UMEM Educational Pearls

  • Over the last decade, multiple studies have shown that pain and sedation in children can be easily and quickly treated via intransal administration of traditional drugs.
  • Inexpensive atomizers are used to quickly administer medications which are absorbed through the mucosal surface and rapidly delivered to the bloodstream and CNS with equivalent effects to intravenous administration.
  • Considerations include using concentrated forms as volumes greater than 1mL per nostril may over-saturate the mucosa and drip out rather than be fully absorbed.
  • The few side effects included cough, vocal cord irritation, and laryngospasm; but pre-treating with a single puff of lidocaine spray minimizes them and has been found to enhance sedative effects.
  • Fentanyl, 2mcg/kg for pain
  • Midazolam, 0.2 - 0.5mg/kg for sedation and antiepileptic.
  • Ketamine and Dexmedetomidine have also been used with success, but standardized doses are still being studied. 


Wolfe TR, Braude DA. Intranasal Medication Delivery for Children: A Review and Update. Pediatrics. 2010;126:532-7.

Mudd S. Intranasal fentanyl for pain management in children: a systematic review of the literature. J PediatrHealth Care 2011;25:316-22.

Chiaretti A, Barone G, Rigante D, et al. Intranasal lidocaine and midazolam for procedural sedation in children. Arch Dis Child 2011;96:160-3.