Practice of administering drugs through the nose in the ER on the rise

Using the intranasal route to deliver medications is gaining popularity as an alternative to using intravenous therapy in emergency rooms, according to a paper published in Annals of Emergency Medicine.

The intranasal route involves administering medications through the patient's nose using a syringe with an atomizer device attached to it. The syringe pushes a fine mist of medications onto the inside surface of the patient's nose, allowing it to quickly reach the brain. The intranasal route does not require needles.

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For the paper, researchers examined the intranasal administration of five commonly used drugs in ERs:
•    Midazolam
•    Fentanyl
•    Naloxone
•    Ketamine
•    Dexmedetomidine

The paper authors discuss previous research that shows midazolam, naloxone and fentanyl can be safely and effectively administered through the nasal cavity. However, the evidence for intranasal ketamine and dexmedetomidine administration is less clear.

The authors also note the disadvantages of intranasal administration, including the fact that it is more expensive than IV medication administration — more commonly used in ERs.

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