Transmucosal sedation

Transmucosal sedation

  • Midazolam + lidocaine solution (off-licence drug in UK)


  • MAD device spray (special syringe with spongy tip to seal nostril)
  • Usually as induction before cannulation and IV sedation. Can be done alone as a sole procedure but needs to be administered by sedationist experienced in intravenous sedation
  • Warn patient re: very unpleasant taste, may get nose bleeding
  • Be quick and decisive, single ‘bolus’ spray, be calm and quiet, avoid unnecessary chat with patient following administration to induce sedation
  • Keep in mind the possibility of use reversal agent IV if necessary (very rarely)


  • much quicker onset that oral midazolam ! 10 mints after intranasal administration


  • Use the standarized MAD device (Mucosal Atomizing Device, image below)

MAD device (3)

20160314_082316_resized (2)