Intranasal sedation is a relatively new form of administering the sedative drug (Midazolam) without the need for an injection.
The drug is given into the nose from a spray pump. It passes through the nasal membranes and starts exerting is sedative effects on the brain in about 15 minutes.
The advantage over oral sedation is that the effect sets in faster, the dose is more controlled and it offers the possibility (at least in theory) to add slightly to the dose in case the effect is not deep enough. The possibility of adjusting the dose is however rarely used since it still is less accurate than with intravenous sedation.
Another advantage of intranasal sedation over oral sedation is that the risk of side-effects due to stomach contents or other medication is smaller. This is due to the fact that the drug does not have to pass through the stomach and does not undergo first-pass metabolism. First pass metabolism is a mechanism where the drugs, once they are absorbed by the stomach, go straight to the liver where they start to be broken down into inactive drugs before they get the chance to reach the brain or other target organs. The liver breaks down a lot of chemicals and the risk of drug interactions is therefore much higher when we take oral drugs. For this reason, intranasal drugs which bypass the liver at least initially are less likely to interact with other drugs compared with drugs taken by mouth.
The best and most accurate method of drug delivery is still the intravenous administration.
Intranasal sedation is a useful technique for needle phobics and for children who may have problems taking oral drugs.
The effect is the same as with intravenous or oral sedation and the pre- and post operative advice is exactly the same as for all sedation with benzodiazepines (Midazolam).
The disadvantage with intranasal or oral sedation is that reversal drugs in case of over-sedation still need to be given intravenously.