P4A221: Use of Intranasal Fentanyl and Midazolam in Children Admitted to the Hospital

Background: This study was performed to examine if intranasal (IN) fentanyl and midazolam are associated with adverse events in pediatric patients admitted to the hospital. While there is emerging data for its safety in the pediatric emergency department, this has not yet been established for the inpatient setting.

Methods: We conducted a retrospective chart review of patients receiving IN fentanyl, midazolam, and their combination at an urban, tertiary care hospital in the southeast ranging from 2014 to 2020. Their indications, dosages, patient characteristics and any adverse events were pulled for data analysis.

Results: A total of 161 patients were reviewed during the study period. The average patient's age was 6 years, ranging from 0 to 21 years (see table 1). 30 of patients were under the age 1, 44 between the ages of 1 and 4, 51 between the ages of 5 and 10, 33 between the ages of 11 and 18, and 3 between the ages of 19 and 21. Of the 161 patients, 42.86% were female and 57.14% were male. The main procedures in which IN fentanyl and midazolam were utilized were nasogastric tube, intravenous placement, peripherally inserted central catheter, lumbar puncture, and chest tubes (see graph 1). A total of 0 adverse events were documented. None of the patients studied required the reversal agent naloxone.

Conclusion: To our knowledge, this is the first study analyzing the use of IN fentanyl and midazolam in in-patient pediatric care centers. Our results suggest that IN fentanyl and midazolam can be safely administered in the absence of any notable adverse outcomes. Intranasal fentanyl and midazolam, both separately and when combined, can provide analgesia and anxiolysis to pediatric patients undergoing procedures. Importantly, they forgo the need to place a peripheral IV, which also saves time and resources. In addition, bedside procedures use up less hospital resources by avoiding use of procedure room and anesthesia personnel. We anticipate that this information will expand the application of IN fentanyl and midazolam in in-patient pediatric settings.