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PED-EM-L  July 2009

PED-EM-L July 2009

Subject:

Re: intranasal versed or fentanyl

From:

Garth Meckler <[log in to unmask]>

Reply-To:

Garth Meckler <[log in to unmask]>

Date:

Wed, 8 Jul 2009 10:45:02 -0700

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (53 lines)

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?
>
> Thanks,
>
> Paul Frandsen, MD
>
>
>
>
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