What are the routes of administration for sedation?

Updated: Nov 06, 2018
  • Author: Arul M Lingappan, MD; Chief Editor: Erik D Schraga, MD  more...
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Every patient responds differently to dose and type of sedative, and durations of action vary greatly among patients. The patient must be reassessed and the drug readministered as needed. To date, however, no guidelines are put forth in the medical literature.

In the ED, the ideal route of administration is intravenous. [1] Oral and intramuscular absorption may be unreliable and can often be delayed. With intravenous administration, the effect can be assessed fully, since time to peak effect can be predicted with reasonable accuracy. This can allow repeated dosing with much less chance of unexpected deterioration due to drug accumulation.

The intramuscular route may be an attractive alternative to intravenous administration, particularly in children. One study in children showed more effective sedation with intramuscular (using 4 times the IM dose compared to IV), but longer recovery times. Adverse respiratory events (including laryngospasm) did not increase, but the study was underpowered to detect a significant difference. [42] The longer recovery time for intramuscular administration was reproduced in a more recent prospective case series, along with more adverse events. [43] The apparently better efficacy of intramuscular ketamine and ease of administration compared to the intravenous route might be offset by more adverse events and longer recovery times.

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