title: Intranasal midazolam for rapid sedation of an agitated patient.
abstract: Rapidly, establishing a difficult intravenous access in a dangerously agitated patient is a real challenge. Intranasal midazolam has been shown to be effective and safe for rapidly sedating patients before anesthesia, for procedural sedation and for control of seizure. Here, we report a patient in intensive care unit who was on mechanical ventilation and on inotropic support for management of septic shock and who turned out extremely agitated after accidental catheter removal. Intravenous access was successfully established following sedation with intranasal midazolam, using ultrasound guidance.
authors.affiliation: Department of Anaesthesiology, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.
authors.forename: Gentle Sunder
authors.initials: GS
authors.lastname: Shrestha
authors.affiliation: Department of Anaesthesiology, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.
authors.forename: Pankaj
authors.initials: P
authors.lastname: Joshi
authors.affiliation: Department of Anaesthesiology, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.
authors.forename: Krishna
authors.initials: K
authors.lastname: Bhattarai
authors.affiliation: Department of Anaesthesiology, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.
authors.forename: Santosh
authors.initials: S
authors.lastname: Chhetri
authors.affiliation: Department of Anaesthesiology, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.
authors.forename: Subhash Prasad
authors.initials: SP
authors.lastname: Acharya
keywords: Difficult intravenous access; intensive care unit; intranasal midazolam