An exploratory emergency study found no significant difference in early plasma levels between two delivery methods. The small comparison did not establish clinical equivalence.
What was compared
Da Rosa and colleagues studied thirteen children with tonic-clonic status epilepticus in a Brazilian emergency department. Children received intranasal midazolam through an atomizer or rapid syringe instillation, with similar weight-adjusted doses.
Blood collection occurred approximately ten minutes after administration. Median concentrations were 148.8 ng/mL with syringe administration and 133.3 ng/mL with an atomizer; the reported comparison was not statistically significant.
A sampled level is not a complete exposure profile
One early blood collection cannot locate each child’s true peak or describe the full concentration–time curve. A nonsignificant result in thirteen children also cannot exclude clinically meaningful differences with adequate precision.
The study was exploratory and cross-sectional rather than a randomized equivalence trial. The authors noted incomplete information about seizure duration before treatment and called for further investigation of clinical outcomes.
Interpretive value
The paper provides preliminary concentration data from actual emergency use. It does not demonstrate equal seizure-termination rates, equal respiratory safety, or interchangeable devices for every formulation. A report should distinguish the measured plasma comparison from the broader clinical claims that would require a larger outcome study.
Source
Original analysis of the supplied paper: Seizure treatment in children can intranasal midazolam be used without an atomizer. Paper identifier: PMC12539848.
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