Dealing with a crying and moving child who needs sedation for a laceration repair? Intranasal midazolam is a good sedative option but what dose do you choose? Learn more in this journal club episode where we talk about a recent study that evaluated the most effective dosing of intranasal midazolam.

This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Julia Marlow (pediatric hospitalist). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.

Follow us on Twitter/X @Pediagogypod, Instagram/Threads @pediagogy, Bluesky @pediagogypodcast.bluesky.social, and connect with us at [email protected] Points:

• Intranasal midazolam is a good non-invasive sedative option. It has similar plasma concentrations as intravenous administration because it bypasses first pass metabolism unlike oral administration. Onset of action is 20-30 minutes and can last 30-60 minutes.
• Dosing of intranasal midazalam for children is 0.2 - 0.5 mg/kg
• Based on the results of this study, 0.4 - 0.5 mg/kg of midazolam was found to provide more effective sedation without increased adverse events for the studied patient population (6 months - 7 years old with simple laceration)
• Always critically think through studies! This study had limitations including the narrow patient population (did not include children with autism or developmental delay, did not include children less than 6 months old, and had a small study sample size with n = 101)

Sources:

• Tsze DS, Woodward HA, McLaren SH, et al. Optimal Dose of Intranasal Midazolam for Procedural Sedation in Children: A Randomized Clinical Trial. JAMA Pediatr. Published online July 28, 2025. doi:10.1001/jamapediatrics.2025.2181 
• UpToDate “Pediatric procedural sedation: pharmacological agents”