A comparison of high dose versus low dose intranasal midazolam for sedation in the pediatric emergency department.

OBJECTIVES

In the pediatric emergency department (PED), minimal sedation is commonly used for procedures such as laceration repairs or radiological imaging, we sought to evaluate high-dose versus low-dose intranasal midazolam (INM) and correlation with the need for additional rescue sedation medications.

METHODS

We conducted a single center, retrospective cohort analysis of pediatric patients admitted to the PED who received INM from August 1, 2022 to August 31, 2023. Patients were included if they were <18 years old, weighed ≤22 kg, and required INM for minimal sedation. The primary outcome was a composite measure of additional sedation medications administration following the initial dose of INM, defined as any additional dose given between 5 and 15 min, 15-45 min, or provider-documented failure after the initial dose of low-dose INM (0.2 mg/kg) or high-dose INM (0.5 mg/kg).

RESULTS

During the study period, 336 patients received INM, with 161 patients meeting inclusion criteria. Among these patients, 25 patients received low-dose INM and 136 patients received high dose INM. Most patients received INM for a laceration repair. More patients required additional sedation medications to complete the procedure in the low-dose vs high-dose INM group (28.0% vs 7.4%, p = 0.01). There was no difference between groups on PED length of stay, time from arrival to initial INM, or time from initial INM to time of discharge.

DISCUSSION: In this study, patients who received high dose INM for minimal sedation were less likely to need additional sedatives without an increase in adverse events or a longer PED length of stay.