Complication of Intranasal Midazolum

The recent article by Theroux et al on the use of intranasal midazolam was interesting. The purpose of this letter is to share our experience regarding a complication associated with the use of this drug. The need for an ideal sedative for pediatric patients undergoing diagnostic and short surgical procedures is well established. In the past 5 years, the literature is replete with reports on the efficacy, ease of administration, and tolerance of intranasal midazolam. Currently, our group is also evaluating the efficacy of intranasal midazolam in pediatric patients (aged 2 to 12 years) undergoing upper endoscopy. Soon after beginning enrollment, however, it became apparent that intranasal midazolam causes intense burning, irritation, and lacrimation on instillation into the nares.