteristics showed no significant change with the use of midazolam (P > 0.05). Despite the suggestion that benzodiazepines, especially diazepam, are useful for the relaxation of pelvic floor striated musculature in voiding dysfunctions, there was no effect on urodynamic variables when midazolam was used in a single dose intranasally. The anxiolytic and sedative effects allowed children to undergo urodynamic studies in comfort.

Comparison of Rectal to Intranasal Administration of Midazolam for Premedication of Children

Sixty children aged 3 to 9, undergoing minor surgical procedures, were studied to compare 0.5 mg/kg intranasal with 0.5 mg/kg rectal midazolam as a premedication. The children were evaluated for their ability to tolerate the medication, preanesthetic sedation, and alertness after anesthesia. Both premedication routes were equally effective in sedating the children. In both groups, a significant loss of effectiveness was noted if induction of the anesthesia began more than 30 minutes after administration of the medication (p < 0.0003). Rectal midazolam was much better tolerated by the children than the intranasal route (30 versus 3, p < 0.0001). We advocate the rectal over the intranasal route for premedication with midazolam in children, and anesthetic induction should occur no more than 30 minutes after administration of premedication.

Sedation with Intranasal Administration of Midazolam for Handicapped Patients during Dental Treatment

Sedation with Intranasal Administration of Midazolam for Handicapped Patients during Dental Treatment

Sedation with Intranasal Administration of Midazolam for Handicapped Patients during Dental Treatment

Sedation with Intranasal Administration of Midazolam for Handicapped Patients during Dental Treatment

Sedation with Intranasal Administration of Midazolam for Handicapped Patients during Dental Treatment

Sedation with Intranasal Administration of Midazolam for Handicapped Patients during Dental Treatment

Plasma Concentrations of Midazolam in Children Following Intranasal Administration

Nasally administered midazolam appears to be a useful method for rapidly sedating children prior to the induction of anesthesia. We determined the peak plasma concentrations after intranasal administration of midazolam and compared this to plasma concentrations achieved after intravenously administered midazolam in 18 children between the ages of 14 months and 5 yr, who underwent elective closure of an asymptomatic atrial septal or ventricular septal defect. Preanesthetic medication was at the discretion of the attending anesthesiologist. Induction of anesthesia was with halothane in N2O and O2 via mask, and tracheal intubation was performed after the administration of fentanyl or sufentanil plus pancuronium. Anesthesia was maintained with these agents, and augmented with halothane or isoflurane. As soon as arterial access was established, the patient received 0.1 mg/kg of either intranasal or intravenous midazolam. Midazolam concentrations were measured by gas chromatography-mass spectrometry. Intranasal midazolam achieved its peak plasma concentration of 72.2 +/- 27.3 ng/ml in 10.2 +/- 2 min. Ten minutes after the administration of midazolam, the mean plasma concentration in the intranasal midazolam group was 57% of the concentrations in the group receiving midazolam intravenously. These results confirm the clinical impression that intranasal administration of midazolam rapidly achieves sedative plasma concentrations in children.

Sédation par midazolam intranasal lors des endoscopies digestives hautes

Twenty-nine patients, ranked ASA 1 or 2, scheduled for diagnostic gastroduodenal fibroscopy were randomly allocated into three treatment groups : intranasal midazolam (IN) 0.15 mg · kg −1 ; intramuscular midazolam (IM) 0.15 mg · kg −1, and placebo (P). Sedation and the fibroscopy were all carried out by the same anaesthetist and fibroscopist. Efficiency and tolerance of the method were assessed by monitoring the heart rate, systolic and diastolic arterial blood pressure, arterial oxygen saturation (pulse oximetry), the degrees of sedation, anxiety, and anterograde as well as retrograde amnesia. The patient's and endoscopist's reactions were also considered. Patients in group P were older than those of the other two groups (p < 0.01). Sedation was more important and patients less anxious in groups IN and IM than in group P. Three patients in group IM had retrograde amnesia. There were no significant differences between the degrees of anterograde amnesia in the three groups. At no time during the study were there any significant differences in SpO 2 between and within groups. Four out of the 9 patients in group P had a bad opinion of their experience, as compared with two out of the 20 in the midazolam groups ; the difference was not statistically significant. Three hours after the procedure, all patients were fully awake. Intranasal administration of midazolam therefore seemed to be an interesting alternative for gastroduodenal fibroscopy, because it was simple, non traumatic, well tolerated, and did not result in arterial desaturation.

Intranasal administration of midazolam to a severely burned child

This report describes the use of intranasally administered midazolam for sedation in a critically ill burned paediatric patient without venous access. Placement of a central venous catheter was successfully carried out following sedation by this method.

Treatment of status epilepticus

Status epilepticus is defined as epileptic seizure with the duration for over 30 min or clustered seizure without complete recovery of consciousness for 30 min or more. From the management point of view, therapeutic intervention is recommended for prolonged seizures for 5 min or more. Intranasal, buccal or intramuscular administration of midazolam is strongly evidence-based and highly recommended method for the treatment of prolonged seizures before the intravenous access. Diazepam or midazolam is the first choice as initial intravenous treatment. Intravenous bolus administration of fosphenytoin or phenobarbital is the second line treatment. General anesthesia using such as thiopental or propofol is indicated for refractory status epileptic, which should be managed in the intensive care unit.