• Jonathan G Chang, Rebecca B Regen, Rahul Peravali, Sarah S Harlan, Matthew P Smeltzer, and Rudy J Kink.
• Le Bonheur Children's Hospital, Memphis, Tennessee; Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee; Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Arkansas Medical Sciences, Little Rock, Arkansas; Arkansas Children's Hospital, Little Rock, Arkansas.
• J Emerg Med. 2021 Dec 1; 61 (6): 731-739.

BackgroundAlthough the efficacy and safety profiles of both intranasal fentanyl and midazolam are well studied in pediatric patients, few studies examine their use in younger children.ObjectivesTo examine and report our experiences in a pediatric emergency department (ED) with intranasal fentanyl and midazolam in children aged 3 years and younger.MethodsThis retrospective study investigated intranasal fentanyl and midazolam administration, alone and in combination, in children 3 years and younger treated in a pediatric ED.ResultsOf 6198 patients included, 1762 received intranasal fentanyl alone, 1115 received intranasal midazolam alone, and 3321 received combination therapy. The median (interquartile range [IQR]) patient age was 2.2 (1.5-3) years. Initial median (IQR) fentanyl dose was 2.7 (2-3) µg/kg, with 13.3% receiving a repeat dose. Initial median (IQR) midazolam dose was 0.3 (0.2-0.3) mg/kg, with 3.3% receiving a second dose. Children receiving both fentanyl and midazolam had median (IQR) initial doses of 2.8 (2.1-3) µg/kg and 0.3 (0.2-0.3) mg/kg, respectively. Of these, 3.2% received repeat doses of both medications. Laceration repairs (33.8%) and incision and drainage (22.2%) accounted for the majority of indications. Only 2.9% (n = 178) received additional opioids. No serious adverse events requiring a reversal agent or respiratory support were reported.ConclusionsIntranasal fentanyl and midazolam, alone and in combination, can provide analgesia and anxiolysis to children aged 3 years and younger in the ED setting. Further prospective studies are needed to better evaluate their safety and efficacy in this younger population.Copyright © 2021 Elsevier Inc. All rights reserved.

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