Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 19 , ISSUE 6 ( 2015 ) > List of Articles

REVIEW ARTICLE

Intranasal midazolam for rapid sedation of an agitated patient

Gentle Sunder Shrestha, Pankaj Joshi, Santosh Chhetri, Krishna Bhattarai, Subhash Prasad Acharya

Keywords : intensive care unit, intranasal midazolam,Difficult intravenous access

Citation Information : Shrestha GS, Joshi P, Chhetri S, Bhattarai K, Acharya SP. Intranasal midazolam for rapid sedation of an agitated patient. Indian J Crit Care Med 2015; 19 (6):356-358.

DOI: 10.4103/0972-5229.158279

License: CC BY-ND 3.0

Published Online: 00-06-2015

Copyright Statement:  Copyright © 2015; Jaypee Brothers Medical Publishers (P) Ltd.


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.


PDF Share
  1. Lorente L, Huidobro MS, Martín MM, Jiménez A, Mora ML. Accidental catheter removal in critically ill patients: A prospective and observational study. Crit Care 2004;8:R229-33.
  2. Silbergleit R, Lowenstein D, Durkalski V, Conwit R, Neurological Emergency Treatment Trials (NETT) Investigators. RAMPART (Rapid Anticonvulsant Medication Prior to Arrival Trial): A double-blind randomized clinical trial of the efficacy of intramuscular midazolam versus intravenous lorazepam in the prehospital treatment of status epilepticus by paramedics. Epilepsia 2011;52 Suppl 8:45-7.
  3. Cheng AC. Intranasal midazolam for rapidly sedating an adult patient. Anesth Analg 1993;76:904.
  4. Henry RJ, Ruano N, Casto D, Wolf RH. A pharmacokinetic study of midazolam in dogs: Nasal drop vs. atomizer administration. Pediatr Dent 1998;20:321-6.
  5. Bhakta P, Ghosh BR, Roy M, Mukherjee G. Evaluation of intranasal midazolam for preanaesthetic sedation in paediatric patients. Indian J Anaesth 2007;51:111-6.
  6. Latson LA, Cheatham JP, Gumbiner CH, Kugler JD, Danford DA, Hofschire PJ, et al. Midazolam nose drops for outpatient echocardiography sedation in infants. Am Heart J 1991;121:209-10.
  7. Saint-Maurice C, Landais A, Delleur MM, Esteve C, MacGee K, Murat I. The use of midazolam in diagnostic and short surgical procedures in children. Acta Anaesthesiol Scand Suppl 1990;92:39-41.
  8. Lahat E, Goldman M, Barr J, Bistritzer T, Berkovitch M. Comparison of intranasal midazolam with intravenous diazepam for treating febrile seizures in children: Prospective randomised study. BMJ 2000;321:83-6.
  9. Rice TL, Kyff JV. Intranasal administration of midazolam to a severely burned child. Burns 1990;16:307-8.
  10. Robinson A, Wermeling DP. Intranasal naloxone administration for treatment of opioid overdose. Am J Health Syst Pharm 2014;71:2129-35.
  11. Costantino TG, Parikh AK, Satz WA, Fojtik JP. Ultrasonography-guided peripheral intravenous access versus traditional approaches in patients with difficult intravenous access. Ann Emerg Med 2005;46:456-61.
  12. Oguzkurt L, Tercan F, Kara G, Torun D, Kizilkilic O, Yildirim T. US-guided placement of temporary internal jugular vein catheters: Immediate technical success and complications in normal and high-risk patients. Eur J Radiol 2005;55:125-9.
  13. Pasin L, Landoni G, Nardelli P, Belletti A, Di Prima AL, Taddeo D, et al. Dexmedetomidine reduces the risk of delirium, agitation and confusion in critically Ill patients: A meta-analysis of randomized controlled trials. J Cardiothorac Vasc Anesth 2014;28:1459-66.
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.