TY - JOUR
T1 - Intranasal drug administration for procedural sedation in children admitted to pediatric Emergency Room
AU - Fantacci, Claudia
AU - Fabrizio, Giovanna Carmela
AU - Ferrara, Pietro
AU - Franceschi, Francesco
AU - Chiaretti, Antonio
PY - 2018
Y1 - 2018
N2 - OBJECTIVE: Pain relief is a very important aspect in Pediatrician's clinical practice. It is often thought that young children, particularly infants, do not perceive as much pain as adults because of their immature nervous system and that untreated pain would not have adverse long-term consequences. Instead, it has been demonstrated that infants and children experience pain in a similar manner to adults. Many factors, particularly emotional factors, can increase the child's pain perception. Children live with anxiety even minor procedures. This suggests the need for an adequate sedation and the way of sedation should be free of pain itself. We believe the route to be followed may be the intranasal (IN) administration of sedative drugs. MATERIALS AND METHODS: We have conducted a brief review of the literature by Pubmed about the most commonly used sedative drugs: sufentanyl, fentanyl, midazolam, ketamine, nitrous oxide and dexmedetomidine. We have investigated in the literature the type of administration of IN drugs: drop instillation or by a mucosal atomizer device (MAD). RESULTS: In our study, it was noted that IN drugs administration is an effective and safe method to reduce anxiety and to deliver analgesia because it is practical and non-invasive. Moreover, therapeutic levels of sedatives are low due to the presence of a rich vascular plexus in the nasal cavity, which communicates with the subarachnoid space via the olfactory nerve and reduce the time of medication delivery, that is, the onset of action. The use of MAD even gives as better bioavailability of drugs. CONCLUSIONS: IN sedation via MAD is effective and safe and should be one of the first choices for procedural sedation in children.
AB - OBJECTIVE: Pain relief is a very important aspect in Pediatrician's clinical practice. It is often thought that young children, particularly infants, do not perceive as much pain as adults because of their immature nervous system and that untreated pain would not have adverse long-term consequences. Instead, it has been demonstrated that infants and children experience pain in a similar manner to adults. Many factors, particularly emotional factors, can increase the child's pain perception. Children live with anxiety even minor procedures. This suggests the need for an adequate sedation and the way of sedation should be free of pain itself. We believe the route to be followed may be the intranasal (IN) administration of sedative drugs. MATERIALS AND METHODS: We have conducted a brief review of the literature by Pubmed about the most commonly used sedative drugs: sufentanyl, fentanyl, midazolam, ketamine, nitrous oxide and dexmedetomidine. We have investigated in the literature the type of administration of IN drugs: drop instillation or by a mucosal atomizer device (MAD). RESULTS: In our study, it was noted that IN drugs administration is an effective and safe method to reduce anxiety and to deliver analgesia because it is practical and non-invasive. Moreover, therapeutic levels of sedatives are low due to the presence of a rich vascular plexus in the nasal cavity, which communicates with the subarachnoid space via the olfactory nerve and reduce the time of medication delivery, that is, the onset of action. The use of MAD even gives as better bioavailability of drugs. CONCLUSIONS: IN sedation via MAD is effective and safe and should be one of the first choices for procedural sedation in children.
KW - Children
KW - Intranasal sedation
KW - Pain
KW - Pharmacology (medical)
KW - Procedures
KW - Children
KW - Intranasal sedation
KW - Pain
KW - Pharmacology (medical)
KW - Procedures
UR - http://hdl.handle.net/10807/110571
UR - http://www.europeanreview.org/wp/wp-content/uploads/217-222-in-drug-administration-for-procedural-sedation-in-children.pdf
U2 - 10.26355/eurrev_201801_14119
DO - 10.26355/eurrev_201801_14119
M3 - Article
SN - 1128-3602
VL - 22
SP - 217
EP - 222
JO - European Review for Medical and Pharmacological Sciences
JF - European Review for Medical and Pharmacological Sciences
ER -