Intranasal drug delivery : another string to intensivist’s bow?

Abstract

Intranasal drug delivery can be useful to the pediatrician in emergency situations. The ease of administration, rapid onset of action and good bioavailability make this route compatible with the management of seizures, moderate to severe breakthrough pain, and major anxiety in patients without a venous access. Intranasal midazolam is a drug of choice for the first-line treatment of seizures lasting more than 5 minutes. Intranasal fentanyl or ketamine are particularly well suited for quality analgesia. Dexmedetomidine provides an interesting quality of sedation for the realization of imaging that requires immobilization, thus avoiding general anesthesia. The association of a sedative (dexmedetomidine or ketamine) with an analgesic (fentanyl or sufentanil) seems to offer even better conditions than these drugs used separately without increasing the side effects. This makes it possible to consider the realization of resuscitation gestures such as drain placement/removal, central venous catheter, burns dressing, fracture reduction for example.