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Intranasal Sedation / Analgesia
Method of Delivery
One of the major limitations in the past to intranasal administration has been the method of delivery. When delivered from the end of a syringe the majority of the dose passes through the nose and is swallowed resulting in a lack of clinical effect. Much higher doses are required if these agents are administered orally and the onset is delayed (30 – 60 mins). In addition this method of delivery is often poorly tolerated by children due to the burning sensation the solution causes to the nasal mucosa and the bitter taste of Midazolam when it reaches the oropharynx.
To deliver intranasal medication effectively an atomizer is required. The atomizer is similar to those used for the administration of topical nasal vasoconstrictors and allows the solution to be delivered to the nasal mucosa as a fine mist. This results in rapid absorption of the drug and minimises the passage of the drug to the nasal pharynx.
One commonly used product that attaches easily to the end of a syringe is the Mucosal Atomizer Device. Provided the dose is delivered at a reasonable rate through the syringe the drug is delivered in an atomised form to the nasal mucosa and is rapidly absorbed.
The Mucosal Atomizer Device is produced by Wolf Tory Medical Inc and available in Australia through LMA Pacmed, ph1800656059. Part Number MAD300.
Question
With respect to the administration of intranasal Midazolam and Fentanyl which (one) of the following statements is not correct ?
The patient should be positioned sitting at 45 degrees
Deliver the dose to both nostrils
A second dose may be given at 10 minutes if there is no effect
The duration of effect is 30 - 45 minutes
The drugs must be given in separate syringes