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This was a retrospective, noninferiority analysis looking at patients 14 years old and younger treated for nontraumatic seizures by EMS with a midazolam dose of 0.1 mg/kg (regardless of route). There were just over 2000 patients with a median age of 6 years included in the study. Midazolam redosing occurred in 25% of patients who received intranasal midazolam versus only 14% who received midazolam via intramuscular, intravenous, or intraosseous routes.
Bottom line: In the prehospital setting, intranasal midazolam at a dose of 0.1 mg/kg was associated with an increased need to redose compared to other routes. This dose may be subtherapeutic for intranasal administration.
References
Denise Whitfield, Nichole Bosson, Amy H. Kaji & Marianne Gausche-Hill (2021) The Effectiveness of Intranasal Midazolam for the Treatment of Prehospital Pediatric Seizures: A Non-Inferiority Study, Prehospital Emergency Care, DOI: 10.1080/10903127.