I am trying to see if there is evidence that intranasal use of midazolam in combination with fentanyl does not reach systemic levels that induce moderate degree of sedation and therefore special monitoring (or certification) is not necessary. Thank you!
Dear Florentina,
Please see the publication contained in the following link which reports that Even IN Fentanyl and IN Midazolam can achieve a moderate/deep level of sedation by using
them in combination or by repeated dosing).
http://www.nwhrn.org/media/No-Pain-Intranasal-Medication-Administration-MBED-Clinical-Practice-Guideline1.pdf
Hoping this will be helpful,
Rafik
Hello
i am not aware of studies addressing this issue.
i fear that unpredictable absorption rates do not support intranasal use of these agents.
Would advise small incremental doses instead.
Israel E Priel, MD, FCCP
The link I have attached in my first answer addresses the answer to the question. The following paragraph was taken from the publication contained in the link:
In general, IN medications alone are usually not sufficient to achieve moderate/deep levels of sedation. However, the exceptions to this are the use of IN Ketamine (in the sedation dosing range of 6-9 mg/kg) and IN Dexmedetomidine. Even IN Fentanyl and IN Midazolam can achieve a moderate/deep level of sedation by using them in combination or by repeated dosing). In any of these situations, following the MHS moderate/deep sedation pathway is required.
Rafik
Hello.
Sorry , I've seen the mail today
Excellent link, Rafik.
I send a case repot on use of IN Midazolam ( a higher dose I use to) and IN sufentanyl, supplemented with N2O, who became oversedated. They use IN naloxone and IV Flumazenil.
I hope you find it illustrating
Xavier
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