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.
References
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.
