Intranasal Fentanyl and Midazolam for Procedural Analgesia and Anxiolysis in Pediatric Urgent Care Centers

Authors

John Matthew Williams, From the Division of Pediatric Emergency Medicine, Department of Pediatrics, Le Bonheur Children's Hospital.
Sarah Schuman, Department of Clinical Pharmacy, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN.
Rebecca Regen, Department of Clinical Pharmacy, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN.
Allyson Berg, Department of Clinical Pharmacy, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN.
Lindsay Stuart, Department of Clinical Pharmacy, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN.
Jampana Raju, From the Division of Pediatric Emergency Medicine, Department of Pediatrics, Le Bonheur Children's Hospital.
William Mabry, Department of Clinical Pharmacy, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN.
Rudy John Kink, From the Division of Pediatric Emergency Medicine, Department of Pediatrics, Le Bonheur Children's Hospital.

Abstract

OBJECTIVES: Intranasal fentanyl and midazolam use is increasing in the acute care setting for analgesia and anxiolysis, but there is a lack of literature demonstrating their use, alone or in combination, at pediatric urgent care centers. METHODS: This retrospective study investigated intranasal fentanyl and midazolam use at an urgent care center located within Le Bonheur Children's Hospital and 2 affiliated off-site centers from September 22, 2011, to December 30, 2015. Data collected included patient demographics, initial fentanyl dose, initial midazolam dose, type of procedure, and serious adverse drug reactions. RESULTS: Of the 490 patients who met the inclusion criteria, 143 patients received intranasal fentanyl alone, 92 received intranasal midazolam alone, and 255 received fentanyl in combination with midazolam. The overall patient population was 50% male with a median (range) age of 4.5 (0.2-17.9) years, and most patients were black at 57.1%. The median (range) initial intranasal fentanyl dose was 2.02 (0.99-4.22) μg/kg, and the median initial (range) intranasal midazolam dose was 0.19 (0.07-0.42) mg/kg. In cases where fentanyl and midazolam were administered in combination, the median (range) initial fentanyl dose was 2.23 (0.6-4.98) μg/kg and median (range) initial midazolam dose was 0.2 (0.03-0.45) mg/kg. There were no serious adverse drug reactions reported. CONCLUSIONS: Intranasal fentanyl and midazolam when administrated alone and in combination can provide analgesia and anxiolysis for minor procedures in pediatric patients treated in the urgent care setting.

Publication Title

Pediatric emergency care

Recommended Citation

Williams, J. M., Schuman, S., Regen, R., Berg, A., Stuart, L., Raju, J., Mabry, W., & Kink, R. J. (2020). Intranasal Fentanyl and Midazolam for Procedural Analgesia and Anxiolysis in Pediatric Urgent Care Centers. Pediatric emergency care, 36 (9), e494-e499. https://doi.org/10.1097/PEC.0000000000001782