Volumes of Administration for Intranasal Midazolam

The intranasal route is an effective means of administering sedative medications for children. However, sometimes the child has to receive a certain dose that requires a very large volume to be administered into the nose, because of the types of concentrations of drugs that are available. Most drugs are not concentrated enough so that small volumes can be consistently given, so as a result, sometimes a very large amount of medication is administered intranasally. When the amount is too large, most of the medication either runs back out the nose, or down the back of the nose and throat and is swallowed, instead of being absorbed in the nasal cavity, where it can be quickly absorbed and produce optimal effectiveness.

Inclusion criteria

• 1 to 7 years of age, inclusive.
• Require intranasal midazolam for minimal sedation to facilitate laceration repair.

Exclusion criteria

• Weight less than 10 kg.
• Known allergy to midazolam.
• Presence of intranasal obstruction (e.g. mucous or blood) that cannot be readily cleared
• Inability to speak English or Spanish
• Developmental delay, psychiatric illness, neurologic impairment, or altered mental status; or illnesses associated with chronic pain (e.g. sickle cell disease, inflammatory bowel disease).
• Foster children or wards.