Which routes are listed for midazolam administration when IV access is challenging?

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When IV access is difficult, you rely on non-IV routes to achieve sedation without needing an IV line. Midazolam is available in several forms, but the two practical options that bypass IV access are intramuscular and intranasal administration. Intranasal midazolam offers rapid onset with a needle-free approach, which is particularly helpful in anxious or uncooperative children. Intramuscular midazolam provides a reliable alternative when intranasal administration isn’t suitable or available, though it may have a slower onset than the intranasal route. By comparison, an oral route can be unpredictable due to variable absorption, and IV administration clearly requires access to a vein, which defeats the purpose when IV access is not readily obtainable. Therefore, the routes listed for use when IV access is challenging are intramuscular and intranasal.