(SC) administration can also be an option for certain medications in patients without IV access Also, pain inflicted on the child must not be ignored; IV, IM, and SC routes are painful Oral medications can be a good option if there is no contraindication, however the onset of action can be delayed compared with other routes The intranasal (IN) delivery route has gained popularity IN drugs have several advantages, including faster absorption compared with oral or IM, no first-pass metabolism, and avoidance of a painful needle stick Some children find the nasal route noxious IN medications should be administered into the well-vascularized nasal vestibule Volumes of 0.3 mL or less are easily absorbed, while larger volumes may run off into the posterior pharynx Although IN medications can be administered by dripping, spray, and nebulization, the majority of recent studies have used atomization into each nostril to increase surface area and decrease swallowing of the drug The ideal medication for the IN route has a low molecular weight, is highly lipophilic, and has neutral pH Conditions that may affect IN drug absorption include presence of blood or nasal secretions, impaired ciliary function, or anatomical conditions such as polyps SEDATIVES The sedative/hypnotic agents include benzodiazepines, chloral hydrate, barbiturates, etomidate, propofol, and nitrous oxide (N2 O) Ketamine is considered a dissociative agent and has both sedative and analgesic properties Dexmedetomidine, an α2 -adrenoceptor agonist, also provides both sedation and analgesia The relative advantages and disadvantages of these agents are listed in Table 129.5 Benzodiazepines Some children who are undergoing painless procedures may be too young, anxious, or emotionally labile to remain still enough for the procedure to be successful Benzodiazepines can provide anxiolysis, sedation, muscle relaxation, and amnesia during frightening or painful procedures such as CT scans, echocardiography, and electroencephalography It is important to remember that these agents not provide any analgesia and should not be used alone for painful procedures Benzodiazepines depress all levels of the central