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Related Concept Videos

Parenteral Anesthetics: Overview01:24

Parenteral Anesthetics: Overview

Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
Inhalational Anesthetics: Overview01:20

Inhalational Anesthetics: Overview

Inhalation anesthetics are drugs that induce general anesthesia upon inhalation. They work by increasing the sensitivity of GABAA receptors or inhibiting NMDA receptors, leading to a decrease in central nervous system activity. The depth of anesthesia can be rapidly adjusted by changing the concentration of the inhaled gas. Some common examples of inhalational anesthetics include volatile liquids like isoflurane, desflurane, sevoflurane and gases like xenon and nitrous oxide. Isoflurane, a...
Drug Delivery: Enteral Route01:18

Drug Delivery: Enteral Route

The enteral drug administration involves three primary routes: oral, sublingual, and buccal. Oral ingestion is the most prevalent, safe, economical, and convenient method for drug administration. However, it has certain drawbacks, including limited absorption due to the drug's low water solubility or poor membrane permeability, possible emesis from GI mucosa irritation, destruction of drugs by digestive enzymes or low gastric pH, and irregular absorption along with food or other drugs.
Drugs in...
Drug Dosing: Infants and Children01:29

Drug Dosing: Infants and Children

Pediatric patient dosages diverge from adults due to disparities in body surface area, total body water, and extracellular fluid per kilogram of body weight. The dosing regimen considers the variations in pharmacokinetics and pharmacology across distinct age groups, encompassing preterm newborns, infants, young children, older children, and adolescents. Calculation of pediatric patient doses is predicated on determining body surface area, which exhibits a superior correlation with the child's...
Pharmacokinetics in Pediatric Patients: Drug Distribution01:17

Pharmacokinetics in Pediatric Patients: Drug Distribution

Drug distribution in the pediatric population exhibits unique challenges and considerations due to the physiological differences between children, particularly neonates and infants, and adults. A crucial aspect of pediatric pharmacology is understanding how these differences impact the pharmacokinetics of various drugs, necessitating age-specific dosing strategies to ensure efficacy and safety.Neonates and infants have a higher total body water content, ~75%–90% of their body weight, compared...
Pharmacokinetics in Pediatric Patients: Drug Excretion01:26

Pharmacokinetics in Pediatric Patients: Drug Excretion

In pediatric medicine, understanding the renal function and drug elimination nuances is crucial for administering safe and effective treatments. Newborns, in particular, display markedly slower renal functions than adults, profoundly affecting how drugs are cleared from their bodies. This slower drug clearance requires clinicians to extend the dosing intervals for many medications to prevent drug accumulation and toxicity while ensuring therapeutic efficacy.One key area where these adjustments...

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Related Experiment Video

Updated: Jul 7, 2026

Novel Methods for Intranasal Administration Under Inhalation Anesthesia to Evaluate Nose-to-Brain Drug Delivery
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Intranasal Versus Intramuscular Midazolam in Pediatric Seizure Control: A Systematic Review and Meta-Analysis.

Jonathan D Mohnkern1, Ayesha Khalid2, Marwa Ibrahim3

  • 1College of Medicine, SUNY Upstate Medical University, Syracuse, New York.

Prehospital Emergency Care
|April 17, 2026
PubMed
Summary

Intramuscular (IM) midazolam is more effective than intranasal (IN) midazolam for rapidly terminating pediatric seizures when intravenous access is unavailable. IM midazolam also reduces the need for additional seizure rescue therapies.

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Area of Science:

  • Pediatric Neurology
  • Emergency Medicine
  • Pharmacology

Background:

  • Rapid termination of pediatric seizures is crucial for neurological outcomes.
  • Benzodiazepines are first-line therapy, but intravenous (IV) access is often unavailable.
  • The optimal non-IV route for midazolam administration remains debated.

Purpose of the Study:

  • To compare intranasal (IN) and intramuscular (IM) midazolam for pediatric seizure control.
  • To determine which non-IV route offers more rapid and reliable seizure termination.

Main Methods:

  • A meta-analysis of studies comparing IN and IM midazolam in pediatric seizure patients.
  • Searched PubMed, Embase, and Cochrane Library.
  • Used random-effects models to calculate pooled risk ratios (RR) and mean differences (MD).

Main Results:

  • IM midazolam was associated with a lower likelihood of requiring rescue therapy (RR 1.29).
  • This association persisted in out-of-hospital settings and with recommended doses (0.2 mg/kg).
  • IM midazolam also showed a shorter time to seizure termination (MD 23.60 seconds).

Conclusions:

  • In settings without IV access, particularly prehospital environments, IM midazolam is superior to IN midazolam.
  • IM midazolam offers more rapid seizure termination and reduced need for rescue therapy.
  • IM midazolam is a reasonable first-line option for pediatric seizures when IV access is not feasible.