La somministrazione dei farmaci per via intranasale in ambito extra-ospedaliero: una revisione narrativa della letteratura [Intranasal drug administration in prehospital emergency setting: a narrative review of literature]

ABSTRACT Introduction: The pre-hospital emergency environment often requires a fast and highly effective pharmacological treatment of the patient; two qualities that do not always easily coexist. Literature considers the intravenous route the gold standard in emergencies because of its high effectiveness; however, establishing a venous access in a complex pre-hospital scenario could be challenging or impossible, causing a delay in the treatment. Furthermore, the risk for accidental needlestick injuries could be exacerbated in the agitatation of an emergency situation. The purpose of this review is to define how intranasal drug administration may represent an alternative route of administration in the pre-hospital emergency setting in terms of safety, efficacy, rapidity and ease of use. Methods: The search for bibliographic sources was carried out by consulting Medline’s database, CINHAL and Web of Science, from May to June 2021. The filters applied to research the articles were: English language and availability of full text. Results: Twenty-six articles were included for review. These articles offer a general overview of intranasal drug administration and analyze the possible use of this route in some medical emergencies: acute pain, seizures, opioid overdose and psychomotor agitation. Conclusions: Intranasal drug delivery represents an advantageous option in pre-hospital emergencies because of its high effectiveness, and the reduction of administration times. Moreover, it showed a high-safety profile for healthcare providers, since it doesn’t require the handling of needles thereby reducing needlestick injuries. Keywords: Administration; injections; intranasal; emergency medical services.