title: Atomized intranasal midazolam use for minor procedures in the pediatric emergency department.
abstract: BACKGROUND
  Procedural sedation is increasingly more common in pediatric emergency departments. We report our experience with intranasal midazolam (INM) using a unique atomization delivery device, specifically the efficacy and safety of this method of sedation.
  
  
  METHODS
  We performed a retrospective chart review of children who received INM sedation in the emergency department from April 1, 2005, through June 30, 2005. All children aged 1 to 60 months who received INM as the initial means of sedation were eligible for the study. Patients were excluded if they were older than 60 months.
  
  
  RESULTS
  There were 205 patients who received INM for sedation and who met the study criteria. The mean age was 31.3 +/- 13.2 months (range, 1.5-60 months). The mean and median initial INM dose was 0.4 mg/kg (range, 0.3-0.8 mg/kg). Laceration repair was the most common procedure necessitating sedation (89%). The median degree-of-sedation score achieved was 2.0 (anxiolysis). Eleven patients (5.4%; 95% CI, 3%-9%) required an additional sedative to complete the procedure. Ten of the 11 patients received ketamine as the adjunctive sedative, and 1 patient required additional INM. The average time of last oral intake to start of sedation was 3.5 hours (range, 0.5-10.0 hours). Thirty six patients (18%) were NPO for 2 hours or less. There was 1 adverse event (0.5%; 95% CI, 0%-3%). This was a minor desaturation episode following ketamine administration requiring brief blow by oxygen. There were no adverse events (0%; 95% CI, 0%-2%) in patients who received INM alone.
  
  
  CONCLUSIONS
  We conclude that atomized INM is effective in providing anxiolysis to children undergoing minor procedures in the pediatric emergency department. We are encouraged that no adverse events occurred with the use of INM alone despite relatively short fasting times.
authors.affiliation: Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Utah, Salt Lake City, UT 84158, USA. roni.lane@hsc.utah.edu
authors.forename: Roni D
authors.initials: RD
authors.lastname: Lane
authors.forename: Jeff E
authors.initials: JE
authors.lastname: Schunk
mesh_terms: D000281:Administration, Intranasal; D000336:Aerosols; D014151:Anti-Anxiety Agents / Q000008:administration & dosage* / Q000009:adverse effects; D002675:Child, Preschool; D016292:Procedural Sedation / Q000145:classification*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008874:Midazolam / Q000008:administration & dosage* / Q000009:adverse effects; D013511:Minor Surgical Procedures; D009330:Nebulizers and Vaporizers; D012189:Retrospective Studies
chemical_list: D000336:Aerosols; D014151:Anti-Anxiety Agents; D008874:Midazolam