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nasal midazolam

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https://www.readbyqxmd.com/read/28620949/nonintravenous-rescue-medications-for-pediatric-status-epilepticus-a-cost-effectiveness-analysis
#1
Iván Sánchez Fernández, Marina Gaínza-Lein, Tobias Loddenkemper
OBJECTIVE: To quantify the cost-effectiveness of rescue medications for pediatric status epilepticus: rectal diazepam, nasal midazolam, buccal midazolam, intramuscular midazolam, and nasal lorazepam. METHODS: Decision analysis model populated with effectiveness data from the literature and cost data from publicly available market prices. The primary outcome was cost per seizure stopped ($/SS). One-way sensitivity analyses and second-order Monte Carlo simulations evaluated the robustness of the results across wide variations of the input parameters...
June 16, 2017: Epilepsia
https://www.readbyqxmd.com/read/28604093/safety-and-efficacy-of-3-pediatric-midazolam-moderate-sedation-regimens
#2
Rachel Gentz, Paul Casamassimo, Homa Amini, Dan Claman, Megann Smiley
Our aim was to characterize effectiveness and complications in children receiving oral midazolam alone, nasal midazolam alone, or oral midazolam with other sedatives. Children received oral midazolam alone, nasal midazolam, or oral midazolam in combination with other sedative medications. All subjects received a presedation history and physical examination and were sedated per protocol by any of 28 resident providers under attending supervision. Sedations were rated for success and complications by clinicians...
2017: Anesthesia Progress
https://www.readbyqxmd.com/read/28544992/pharmacokinetics-pharmacodynamics-and-tolerability-of-usl261-midazolam-nasal-spray-randomized-study-in-healthy-geriatric-and-non-geriatric-adults
#3
Alexander K Berg, Michael J Myrvik, Peter J Van Ess
AIM: Characterize pharmacokinetics, pharmacodynamics, and safety/tolerability of USL261 in geriatric adults to inform its potential for treating bouts of increased seizure activity. METHODS: Phase 1, randomized, double-blind, 2-way crossover study in healthy geriatric (≥65years; n=18) and non-geriatric (18-40years; n=12) adults evaluated single USL261 doses (2.5 and 5.0mg) administered intranasally. Pharmacokinetic parameters were estimated for midazolam and 1-hydroxymidazolam (active metabolite), including area under the plasma concentration-time curve (AUC), maximum plasma concentration (Cmax), time to Cmax (Tmax), and half-life (t1/2)...
June 2017: Epilepsy & Behavior: E&B
https://www.readbyqxmd.com/read/28282553/challenges-in-the-treatment-of-convulsive-status-epilepticus
#4
REVIEW
Gaetano Zaccara, Gianfranco Giannasi, Roberto Oggioni, Eleonora Rosati, Luciana Tramacere, Pasquale Palumbo
Convulsive status epilepticus (CSE) is a medical emergency associated with high mortality and morbidity. The most recent definition of CSE is a convulsive seizure lasting more than 5min or consecutive seizures without recovery of consciousness. In adults, for the treatment of the early stages of CSE, diazepam, lorazepam or midazolam are the most common treatments, although the choice of agent seems less important than rapid treatment. Midazolam, when administered intramuscularly (best evidence), buccally, or nasally, is effective and safe in the pre-hospital setting...
April 2017: Seizure: the Journal of the British Epilepsy Association
https://www.readbyqxmd.com/read/28271228/comparison-of-ease-of-administration-of-intranasal-midazolam-spray-and-oral-midazolam-syrup-by-parents-as-premedication-to-children-undergoing-elective-surgery
#5
Milthi Manoj, M V S Satya Prakash, Srinivasan Swaminathan, Rithu Krishna Kamaladevi
BACKGROUND: The efficacy of midazolam as premedication in children for providing pre-operative sedation and reducing parental separation anxiety has been well established. Many studies have compared the effectiveness and medication acceptance of midazolam via oral and intranasal routes. In this study, we have compared the ease of administration of oral midazolam syrup and intranasal midazolam spray as premedication, administered by parents to children. METHODS: Ninety children were randomly allocated into one of the two groups: group N received nasal midazolam spray 0...
June 2017: Journal of Anesthesia
https://www.readbyqxmd.com/read/28259526/review-of-intranasally-administered-medications-for-use-in-the-emergency-department
#6
Abby M Bailey, Regan A Baum, Karolyn Horn, Tameka Lewis, Kate Morizio, Amy Schultz, Kyle Weant, Stephanie N Justice
BACKGROUND: Intranasal (IN) medication delivery is a viable alternative to other routes of administration, including intravenous (IV) and intramuscular (IM) administration. The IN route bypasses the risk of needle-stick injuries and alleviates the emotional trauma that may arise from the insertion of an IV catheter. OBJECTIVE: This review aims to evaluate published literature on medications administered via the IN route that are applicable to practice in emergency medicine...
March 1, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28121974/intranasal-analgesia-and-sedation-in-pediatric-emergency-care-a-prospective-observational-study-on-the-implementation-of-an-institutional-protocol-in-a-tertiary-children-s-hospital
#7
Marcus Nemeth, Nils Jacobsen, Carsten Bantel, Melanie Fieler, Robert Sümpelmann, Christoph Eich
OBJECTIVES: Children presenting with acute traumatic pain or in need of therapeutic or diagnostic procedures require rapid and effective analgesia and/or sedation. Intranasal administration (INA) promises to be a reliable, minimally invasive delivery route. However, INA is still underused in Germany. We hence developed a protocol for acute pain therapy (APT) and urgent analgesia and/or sedation (UAS). Our aim was to evaluate the effectiveness and safety of our protocol. METHODS: We performed a prospective observational study in a tertiary children's hospital in Germany...
January 24, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28100064/a-risk-stratifying-tool-to-facilitate-safe-late-stage-percutaneous-endoscopic-gastrostomy-in-als
#8
Alexander G Thompson, Victoria Blackwell, Rachael Marsden, Emma Millard, Clare Lawson, Annabel H Nickol, James E East, Kevin Talbot, Philip J Allan, Martin R Turner
BACKGROUND: The safety of percutaneous endoscopic gastrostomy (PEG) insertion in amyotrophic lateral sclerosis (ALS) patients with significant respiratory compromise has been questioned. OBJECTIVES: To review the characteristics of an ALS clinic patient cohort undergoing PEG, and the introduction of a risk stratification tool with procedural adaptations for higher-risk individuals. METHODS: Patients undergoing PEG insertion were analysed (n = 107)...
May 2017: Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration
https://www.readbyqxmd.com/read/27780297/pharmacokinetics-and-pharmacodynamics-of-a-new-highly-concentrated-intranasal-midazolam-formulation-for-conscious-sedation
#9
Lenneke Schrier, Rob Zuiker, Frans W H M Merkus, Erica S Klaassen, Zheng Guan, Bert Tuk, Joop M A van Gerven, Ronald van der Geest, Geert Jan Groeneveld
AIM: To evaluate the pharmacokinetics, pharmacodynamics, nasal tolerance and effects on sedation of a highly concentrated aqueous intranasal midazolam formulation (Nazolam) and to compare these to intravenous midazolam. METHODS: In this four-way crossover, double-blind, double-dummy, randomized, placebo-controlled study, 16 subjects received 2.5 mg Nazolam, 5.0 mg Nazolam, 2.5 mg intravenous midazolam or placebo on different occasions. Pharmacokinetics of midazolam and α-hydroxy-midazolam were characterized and related to outcome variables for sedation (saccadic peak velocity, the Bond and Lader visual analogue scale for sedation, the simple reaction time task and the observer's assessment of alertness/sedation)...
April 2017: British Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/27652069/evaluation-of-the-effects-of-sedation-administered-via-three-different-routes-on-the-procedure-child-and-parent-satisfaction-during-cystometry
#10
Sengül Özmert, Feyza Sever, Hüseyin Tuğrul Tiryaki
PURPOSE: In this study, we retrospectively investigated case reports with and without midazolam administration via oral, intranasal and rectal before cystometry procedure. We aimed to compare the data to evaluate the effects of sedation before cystometry on the pediatric patients and parents' satisfaction. METHODS: A total of 124 ASA I-II pediatric cases aged 5-14 years were retrospectively investigated from the hospital records. One of the three administration routes was chosen; oral midazolam at a dose of 0...
2016: SpringerPlus
https://www.readbyqxmd.com/read/27625485/comparison-of-preanesthetic-sedation-in-pediatric-patients-with-oral-and-intranasal-midazolam
#11
Purvashree Vijay Deshmukh, Sadhana Sudhir Kulkarni, Mukund Kachru Parchandekar, Sneha Purshottam Sikchi
BACKGROUND AND AIMS: Preoperative anxiety in children leading to postoperative negative changes and long-term behavioral problems needs better preanesthetic sedation. Across the world, midazolam is the most commonly used premedicant in pediatric patients. The fact that no single route has achieved universal acceptance for its administration suggests that each route has its own merits and demerits. This study compares oral midazolam syrup and intranasal midazolam spray as painless and needleless systems of drug administration for preanesthetic sedation in children...
July 2016: Journal of Anaesthesiology, Clinical Pharmacology
https://www.readbyqxmd.com/read/27448414/upper-airway-collapsibility-assessed-by-negative-expiratory-pressure-while-awake-is-associated-with-upper-airway-anatomy
#12
Raquel P Hirata, Fabiola Schorr, Fabiane Kayamori, Henrique Takachi Moriya, Salvatore Romano, Giuseppe Insalaco, Eloisa M Gebrim, Luis Vicente Franco de Oliveira, Pedro R Genta, Geraldo Lorenzi-Filho
STUDY OBJECTIVES: There is a growing interest to develop a simple method to characterize the mechanisms leading to upper airway collapse in order to guide treatment options in patients with obstructive sleep apnea (OSA). Critical closing pressure (Pcrit) during sleep is able to predict the anatomical component of OSA. However, Pcrit is a laborious method that is only used for research purposes. The application of negative expiratory pressure (NEP) is a simple method to assess upper airway collapsibility that can be easily performed during wakefulness...
October 15, 2016: Journal of Clinical Sleep Medicine: JCSM: Official Publication of the American Academy of Sleep Medicine
https://www.readbyqxmd.com/read/27224039/ventriculoperitoneal-shunt-insertion-under-monitored-anesthesia-care-in-a-patient-with-severe-pulmonary-hypertension
#13
Mark A Burbridge, Jessica Brodt, Richard A Jaffe
A 32-year-old man with severe pulmonary arterial hypertension and Eisenmenger syndrome secondary to congenital ventricular septal defects presented for ventriculoperitoneal shunt insertion. Consultation between surgical and anesthesia teams acknowledged the extreme risk of performing this case, but given ongoing symptoms related to increased intracranial pressure from a large third ventricle colloid cyst, the case was deemed urgent. After a full discussion with the patient, including an explanation of anesthetic expectations and perioperative risks, the case was performed under monitored anesthesia care...
July 15, 2016: A & A Case Reports
https://www.readbyqxmd.com/read/27145560/the-use-of-midazolam-as-an-intranasal-sedative-in-dentistry
#14
Anwen Greaves
The administration of midazolam intranasally exploits the unique structure of the nasopharynx thus ensuring rapid delivery to the systemic circulation (The Nose - Brain Pathway). The absorption of midazolam nasally is influenced by the volume and concentration of midazolam, its physicochemical properties and the characteristics of the nasal mucosa. Delivering midazolam intranasally is non-titratable. The level of conscious sedation may be equivalent to that achieved by intravenous routes but is approached in a less controlled manner...
January 2016: SAAD Digest
https://www.readbyqxmd.com/read/27132703/impact-of-acute-changes-in-cpap-flow-route-in-sleep-apnea-treatment
#15
Rafaela G S Andrade, Fernanda Madeiro, Vivien S Piccin, Henrique T Moriya, Fabiola Schorr, Priscila S Sardinha, Marcelo G Gregório, Pedro R Genta, Geraldo Lorenzi-Filho
BACKGROUND: CPAP is the gold standard treatment for OSA and was conceived to be applied through a nasal interface. This study was designed to determine the acute effects of changing the nasal CPAP route to oronasal and oral in upper airway patency during sleep in patients with OSA. We hypothesized that the oronasal route may compromise CPAP's effectiveness in treating OSA. METHODS: Eighteen patients (mean ± SD age, 44 ± 9 years; BMI, 33.8 ± 4.7 kg/m(2); apnea-hypopnea index, 49...
December 2016: Chest
https://www.readbyqxmd.com/read/26930911/-analysis-of-risk-factors-for-emergence-agitation-in-adults-undergoing-general-anesthesia-for-nasal-surgery
#16
Zhan Liu
OBJECTIVE: To identify the incidence and the risk factors for emergence agitation (EA) in adults undergoing general anesthesia for nasal surgery. METHOD: We examined 674 patients aged ≥ 18 years who underwent general anesthesia for nasal surgery between February 2013 and February 2015. The patients were divided into control group (518 cases) and EA group (156 cases) by Sedation-agitation scale (SAS) method. Demographic and clinical variables were assessed and the data were analyzed by multiple logistic regression analysis...
November 2015: Journal of Clinical Otorhinolaryngology, Head, and Neck Surgery
https://www.readbyqxmd.com/read/26922313/efficacy-and-safety-of-anti-epileptic-drugs-in-patients-with-active-convulsive-seizures-when-no-iv-access-is-available-systematic-review-and-meta-analysis
#17
REVIEW
Puneet Jain, Suvasini Sharma, Tarun Dua, Corrado Barbui, Rashmi Ranjan Das, Satinder Aneja
OBJECTIVES: To explore the existing evidence for anti-convulsant drugs and their routes of administration in treating acute seizures in children and adults when intravenous access is not available. METHODS: All major databases including Medline via Ovid, PubMed, Cochrane CENTRAL, Embase, and Google Scholar were searched till May 2015. Randomized and quasi-randomized controlled trials comparing two anti-convulsant drugs (at least one comparator being administered through non-intravenous route) for treatment of acute seizures were included...
May 2016: Epilepsy Research
https://www.readbyqxmd.com/read/26920416/treatment-of-convulsive-status-epilepticus
#18
Eric H Grover, Yara Nazzal, Lawrence J Hirsch
Convulsive status epilepticus (CSE) is a medical emergency with an associated high mortality and morbidity. It is defined as a convulsive seizure lasting more than 5 min or consecutive seizures without recovery of consciousness. Successful management of CSE depends on rapid administration of adequate doses of anti-epileptic drugs (AEDs). The exact choice of AED is less important than rapid treatment and early consideration of reversible etiologies. Current guidelines recommend the use of benzodiazepines (BNZ) as first-line treatment in CSE...
March 2016: Current Treatment Options in Neurology
https://www.readbyqxmd.com/read/26887587/a-randomised-double-blind-controlled-trial-of-intranasal-midazolam-for-the-palliation-of-dyspnoea-in-patients-with-life-limiting-disease
#19
Janet Hardy, Clare Randall, Eve Pinkerton, Christopher Flatley, Kristen Gibbons, Simon Allan
PURPOSE: Anxiety is a major component of breathlessness and is often palliated with benzodiazepines. Midazolam is a short-acting water-soluble benzodiazepine with a rapid onset of action and short half-life. Intranasal midazolam had been shown to be of marked clinical benefit in an uncontrolled pilot study for the control of dyspnoea. A blinded randomised controlled study was therefore undertaken across four Australasian palliative care services. METHODS: All participants received six numbered study nasal spray (SNS) bottles, three of which contained midazolam and three placebo...
July 2016: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
https://www.readbyqxmd.com/read/26512627/oxygen-supplementation-before-induction-of-general-anaesthesia-in-horses
#20
RANDOMIZED CONTROLLED TRIAL
H van Oostrom, M W H Schaap, J P A M van Loon
REASONS FOR PERFORMING STUDY: Hypoventilation or apnoea, caused by the induction of general anaesthesia, may cause hypoxaemia. Preoxygenation may lengthen the period before this happens. No scientific studies are published on preoxygenation in equine anaesthesia. OBJECTIVES: To determine whether supplementation of oxygen at a flow rate of 15 l/min for 3 min via a nasal cannula before induction of general anaesthesia is effective in elevating the arterial partial pressure of oxygen (PaO2 ) directly after induction...
January 2017: Equine Veterinary Journal
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