Intranasal midazolam as an alternative to rectal diazepam for management of canine status epilepticus

Question In canine patients in status epilepticus, is intranasal midazolam as effective as rectal diazepam for controlling seizures? Clinical bottom line The category of research question was: Treatment. The number and type of study designs that were critically appraised were: One study was found—a multicentre randomised open-label clinical trial comparing intranasal midazolam and rectal diazepam in canine patients. Critical appraisal of the selected papers meeting the inclusion criteria collectively provide zero/weak/moderate/strong evidence in terms of their experimental design and implementation: Weak. The outcomes reported are summarised as follows… The study critically appraised in this summary indicated that intranasal midazolam is effective in achieving seizure control in canine patients, with tolerable safety margins. Mild adverse effects associated with benzodiazepine administration such as sedation and drowsiness were noted, but there were no reports of serious adverse events related to the use of intranasal midazolam. In view of the strength of evidence and the outcomes from the studies the following conclusion is made… Intranasal midazolam appears to be safe and effective for achieving seizure control in canine patients, both in terms of efficacy and speed of onset, and is a suitable first-line treatment option for status epilepticus, especially when intravenous access is not rapidly available. Patients should be monitored after drug administration for development of adverse effects, including sedation, sneezing, and nasal irritation. A nasal mucosal atomisation device may be used to enhance bioavailability of the drug, improving efficacy.