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Intranasal midazolam is a valuable sedative in children, but nasal burning and irritation make it difficult to use. Investigators in Italy prospectively evaluated the safety and efficacy of administering lidocaine spray before intranasal midazolam to alleviate nasal discomfort in 46 children (mean age, 18 months) undergoing painful or frightening procedures (e.g., intravenous line placements, intramuscular injections, echocardiography, dental extraction).
A puff of intranasal lidocaine (10 mg/puff) was administered to each nostril by the child's mother 60 seconds before the physician administered midazolam (0.5 mg/kg) in each nostril with a syringe connected to a mucosal atomizer. All children achieved a modified Ramsay sedation score of 1 (…