I would've thought that the intranasal route would have much quicker absorption than the intramuscular route. We certainly see this effect with intranasal diamorphine. I'm not convinced the atomiser is strictly necessary however, although I suspect it may well lead to higher mucosal uptake by reducing the amount of fluid going down the back of the kid's throat (where it can be spat out or swallowed, neither of which are good for absorption)!
Adrian Fogarty
> from: Ray McGlone <[log in to unmask]>
> date: Sun, 03 Nov 2002 16:52:03
> to: [log in to unmask]
> subject: Re: Intra nasal midazolam for fits
>
> Nothing, that's the advantage of midazolam over diazepam and lorazepam. There just needs to be some large scale study comparing the 3 drugs. The intra-nasal route is more likely to be used by non-medics though.
>
> Emergency Medicine Journal 2001 , McGlone and Smith 18 (3): 234
>
> Ray McGlone
> ----- Original Message -----
> From: Shane Curran
> To: [log in to unmask]
> Sent: Sunday, November 03, 2002 4:43 AM
> Subject: Re: Intra nasal midazolam for fits
>
>
> What's wrong with intramuscular midazolam?
>
> Shane
> Wagga Wagga
> Australia
> -----Original Message-----
> From: Accident and Emergency Academic List [mailto:[log in to unmask]] On Behalf Of Ray McGlone
> Sent: Sunday, November 03, 2002 5:16 AM
> To: [log in to unmask]
> Subject: Intra nasal midazolam for fits
>
>
> http://www.wolfetory.com/mad100400order.html
>
> Had a 16 mth child into today who had been fitting continously since the 999 call. Rectal diazepam given by the paramedics had no effect. It was a stand by call so all the paediatric team (including senior and SpR) were there.
>
> I'd given intranasal midazolam and the fits had stopped whilst the team had still not managed to get iv access.
>
> The above web site is a firm making atomizers for drugs. The atomizer simply fits onto the syringe. My colleague Stuart Durham found out about them and they certainly work. The site also has an atomizer in the shape of a fish, but I think that is a bit OTT.
>
> It's a shame paramedics don't have access to this route particularly in rural areas like mine. In case anyone from JRCALC is reading this?????
>
>
> Ray McGlone
>
> A&E Consultant
>
> Morecambe Bay Hospitals NHS Trust
> http://www.mbha.nhs.uk/morecambe_bay_hospitals_trust.htm
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