https://doi.org/10.4081/scenario.2022.512
Intranasal drug administration in the out-of-hospital setting: a narrative review of the literature
Submitted: 7 June 2022
Accepted: 7 June 2022
Published: 7 June 2022
Accepted: 7 June 2022
Abstract Views: 390
PDF (Italiano): 114
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
In the context of out-of-hospital emergencies, the need for timely but at the same time highly effective pharmacological treatment of the patient is common, two qualities that are not always easy to combine. The intravenous route is considered in the literature to be the gold standard in emergency settings because of its high efficacy, but finding venous access, in the complex and varied out-of-hospital environment, can be difficult or impossible, leading to delayed patient treatment. No less important is the issue related to accidental needle sticks, a critical issue that is exacerbated in the hectic moments of an emergency, especially in the precarious pre-hospital settings. The objective of this review is to understand how intranasal drug administration is an alternative route in the out-of-hospital setting in terms of efficacy, speed, ease of use and safety.
Claire Rickard, Peter O'Meara, Matthew McGrail et al. A randomized controlled trial of intranasal fentanyl vs intravenous morphine for analgesia in the prehospital setting. Am J Emerg Med. 2007 Oct;25(8):911-7. doi: 10.1016/j.ajem.2007.02.027.
Stephen J. Stapleton, Anna Maria Valdez, Marylou Killian et al. Clinical Practice Guideline: Intranasal Medication Administration. J Emerg Nurs. 2018 Jan;44(1):5.e1-5.e43. doi: 10.1016/j.jen.2017.11.003.
Meredith Borland, Ian Jacobs, Barbara King et al. A Randomized Controlled Trial Comparing Intranasal Fentanyl to Intravenous Morphine for Managing Acute Pain in Children in the Emergency Department. Ann Emerg Med. 2007 Mar;49(3):335-40. doi: 10.1016/j.annemergmed.2006.06.016.
Timothy R. Wolfe and Tony Bernstone. Intranasal Drug Delivery: An Alternative to Intravenous Administration in Selected Emergency Cases. J Emerg Nurs. 2004 Apr;30(2):141-7. doi: 10.1016/j.jen.2004.01.006.
Jared A. Schaefer, Tamara J. Mlekoday. Time to opioid administration after implementation of an intranasal fentanyl protocol. Am J Emerg Med. 2015 Dec;33(12):1805-7. doi: 10.1016/j.ajem.2015.08.050.
Anna Holdgate, Anthony Cao, Ka Mei Lo. The implementation of intranasal fentanyl for children in a mixed adult and pediatric emergency department reduces time to analgesic administration. Acad Emerg Med. 2010 Feb;17(2):214-7. doi: 10.1111/j.1553-2712.2009.00636.x.
Gary Andolfatto, Kelsey Innes , William Dick et al. Prehospital Analgesia With Intranasal Ketamine (PAIN-K): A Randomized Double-Blind Trial in Adults. Ann Emerg Med. 2019 Aug;74(2):241-250. doi: 10.1016/j.annemergmed.2019.01.048.
Megan A Rech, Brian Barbas, Whitney Chaney et al. When to Pick the Nose: Out-of-Hospital and Emergency Department Intranasal Administration of Medications. Ann Emerg Med. 2017 Aug;70(2):203-211. doi: 10.1016/j.annemergmed.2017.02.015.
Abby M Bailey, Regan A Baum, Karolyn Horn et al. Review of Intranasally Administered Medications for Use in the Emergency Department. J Emerg Med. 2017 Jul;53(1):38-48. doi: 10.1016/j.jemermed.2017.01.020.
Ahmed Belkouch, Saad Zidouh, Mostafa Rafai et al. Does intranasal fentanyl provide efficient analgesia for renal colic in adults?. Pan Afr Med J. 2015 Apr 24;20:407. doi: 10.11604/pamj.2015.20.407.6010.
Shachar Shimonovich, Roy Gigi, Amir Shapira et al. Intranasal ketamine for acute traumatic pain in the Emergency Department: a prospective, randomized clinical trial of efficacy and safety. BMC Emerg Med. 2016 Nov 9;16(1):43. doi: 10.1186/s12873-016-0107-0.
Michal Zelcer, Ran D Goldman. Intranasal midazolam for seizure cessation in the community setting. Can Fam Physician. 2016 Jul;62(7):559-61.
Daniel S Tsze, Sharon S Pan, Kerrin C DePeter et al. Intranasal hydromorphone for treatment of acute pain in children: A pilot study. Am J Emerg Med. 2019 Jun;37(6):1128-1132. doi: 10.1016/j.ajem.2019.03.013.
Gary Andolfatto, Elaine Willman, Daniel Joo et al. Intranasal ketamine for analgesia in the emergency department: a prospective observational series. Acad Emerg Med. 2013 Oct;20(10):1050-4. doi: 10.1111/acem.12229.
Billy Sin, Iain Jeffrey, Zachary Halpern et al. Intranasal Sufentanil Versus Intravenous Morphine for Acute Pain in the Emergency Department: A Randomized Pilot Trial. J Emerg Med. 2019 Mar;56(3):301-307. doi: 10.1016/j.jemermed.2018.12.002.
Jason Kendall, Ian Maconochie, Ian C K Wong et al. A novel multipatient intranasal diamorphine spray for use in acute pain in children: pharmacovigilance data from an observational study. Emerg Med J. 2015 Apr;32(4):269-73. doi: 10.1136/emermed-2013-203226.
Eric C Silverman, Karl A Sporer, Justin M Lemieux et al. Prehospital Care for the Adult and Pediatric Seizure Patient: Current Evidence-based Recommendations. West J Emerg Med. 2017 Apr;18(3):419-436. doi: 10.5811/westjem.2016.12.32066.
Mamta Kapoor, Tate Winter, Lev Lis et al. Rapid delivery of diazepam from supersaturated solutions prepared using prodrug/enzyme mixtures: toward intranasal treatment of seizure emergencies. AAPS J. 2014 May;16(3):577-85. doi: 10.1208/s12248-014-9596-5.
E. Lahat, M. Goldman, J. Barr et al. Comparison of intranasal midazolam with intravenous diazepam for treating febrile seizures in children: prospective randomised study. BMJ. 2000 Jul 8;321(7253):83-6. doi: 10.1136/bmj.321.7253.83.
Arpita Thakker, Preeti Shanbag. A randomized controlled trial of intranasal-midazolam versus intravenous-diazepam for acute childhood seizures. J Neurol. 2013 Feb;260(2):470-4. doi: 10.1007/s00415-012-6659-3.
Maija Holsti, Benjamin L Sill, Sean D Firth et al. Prehospital intranasal midazolam for the treatment of pediatric seizures. Pediatr Emerg Care. 2007 Mar;23(3):148-53. doi: 10.1097/PEC.0b013e3180328c92.
Kenneth Williams, Eddy S. Lang, Ashish R. Panchal et al. Evidence-Based Guidelines for EMS Administration of Naloxone. Prehosp Emerg Care. Nov-Dec 2019;23(6):749-763. doi: 10.1080/10903127.2019.1597955.
Erik D Barton, Christopher B Colwell, Timothy Wolfe et al. Efficacy of intranasal naloxone as a needleless alternative for treatment of opioid overdose in the prehospital setting. J Emerg Med. 2005 Oct;29(3):265-71. doi: 10.1016/j.jemermed.2005.03.007
Debra Kerr, Anne-Maree Kelly, Paul Dietze et al. Randomized controlled trial comparing the effectiveness and safety of intranasal and intramuscular naloxone for the treatment of suspected heroin overdose. Addiction. 2009 Dec;104(12):2067-74. doi: 10.1111/j.1360-0443.2009.02724.x
Ryan M Huebinger, Hashim Q Zaidi, Katie L Tataris et al. Retrospective Study of Midazolam Protocol for Prehospital Behavioral Emergencies. West J Emerg Med. 2020 Apr 21;21(3):677-683. doi: 10.5811/westjem.2020.3.45552
Patricia A Normandin, Stacia J Khorey, Margaret A Donahue et al. Use of Intranasal Ketamine for the Severely Agitated or Violent ED Patient. J Emerg Nurs. 2016 Jan;42(1):61-3. doi: 10.1016/j.jen.2015.09.017
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How to Cite
Izzo, L. L., Trapassi, S., & Righi, L. (2022). Intranasal drug administration in the out-of-hospital setting: a narrative review of the literature. Scenario® - Il Nursing Nella Sopravvivenza, 39(2), 11–17. https://doi.org/10.4081/scenario.2022.512
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