Route of administration.

Route of administration. The IM and IV routes display
similar risk of airway and respiratory adverse events and of
clinically important recovery agitation.2,3,28 However, the IM
route is associated with a higher rate of vomiting3,76 and a
longer recovery,70 and thus the literature supports preference for
IV administration in settings in which venous access can be
obtained rapidly with minimal upset to the child.2,3 The simple
and inexpensive IM route may be preferable in other settings.
The IV route is also advantageous for lengthy procedures
(20 minutes) in that it permits convenient repeated dosing.
IV access is also preferred for adults in the event of a clinically
important unpleasant recovery reaction because occasional
combativeness has been reported and midazolam can thus be
promptly administered.36,43 Although some physicians may
prefer having IV access as a precaution in case of an adverse
event, the evidence strongly supports similar safety between the
IV and IM routes,2,3,19,71,78 and there are no reported cases in
which IV access averted or would have averted an adverse
outcome.4,12,16 However, the expertise to promptly initiate IV
or, if necessary, intraosseous access should be immediately
available, as is typical in the ED.