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)