I agree with Dr. Corboy. We have used both IN versed and fentanyl.
Versed is acidic and stings quite a bit and seems to be poorly
tolerated by most patients. Furthermore, it comes as 5mg/mL at its
most concentrated which often results in high volume, when
administered in the 0.2 mg/kg recommended dose. IN fentanyl, on the
other hand, has worked well for us. We typically start with this as
our initial rapid-onset potent analgesic of choice prior to x-ray and
to facilitate IV placement. Fentanyl comes at concentrations up to
100mcg/mL and is neutral pH so has been well tolerated and effective.
We dose at 2 mcg/kg nasally.
Though there are other drawbacks (including higher incidence of
vomiting), we are now using low-dose IM ketamine (1-2 mg/kg) for
autistic or very anxious children and then place a PIV after they are
sedated with this for additional dosing or adjunct medications. With
this lower IM dose we have anecdotally found shorter recovery times
and we pre-treat all ketamine patients with ondansetron for vomiting.
Garth Meckler, MD, MSHS
Assistant Section Chief and Fellowship Director
Pediatric Emergency Medicine
Oregon Health & Science University
On Jul 8, 2009, at 8:04 AM, paul frandsen wrote:
> A quick question,
> During residency, we often used ketamine and propofol for sedation.
> At the new facility were I work, there are docs who like to use
> intranasal versed or fentanyl to avoid IV placement in the child.
> Do any of you have experience with this technique? Are you in favor
> or against?
> Paul Frandsen, MD
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