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ACEP Now: Vol 34 – No 10 – October 2015

Figure 2. Mucosal atomization device

the drip method, but this does require a compliant child to achieve success. Probably the most widely used device is the mucosal atomizer. It screws on to the top of your medication syringe, and when you spray it into the nare, it rapidly distributes the particles after breaking them down into smaller ones that are more easily absorbed (see Figure 2).³

Intranasal medication delivery can be a useful tool when dealing with children (see Table 2 for suggestions on when to consider intranasal delivery). Some tips that will allow for greater success include:

• Consider suctioning prior to administration if there is a lot of mucus present.
• Use small volumes .
• Use the highest concentration of medication available and do not dilute.

Use both nares to increase surface area Intranasal medications are a quick, safe, and relatively painless way to deliver analgesia and anxiolysis to pediatric patients. They are a great resource to have in your tool kit!

Dr. Sorrentino is professor of pediatrics in the division of emergency medicine at the University of Alabama at Birmingham.

References

1. Fortuna A, Alves G, Serralheiro A, et al. Intranasal delivery of systemic-acting drugs: small-molecules and biomacromolecules. Eur J Pharm Biopharm. 2014;88:8-27.
2. Grassin-Delyle S, Buenestado A, Naline E, et al. Intranasal drug delivery: an efficient and non-invasive route for systemic administration: focus on opioids. Pharmacol Ther. 2012;134:366-379.
3. Del Pizzo J, Callahan JM. Intranasal medications in pediatric emergency medicine. Pediatr Emerg Care. 2014;30:496-504.
4. Kaminsky BM, Bostwick JR, Guthrie SK. Alternate routes of administration of antidepressant and antipsychotic medications. Ann Pharmacother. 2015;49:808-817.
5. Chiaretti A, Barone G, Rigante D, et al. Intranasal lidocaine and midazolam for procedural sedation in children. Arch Dis Child. 2011;96:160-163.
6. Graudins A, Meek R, Egerton-Warburton D, et al. The PICHFORK (pain in children fentanyl or ketamine) trial: a randomized controlled trial comparing intranasal ketamine and fentanyl for the relief of moderate to severe pain in children with limb injuries. Ann Emerg Med. 2015;65:248-255.
7. Filho EM, Robinson F, de Carvalho WB, et al. Intranasal dexmedetomidine for sedation for pediatric computed tomography imaging. J Pediatr. 2015;166:1313-1315.
8. Tsze DS, Steele DW, Machan JT, et al. Intranasal ketamine for procedural sedation in pediatric laceration repair. Ped Emerg Care. 2012;28:767-770.
9. Yuen VM, Hui TW, Irwin MG, et al. A randomized comparison of two intranasal dexmedetomidine doses for premedication in children. Anaesthesia. 2012;67:1210-1216.