Comparison of Administration of Midazolam via Intravenous Infusion with Nasal Atomizer in an Office-based Vasectomy Procedure Clinic

Background: This study compared administration of midazolam via intravenous route with nasal atomizer route for moderate sedation in an office-based vasectomy clinic. Methods: Patients were randomly assigned to one of two groups: midazolam given via traditional intravenous route or with a nasal atomizer. Outcomes were patient perception of anxiety with the drug deliver method, discomfort with administration, pain during the procedure, length of sedation effects. Medical personnel rated ease of use, efficacy, time to sedation and time to transport after procedure. Results: Patient surveys showed no significant differences between the administration groups for being anxious when seeing the delivery device, experiencing discomfort when the medication was given, length of sedation effects, and overall pain level experienced during the procedure. Nurses felt that patients experienced significantly more discomfort with drug delivery via the Nasal Atomizer, and that IV method of delivery provided significantly better sedation for the vasectomy procedure. The nurses did not rate the two delivery methods differently for ease of use, and there were no differences in the amount of Versed administered, the amount of time from the patient being brought the procedure room to the beginning of the procedure, or the amount of time until transport was called. Surgeon’s rating of delivery method efficacy showed no difference between the groups. Conclusion: Midazolam administered with a nasal atomizer device showed similar perceptions of sedation on patient and surgeon survey. Midazolam administration via nasal atomizer is an acceptable alternative for moderate sedation in an office-based vasectomy procedure for patients who desire a method that does not require an IV. Trial Registration: This study was registered at clinicaltrials.gov (clinical trial # NCT06449365).