{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T15:41:26Z","timestamp":1791819686864,"version":"4.3.4"},"reference-count":27,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pediatr Emer Care"],"published-print":{"date-parts":[[2019,2]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>Children presenting with acute traumatic pain or in need of therapeutic or diagnostic procedures require rapid and effective analgesia and\/or sedation. Intranasal administration (INA) promises to be a reliable, minimally invasive delivery route. However, INA is still underused in Germany. We hence developed a protocol for acute pain therapy (APT) and urgent analgesia and\/or sedation (UAS). Our aim was to evaluate the effectiveness and safety of our protocol.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We performed a prospective observational study in a tertiary children's hospital in Germany. Pediatric patients aged 0 to 17 years requiring APT or UAS were included. Fentanyl, s-ketamine, midazolam, or combinations were delivered according to protocol. Primary outcome variables included quality of analgesia and\/or sedation as measured on age-appropriate scales and time to onset of drug action. Secondary outcomes were adverse events and serious adverse events.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>One hundred pediatric patients aged 0.3 to 16 years were enrolled, 34 for APT and 66 for UAS. The median time onset of drug action was 5 minutes (ranging from 2 to 15 minutes). Fentanyl was most frequently used for APT (n = 19). Pain scores decreased by a median of 4 points (range, 0-10;<jats:italic toggle=\"yes\">P<\/jats:italic>&lt; 0.0001). For UAS, s-ketamine\/midazolam was most frequently used (n = 25). Sedation score indicated minimal sedation in most cases. Overall success rate after the first attempt was 82%. Adverse events consisted of nasal burning (n = 2) and vomiting (n = 2). No serious adverse events were recorded.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>A fentanyl-, s-ketamine-, and midazolam-based INA protocol was effective and safe for APT and UAS. It should then be considered where intravenous access is impossible or inappropriate.<\/jats:p><\/jats:sec>","DOI":"10.1097\/pec.0000000000001017","type":"journal-article","created":{"date-parts":[[2017,1,25]],"date-time":"2017-01-25T23:58:14Z","timestamp":1485388694000},"page":"89-95","source":"Crossref","is-referenced-by-count":40,"title":["Intranasal Analgesia and Sedation in Pediatric Emergency Care\u2014A Prospective Observational Study on the Implementation of an Institutional Protocol in a Tertiary Children's Hospital"],"prefix":"10.1097","volume":"35","author":[{"given":"Marcus","family":"Nemeth","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nils","family":"Jacobsen","sequence":"additional","affiliation":[{"name":"University Department of Anesthesiology, Critical Care, Emergency and Pain Medicine, Klinikum Oldenburg, Oldenburg; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carsten","family":"Bantel","sequence":"additional","affiliation":[{"name":"University Department of Anesthesiology, Critical Care, Emergency and Pain Medicine, Klinikum Oldenburg, Oldenburg; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melanie","family":"Fieler","sequence":"additional","affiliation":[{"name":"Clinic for Anesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"S\u00fcmpelmann","sequence":"additional","affiliation":[{"name":"Clinic for Anesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Eich","sequence":"additional","affiliation":[{"name":"Anesthesia, Pediatric Intensive Care and Emergency Medicine, 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