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Gulfam M, Kim JE, Lee JM, Ku B, Chung BH, Chung BG. Anticancer drug-loaded gliadin nanoparticles induce apoptosis in breast cancer cells. LANGMUIR : THE ACS JOURNAL OF SURFACES AND COLLOIDS 2012; 28:8216-8223. [PMID: 22568862 DOI: 10.1021/la300691n] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Nanoscale drug carriers play an important role in regulating the delivery, permeability, and retention of the drugs. Although various carriers have been used to encapsulate anticancer drugs, natural biomaterials are of great benefit for delivery and controlled release of drugs. We used the electrospray deposition system to synthesize gliadin and gliadin-gelatin composite nanoparticles for delivery and controlled release of an anticancer drug (e.g., cyclophosphamide). The size profile and synthesis of nanoparticles was characterized by dynamic light scattering and X-ray diffractometry. Cyclophosphamide was gradually released from the gliadin nanoparticles for 48 h. In contrast, the gliadin-gelatin composite nanoparticles released cyclophosphamide in a rapid manner. Furthermore, we demonstrated that breast cancer cells cultured with cyclophosphamide-loaded 7% gliadin nanoparticles for 24 h became apoptotic, confirmed by Western blotting analysis. Therefore, the gliadin-based nanoparticle could be a powerful tool for delivery and controlled release of anticancer drugs.
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Affiliation(s)
- Muhammad Gulfam
- Department of Bionano Engineering, Hanyang University, Ansan, Korea
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Tho I. [Orally disintegrating tablets--advantages and drawbacks]. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2012; 132:424-5. [PMID: 22353836 DOI: 10.4045/tidsskr.10.1464] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Orally disintegrating tablets (ODT) or fast-melting tablets have gained appeal lately. ODT are tablets which disintegrate in the mouth within seconds without the need for additional liquid. This dosage form was originally developed to improve the compliance of patients who had difficulty in swallowing tablets, such as children, the elderly and bedridden patients. ODTs combine the advantages of solid dosage forms with those of liquid forms and appeal to broader groups of patients than originally expected. ODTs may prove to have higher bioavailability and an earlier pharmacological effect than conventional tablets. Technical challenges are related to taste masking, mechanical strength and stability to humidity.
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Affiliation(s)
- Ingunn Tho
- Institutt for farmasi, Universitetet i Tromsø, Norway.
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Rapidfilm®: An innovative pharmaceutical form designed to improve patient compliance. Int J Pharm 2010; 393:55-60. [DOI: 10.1016/j.ijpharm.2010.03.055] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Revised: 03/22/2010] [Accepted: 03/27/2010] [Indexed: 11/22/2022]
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Pirat A, Tuncay ŞF, Torgay A, Candan S, Arslan G. Ondansetron, orally disintegrating tablets versus intravenous injection for prevention of intrathecal morphine-induced nausea, vomiting, and pruritus in young males. Anesth Analg 2005; 101:1330-1336. [PMID: 16243989 DOI: 10.1213/01.ane.0000180830.12355.d9] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In this study we compared the efficacy of orally disintegrating tablets (ODT) and IV ondansetron for preventing spinal morphine-induced pruritus and postoperative nausea and vomiting (PONV) in healthy young male patients. Patients who received bupivacaine with 0.20 mg morphine for spinal anesthesia were randomly assigned to the ODT group (ODT ondansetron 8 mg, n = 50), the IV group (4 mg ondansetron IV, n = 50), or the placebo group (n = 50). Each individual was assessed for pruritus, postoperative nausea and vomiting, and pain at 0, 2, 6, 12, 18, and 24 h after surgery using three distinct visual analog scales. The frequencies of postoperative nausea and vomiting and frequencies of requirement for rescue antiemetic and antipruritic were recorded. There were no significant differences among the three groups with respect to incidence or severity of PONV or postoperative pain visual analog scale scores. The incidences of pruritus in the ODT (56%) and IV (66%) groups were significantly different from that in the placebo group (86%) (P < 0.02 for both). Only the ODT group had significantly lower mean pruritus visual analog scale scores at 0, 2, 6, and 12 h postsurgery than the placebo group (P < 0.023 for all). The frequency of requirement for rescue antipruritic was significantly less in the ODT group than the placebo group (P = 0.013). Both ODT ondansetron 8 mg and IV ondansetron 4 mg are more effective than placebo for preventing spinal morphine-induced pruritus, but neither form of this agent reduces spinal morphine-induced postoperative nausea and vomiting in this patient group.
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Affiliation(s)
- Arash Pirat
- Başkent University Faculty of Medicine, Department of Anesthesiology, Ankara, Turkey and Department of Anesthesiology, Air Force Hospital, Etimesgut, Ankara, Turkey
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Hartsell T, Long D, Kirsch JR. The efficacy of postoperative ondansetron (Zofran) orally disintegrating tablets for preventing nausea and vomiting after acoustic neuroma surgery. Anesth Analg 2005; 101:1492-1496. [PMID: 16244017 DOI: 10.1213/01.ane.0000181007.01219.38] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Postoperative nausea and vomiting is a frequent complication of craniotomy. We evaluated the ability of intraoperative IV ondansetron followed by postoperative ondansetron in an orally disintegrating tablet formulation to reduce the frequency and severity of postoperative nausea and vomiting in a prospective, randomized, placebo-controlled double-blind trial of 60 patients undergoing acoustic neuroma resection. Each patient received intraoperative ondansetron (4 mg IV) or placebo 30 min before case end. Postoperatively, patients received ondansetron in an orally disintegrating tablet formulation (8 mg BID) or placebo twice a day for up to 72 h. Metoclopramide was available as rescue therapy for both groups. Severity of nausea (as measured on a 10-cm visual scale), number of emetic episodes, and requirement for rescue therapy were recorded. In the immediate postoperative period, nausea severity was less in patients treated with ondansetron than placebo (3.3 +/- 4.1 versus 7.3 +/- 4.2; P < 0.001) and fewer patients experienced vomiting (3 of 28 versus 11 of 32; chi2 P < 0.01). More patients required some form of rescue treatment in the placebo group on the first postoperative day (26 of 32 versus 16 of 28; chi2 P < 0.01). We conclude that after acoustic neuroma surgery IV ondansetron treatment prevents immediate postoperative nausea and vomiting. Postoperative treatment with ondansetron in an orally disintegrating tablet formulation was associated with less frequent rescue therapy as compared with placebo on the first postoperative day.
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Affiliation(s)
- Theresa Hartsell
- *Departments of Anesthesiology and Critical Care Medicine and †Neurosurgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland
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Cohen IT, Joffe D, Hummer K, Soluri A. Ondansetron Oral Disintegrating Tablets: Acceptability and Efficacy in Children Undergoing Adenotonsillectomy. Anesth Analg 2005; 101:59-63, table of contents. [PMID: 15976206 DOI: 10.1213/01.ane.0000154186.03161.35] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Postoperative nausea and vomiting (PONV), a major complication in children, is responsive to IV and oral ondansetron. Because these routes are not always available, we studied the acceptability and efficacy of ondansetron oral disintegrating tablets (ODT). In this double-blind, randomized, placebo-controlled study, 62 patients undergoing adenotonsillectomy, aged 5 to 11 years, preoperatively received ODT (4 mg) or placebo. Patients assessed the medication for taste and sensation. Anesthesia was induced with sevoflurane, maintained with desflurane, and supplemented with fentanyl 2.5 microg/kg and dexamethasone 0.5 mg/kg (maximum dose, 12 mg). An observer blinded to treatment evaluated patients for pain, agitation, and PONV. Postoperative treatment consisted of fentanyl 1 microg/kg for pain and agitation and metoclopramide 0.15 mg/kg (maximum dose, 10 mg) for PONV. There were no significant differences between study groups with regard to age, weight, recovery time, agitation, or pain. Approximately 90% of the subjects found the ODT to taste good. No subject rejected the study medication, but the ondansetron-containing tablets were found to be less palatable than the placebo. The incidence of vomiting was significantly less in the ondansetron-medicated group.
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Affiliation(s)
- Ira Todd Cohen
- Department of Anesthesiology, Children's National Medical Center, 111 Michigan Ave. NW, Washington, DC 20010, USA.
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Herrstedt J, Koeller JM, Roila F, Hesketh PJ, Warr D, Rittenberg C, Dicato M. Acute emesis: moderately emetogenic chemotherapy. Support Care Cancer 2004; 13:97-103. [PMID: 15565276 DOI: 10.1007/s00520-004-0701-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2004] [Accepted: 08/26/2004] [Indexed: 11/25/2022]
Abstract
This paper is a review of the recommendations for the prophylaxis of acute emesis induced by moderately emetogenic chemotherapy as concluded at the Perugia Consensus Conference, which took place at the end of March 2004. The review focuses on new studies appearing since the last consensus conference in 1997. The following issues are addressed: dose and schedule of antiemetics, different groups of antiemetics such as corticosteroids, serotonin (5-HT(3))-receptor antagonists, dopamine D(2) receptor antagonists, and neurokinin (NK(1)) receptor antagonists. Antiemetic prophylaxis in patients receiving multiple cycles of moderately emetogenic chemotherapy is also reviewed. Consensus statements are given, including optimal dose and schedule of 5-HT(3)-receptor antagonists and of dexamethasone. The new 5-HT(3)-receptor antagonist, palonosetron, is a reasonable alternative to the well-established agents of this class--ondansetron, granisetron, tropisetron and dolasetron. It is concluded that the best prophylaxis in patients receiving moderately emetogenic chemotherapy is still the combination of one of the 5-HT(3)-receptor antagonists and dexamethasone. The results of studies adding a NK(1)-receptor antagonist to this combination are awaited and might change future recommendations.
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Affiliation(s)
- Jørn Herrstedt
- Department of Oncology 54 B1, Copenhagen University Hospital, DK-2730 Herlev, Denmark.
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Tyther R, O'Brien J, Wang J, Redmond HP, Shorten G. Effect of sevoflurane on human neutrophil apoptosis. Eur J Anaesthesiol 2003; 20:111-5. [PMID: 12622493 DOI: 10.1017/s0265021503000206] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVE Both chronic occupational exposure to volatile anaesthetic agents and acute in vitro exposure of neutrophils to isoflurane have been shown to inhibit the rate of apoptosis of human neutrophils. It is possible that inhibition of neutrophil apoptosis arises through delaying mitochondrial membrane potential collapse. We assessed mitochondrial depolarization and apoptosis in unexposed neutrophils and neutrophils exposed to sevoflurane in vivo. METHODS A total of 20 mL venous blood was withdrawn pre- and postinduction of anaesthesia, the neutrophils isolated and maintained in culture. At 1, 12 and 24 h in culture, the percentage of neutrophil apoptosis was assessed by dual staining with annexin V-FITC and propidium iodide. Mitochondrial depolarization was measured using the dual emission styryl dye JC-1. RESULTS Apoptosis was significantly inhibited in neutrophils exposed to sevoflurane in vivo at 24 (exposed: 38 (12)% versus control: 28 (11)%, P = 0.001), but not at 1 or 12 h, in culture. Mitochondrial depolarization was not delayed in neutrophils exposed to sevoflurane. CONCLUSIONS The most important findings are that sevoflurane inhibits neutrophil apoptosis in vivo and that inhibition is not mediated primarily by an effect on mitochondrial depolarization.
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Affiliation(s)
- R Tyther
- Cork University Hospital, Department of Anaesthesia and Intensive Care Medicine, Cork, Ireland
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Bouillon T, Bruhn J, Roepcke H, Hoeft A. Opioid-induced respiratory depression is associated with increased tidal volume variability. Eur J Anaesthesiol 2003; 20:127-33. [PMID: 12622497 DOI: 10.1017/s0265021503000243] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVE mu-agonistic opioids cause concentration-dependent hypoventilation and increased irregularity of breathing. The aim was to quantify opioid-induced irregularity of breathing and to investigate its time-course during and after an opioid infusion, and its ability to predict the severity of respiratory depression. METHODS Twenty-three patients breathing spontaneously via a continuous positive airway pressure (CPAP) mask received an intravenous (i.v.) infusion of alfentanil (2.3 microg kg(-1) min(-1), 14 patients) or pirinitramide (piritramide) (17.9 microg kg(-1) min(-1), nine patients) until either a cumulative dose of 70 microg kg(-1) for alfentanil or 500 microg kg(-1) for pirinitramide had been achieved or the infusion had to be stopped for safety reasons. Tidal volumes (VT) and minute ventilation were measured with an anaesthesia workstation. For every 20 breaths, the quartile coefficient was calculated (Qeff20V(T)). RESULTS Both the decrease of minute volume and the increase of Qeff20V(T) during and after opioid infusion were highly significant (P < 0.001, ANOVA). Patients in which the alfentanil infusion had to be terminated prematurely had lower minute volumes (P = 0.002, t-test) and higher Qeff20V(T) (P = 0.034, t-test) than those who received the complete dose. Changes in the regularity of breathing measured as Qeff20V(T) parallel those of minute ventilation during and after opioid infusion. CONCLUSIONS Opioids cause a more complicated disturbance of the control of respiration than a mere resetting to higher PCO2. Furthermore, Qeff20V(T) appears to predict the severity of opioid-induced respiratory depression.
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Affiliation(s)
- T Bouillon
- University of Bonn, Department of Anaesthesia and Critical Care Medicine, Bonn, Germany.
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Erolçay H, Yüceyar L. Intravenous patient-controlled analgesia after thoracotomy: a comparison of morphine with tramadol. Eur J Anaesthesiol 2003; 20:141-6. [PMID: 12622499 DOI: 10.1017/s0265021503000267] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND OBJECTIVE This study examined the quality of analgesia together with the side-effects produced by tramadol compared with morphine using intravenous patient-controlled analgesia during the first 24 h after thoracotomy. METHODS Forty-four patients scheduled for thoracotomy were included in the study. Morphine 0.3 mg kg(-1) was given interpleurally 20 min before a standard general anaesthetic. In the postanaesthetic care unit, the patients were randomly allocated to one of two groups to self-administer tramadol or morphine using a patient-controlled analgesia device throughout a 24 h period. The patient-controlled analgesia device was programmed to deliver tramadol 20 mg as an intravenous bolus or morphine 2 mg with a lockout time of 10 min. RESULTS Mean cumulative morphine and tramadol consumption were 48.13 +/- 30.23 and 493.5 +/- 191.5 mg, respectively. There was no difference in the quality of analgesia between groups. Five (26.3%) patients in the tramadol group and seven (33%) in the morphine group had nausea, and three of the latter patients vomited. The incidence rate of vomiting with tramadol was 5.2%. All vital signs were within safe ranges. Sedation was less in the tramadol group, but not statistically significant. CONCLUSIONS In this clinical setting, which includes interpleural morphine pre-emptively, postoperative analgesia provided by tramadol was similar to that of morphine at rest and during deep inspiration. Side-effects were slight and comparable between the patients receiving morphine and tramadol.
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Affiliation(s)
- H Erolçay
- Istanbul University, Cerrahpaşa Medical Faculty, Department of Anaesthesiology, Istanbul, Turkey
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Lehot JJ, Helou S, Bastien O. Survey of antibiotic prophylaxis in cardiac surgery. Eur J Anaesthesiol 2003; 20:166-7. [PMID: 12622505 DOI: 10.1017/s0265021503230301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Mikawa K, Akamarsu H, Nishina K, Shiga M, Obara H, Niwa Y. Effects of ropivacaine on human neutrophil function: comparison with bupivacaine and lidocaine. Eur J Anaesthesiol 2003; 20:104-10. [PMID: 12622492 DOI: 10.1017/s026502150300019x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND OBJECTIVE Neutrophils are important both for the immunological defence system and for the inflammatory tissue autoinjury mechanism. However, many local anaesthetics impair certain neutrophil functions. The aim was to assess the effects of ropivacaine, bupivacaine and lidocaine on human neutrophils from adult volunteers. METHODS Chemotaxis, phagocytosis, reactive oxygen species production, intracellular calcium ion ([Ca2+]i) concentrations and protein kinase C activity were measured in the absence and presence of ropivacaine, bupivacaine or lidocaine. The lowest concentrations of the local anaesthetics were similar to those clinically observed in the plasma. RESULTS Bupivacaine did not affect any neutrophil function (P > 0.05). Ropivacaine failed to change chemotaxis or phagocytosis, while lidocaine suppressed both these neutrophil functions. Ropivacaine (15, 150 microg mL(-1)) and lidocaine (20, 200 microg mL(-1)) impaired neutrophil production of O2-, H2O2 and OH- (P < 0.05) at similar rates (by 7-10%). These same concentrations of ropivacaine and lidocaine suppressed [Ca2+1i elevation. Finally, neither ropivacaine nor bupivacaine inhibited protein kinase C activity, while lidocaine did. CONCLUSIONS Suppression of the [Ca2+]i response in neutrophils by ropivacaine may represent one of the mechanisms responsible for the impairment of neutrophil functions. It should be emphasized that the inhibitory effects of ropivacaine are minor and are attained only at high concentrations, which may minimize the clinical implication of ropivacaine-associated impairment of reactive oxygen species production. Further studies using in vivo systems are required to identify the inhibitory effects of ropivacaine on reactive oxygen species production in clinical settings.
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Affiliation(s)
- K Mikawa
- Kobe University Graduate School of Medicine, Department of Anesthesia and Perioperative Medicine, Faculty of Medical Sciences, Kobe, Japan.
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Santanen OAP, Svartling N, Haasio J, Paloheimo MPJ. Neural nets and prediction of the recovery rate from neuromuscular block. Eur J Anaesthesiol 2003; 20:87-92. [PMID: 12622489 DOI: 10.1017/s0265021503000164] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVE The aim was to train artificial neural nets to predict the recovery of a neuromuscular block during general anaesthesia. It was assumed that the initial/early neuromuscular recovery data with the simultaneously measured physical variables as inputs into a well-trained back-propagation neural net would enable the net to predict a rough estimate of the remaining recovery time. METHODS Spontaneous recovery from neuromuscular block (electrically evoked electromyographic train-of-four responses) were recorded with the following variables known to affect the block: multiple minimum alveolar concentration, end-tidal CO2 concentration, and peripheral and central temperature. RESULTS The mean prediction errors, mean absolute prediction errors, root-mean-squared prediction errors and correlation coefficients of all the nets were significantly better than those of average-based predictions used in the study. The root-mean-squared prediction error of the net - employing minimum alveolar concentrations from the whole recovery period (the recovery time from E2/E1 = 0.30 to E4/E1 = 0.75; E1 = first response of train-of-four, E2 = second response of train-of-four, etc.)--were significantly smaller than those of other nets, or the same net employing minimum alveolar concentrations only from the initial recovery period (from E2/E1 = 0.30 to E4/E1 = 0.25). CONCLUSIONS Neural nets could predict individual recovery times from the neuromuscular block significantly better than the average-based method used here, which was supposed to be more accurate than guesses by any clinician. The minimum alveolar concentration was the only monitored variable that influenced the recovery rate, but it did not aid neural net prediction.
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Affiliation(s)
- O A P Santanen
- Helsinki University Central Hospital, Department of Anaesthesia and Intensive Care Medicine, Eye-ENT Clinic, Finland
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Heindl B, Reichle F, Becker BF. Sevoflurane but not isoflurane can reduce prostacyclin production of endothelial cells. Eur J Anaesthesiol 2003; 20:116-9. [PMID: 12622494 DOI: 10.1017/s0265021503000218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVE Little is known about the interaction of newer volatile anaesthetics with endothelial eicosanoid production. Sevoflurane may possibly reduce prostacyclin formation. Thus, we compared the influences of sevoflurane and isoflurane on endothelial prostacyclin production. METHODS Production of prostacyclin of human umbilical vein endothelial cells was measured by the ELISA technique under basal conditions and after stimulation with calcium ionophore A 23187 10 micromol or histamine 0.1 micromol in the absence and presence of 1 and 2 minimal alveolar concentrations (MAC) of sevoflurane or isoflurane. RESULTS The basal production of prostacyclin was unaffected by the volatile anaesthetics. Stimulation of endothelial cells increased prostacyclin formation 3-5-fold. Sevoflurane at 2 MAC, but not at 1 MAC, could reduce stimulated prostacyclin production by about half (P < 0.05). Isoflurane had no inhibitory effect. Inhibition of cyclo-oxygenase function by acetylsalicylic acid abolished the induced burst of prostacyclin formation completely. CONCLUSIONS Sevoflurane, but not isoflurane, can reduce stimulated endothelial prostacyclin production in a concentration-dependent manner. Because at least 2 MAC of sevoflurane were required, this effect should be of minor importance under clinical conditions of balanced anaesthesia.
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Affiliation(s)
- B Heindl
- Ludwig Maximilians University, Department of Anaesthesiology, Munich, Germany.
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Westphal M, Hohage H, Buerkle H, Van Aken H, Ermert T, Brodner G. Adsorption of sufentanil to epidural filters and catheters. Eur J Anaesthesiol 2003; 20:124-6. [PMID: 12622496 DOI: 10.1017/s0265021503000231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVE Stable drug concentrations must be administered to provide adequate patient-controlled epidural analgesia. This study investigated the stability of sufentanil after the epidural delivery system had been flushed with solutions containing the drug. METHODS Sufentanil citrate, 5 microg mL(-1) was injected through an epidural catheter system into a glass container. The concentrations of the drug leaving the system, in 1 mL aliquots (1-5 mL) were measured using high-performance liquid chromatography. In the same manner, sufentanil samples were analysed after flushing the filter, as well as after priming the filter and catheter. RESULTS ANOVA for repeated measurements demonstrated that sufentanil concentrations remained constant as long as the catheter had been adequately flushed. However, the concentration of sufentanil in the solution exiting the filter was reduced significantly. Hardly any sufentanil could be detected (0.09 +/- 0.01 microg mL(-1), P < 0.001) in the first 1 mL aliquot (probe) leaving the filter. Altogether, 3 mL sufentanil solution was needed to pass through the filter before the baseline values were restored (P > 0.05). The greatest decrease occurred when the whole epidural delivery apparatus (catheter and filter) was primed; to regain baseline values, as much as 4 mL solution was needed to flush the system. CONCLUSIONS Sufentanil citrate is adsorbed by the materials used to manufacture systems (catheters, filters) used in epidural anaesthesia. Hence, the epidural catheter system should be primed with sufentanil before connecting it to the patient so as to deliver reliable concentrations.
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Affiliation(s)
- M Westphal
- University of Münster, Department of Anesthesiology and Intensive Care, Münster, Germany.
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Harmon D, Rozario C, Lowe D. Nitrous oxide/oxygen mixture and the prevention of pain during injection of propofol. Eur J Anaesthesiol 2003; 20:158-61. [PMID: 12622502 DOI: 10.1017/s0265021503000292] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVE The incidence of pain associated with the injection of propofol still remains a problem. This study sought to examine the analgesic effects of inhaled nitrous oxide in oxygen on the prevention of propofol injection pain. METHODS Nitrous oxide in oxygen was compared with a lidocaine (20 mg)-propofol mixture and with propofol alone (control) in a prospective, randomized, observer-blinded study. ASA I and II patients (n = 135) scheduled for elective surgical procedures were studied. A standard propofol injection technique and scoring system to measure the pain on injection was used. RESULTS Demographic variables were similar between the study groups. Without analgesia (control) 26 of 45 patients (58%) reported pain on injection compared with 11 of 45 patients (24%) in both the nitrous oxide (95% CI: 14-52%, P = 0.001) and lidocaine groups (95% CI: 14-52%, P = 0.001). CONCLUSIONS The inhalation of a nitrous oxide/oxygen mixture significantly reduces the incidence of pain during propofol injection. This therapeutic stratagem was as effective as a lidocaine-propofol mixture.
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Affiliation(s)
- D Harmon
- University College Hospital, Department of Anaesthesia, Galway, Ireland.
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Ondansetron disintegrating tablets of 8 mg twice a day for 3 days did not reduce the incidence of nausea or vomiting after laparoscopic surgery. Eur J Anaesthesiol 2003. [DOI: 10.1097/00003643-200302000-00013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hanning CD, Blokland A, Johnson M, Perry EK. Effects of repeated anaesthesia on central cholinergic function in the rat cerebral cortex. Eur J Anaesthesiol 2003; 20:93-7. [PMID: 12622490 DOI: 10.1017/s0265021503000176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVE General anaesthesia may contribute to postoperative cognitive decline in the elderly. The aim was to determine the effects of repeated pentobarbital anaesthesia throughout life on central cholinergic function in the rat. METHODS Young Lewis rats were randomly allocated to two groups. The anaesthesia group (n = 15) was anaesthetized with pentobarbital 20 mg kg(-1) intraperitoneally at 6, 8.5, 11, 13.5, 16, 18.5, 21 and 23.5 months of age. The control group (n = 12) was treated identically, apart from the anaesthesia. At 26 months of age, the animals were killed and the brain dissected and stored for analysis. Central cholinergic function in the cortex and hippocampus was assessed by measuring [3H]-epibatidine and [125I]alpha-bungarotoxin binding to nicotinic receptors and choline acetyltransferase (ChAT) activity. RESULTS Tissue from nine rats in the anaesthesia group and eight in the control group was available for analysis. There was a significant reduction in alpha-bungarotoxin binding in the anaesthetized compared with the control group in the superior cortex (P < 0.0002) and molecular cortex (P < 0.04). There were no significant differences between the groups for epibatidine binding or ChAT. CONCLUSIONS Repeated anaesthesia in rat reduces central nicotinic cholinergic binding in the cortex. The findings may have implications for postoperative cognitive function studies.
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Affiliation(s)
- C D Hanning
- Leicester General Hospital, Department of Anaesthesia, Leicester, UK.
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von Knobelsdorff G, Höppner RM, Tonner PH, Paris A, Nienaber CA, Scholz J, Schulte am Esch J. Induced arterial hypotension for interventional thoracic aortic stent-graft placement: impact on intracranial haemodynamics and cognitive function. Eur J Anaesthesiol 2003; 20:134-40. [PMID: 12622498 DOI: 10.1017/s0265021503000255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVE The study investigated the impact of induced arterial hypotension for the facilitation of endovascular stent-graft placement in patients with thoracic aortic aneurysm on cerebral blood flow velocity and neurological/neurocognitive outcome. METHODS In 27 ASA III patients, cerebral blood flow velocity was recorded during induced arterial hypotension for endovascular stent-graft placement using transcranial Doppler sonography and the Folstein Mini Mental State Examination and the National Institute of Health Stroke Scale were performed before and after the intervention. RESULTS Mean arterial pressure was decreased <50 mmHg, and in 22 patients it was <40 mmHg. Diastolic cerebral blood flow velocity decreased by 59%. Postoperatively, six of 21 patients exhibited changes in the Folstein Mini Mental State Examination and four of these six patients in the National Institute of Health Stroke Scale as indices of new-found neurocognitive dysfunction, but there were no signs of stroke. Loss of the diastolic blood flow profile was detected in two of six patients with new-found neurocognitive dysfunctions and in 18 of 21 patients with no new-found neurocognitive dysfunction. Changes in the Folstein Mini Mental State Examination on postoperative day 1 were correlated to the pre-procedural Folstein Mini Mental State Examination, but not to the time spent with a mean arterial pressure <50 mmHg, <40 mmHg or with a loss of diastolic blood flow profile. CONCLUSIONS Transcranial Doppler sonography visualizes the individual effect of induced hypotension and the period of intracranial circulatory arrest during aortic stent-graft placement. However, transient new-found neurocognitive dysfunctions occur independently of the transcranial Doppler data, and are in close correlation to the neurocognitive state before the procedure. The results suggest that induced arterial hypotension is not the major factor for postoperative new-found neurocognitive dysfunction.
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Affiliation(s)
- G von Knobelsdorff
- University Hospital Hamburg-Eppendorf, Department of Anaesthesiology, Hamburg, Germany.
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Lebuffe G, Onimus T, Vallet B. Gastric mucosal-to-end-tidal PCO2 difference during major abdominal surgery: influence of the arterial-to-end-tidal PCO2 difference? Eur J Anaesthesiol 2003; 20:147-52. [PMID: 12622500 DOI: 10.1017/s0265021503000279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND OBJECTIVE Because gastric mucosal PCO2 must be referenced to arterial values via a gastric-to-arterial PCO2 gap (Pg-aCO2), the gastric-to-end-tidal PCO2 difference (Pg-ETCO2) may be proposed as a surrogate method to monitor Pg-aCO2. However, the influence of arterial-to-end-tidal PCO2 (Pa-ETCO2) on its value remains unknown. Pa-ETCO2 may be enhanced by a low cardiac output and subsequent reduced perfusion of the lungs. This study was designed to compare such gaps observed during abdominal surgery in patients with or without preoperative cardiac dysfunction. METHODS Haemodynamic, metabolic and tonometric variables were measured in seven patients with Crohn's disease and in five patients with chronic heart failure scheduled for abdominal surgery. Data were collected before skin incision (T0); at extractor placement (T1), 30 (T2) and 60 (T3) min later; at organ extraction (T4), 30 (T5) and 60 (T6) min later, and at the end of surgery (T7). RESULTS Gradients appeared larger in the cardiac group. The difference was significant for Pg-ETCO2 during the whole study period, while it was only reached at T1-T2 for Pa-ETCO2 and at T5-T6 for Pg-aCO2. Gaps did not change significantly over the peroperative time points in either group. No major haemodynamic variations were registered in either group. CONCLUSIONS In patients with preoperative chronic heart failure, Pg-ETCO2 remained constant throughout a major general surgical procedure and was only moderately influenced by the Pa-ETCO2 gap. In these patients, Pg-ETCO2 may be used as a reliable index of gastrointestinal perfusion after control of PaCO2.
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Affiliation(s)
- G Lebuffe
- Hôpital Claude Huriez, Département d'anesthésie-réanimation II, Centre Hospitalier Universitaire, Lille, France
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Anzawa N, Hirota K, Kitayama M, Kushikata T, Matsuki A. Fentanyl-mediated reduction in the bispectral index and 95% spectral edge frequency is age-dependent. Eur J Anaesthesiol 2003; 20:167-9. [PMID: 12622506 DOI: 10.1017/s0265021503240308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Kierzek G, Audibert J, Pourriat JL. Anaphylaxis after rocuronium. Eur J Anaesthesiol 2003; 20:169-70. [PMID: 12622507 DOI: 10.1017/s0265021503250304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Thagaard KS, Steine S, Raeder J. Ondansetron disintegrating tablets of 8 mg twice a day for 3 days did not reduce the incidence of nausea or vomiting after laparoscopic surgery. Eur J Anaesthesiol 2003; 20:153-7. [PMID: 12622501 DOI: 10.1017/s0265021503000280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVE Although many antiemetic drugs are available for intravenous use in the hospital setting, few are available after patient discharge. Consequently, nausea and vomiting are frequent complaints from patients at home after ambulatory surgery. We tested the hypothesis that the new 8 mg ondansetron disintegrating tablets will decrease the rate of nausea and vomiting at home after laparoscopic surgery. METHODS Ninety-six patients were studied in a randomized double-blind study. Starting the first evening after operation and continuing every 12 h for 3 days, patients received either placebo or ondansetron 8 mg disintegrating tablets orally. The patients returned a questionnaire about postoperative nausea and vomiting, other side-effects, e.g. dizziness, headache, nightmare, anxiety and pain, as well as their overall satisfaction at 24 and 72 h after completion of surgery. RESULTS The rates of nausea and vomiting were similar in the two groups, both during the first 24 h (28 versus 48%, placebo and ondansetron, respectively (ns) and during the 24-72 h (21 versus 35% (ns)). The incidence rate of vomiting was 8% (placebo) versus 12% (ondansetron) during the first 24 h (ns) and 9 versus 13% respectively in the 24-72 h (ns). No difference between groups was observed in overall satisfaction, incidence of postoperative pain or other side-effects. CONCLUSIONS The use of ondansetron disintegrating tablets of 8 mg twice a day for 3 days did not reduce the incidence of nausea and vomiting in patients undergoing outpatient laparoscopic surgery.
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Affiliation(s)
- K S Thagaard
- Ullevaal University Hospital, Department of Anaesthesia, Oslo, Norway
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O'Rourke J, Fahy C, Donnelly M. Subcutaneous emphysema at the site of central line placement due to the haematogenous spread of Clostridium septicum. Eur J Anaesthesiol 2003; 20:162-3. [PMID: 12622503 DOI: 10.1017/s0265021503210309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Turan A, Karamanlioğlu B, Memiş D, Pamukçu Z. Alternative application site of transdermal nitroglycerin and the reduction of pain on propofol injection. Eur J Anaesthesiol 2003; 20:170-2. [PMID: 12622508 DOI: 10.1017/s0265021503260300] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Villevieille T, Mercier F, Shannon PE, Auroy Y, Benhamou D. Efficacy of epidural analgesia during labour and delivery: a comparison between singleton vertex presentation, singleton breech presentation and twin pregnancies. Eur J Anaesthesiol 2003; 20:164-5. [PMID: 12622504 DOI: 10.1017/s0265021503220305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
BACKGROUND AND OBJECTIVE The effects of xenon on mesenteric vascular resistance have not been investigated. Because human beings anaesthetized with xenon show good cardiovascular stability, we believed that the agent would have little or no effect on vascular resistance in the splanchnic bed. We determined the effects of different inhaled xenon concentrations on mesenteric blood flow and mesenteric oxygen consumption in pigs sedated with intravenous propofol. METHODS Twenty-three minipigs were instrumented with transit time flow probes around the pulmonary and superior mesenteric arteries as well as with pulmonary artery and portal venous catheters. A 14 h recovery was allowed followed by recordings of baseline values. Xenon was then randomly administered in 0.30, 0.50, and 0.70 end-tidal fractions. RESULTS The administration of xenon resulted in an 8% (not dose dependent) decrease in mean arterial pressure (from 99 +/- 15 to 91 +/- 19 mmHg; P < 0.05), a 20% decrease in calculated systemic oxygen consumption (from 0.23 +/- 0.07 to 0.19 +/- 0.04L min(-1); P < 0.01), a 20% reduction in mesenteric oxygen delivery (from 41 +/- 12 to 33 +/- 11 mL min; P < 0.001), a 37% reduction in mesentericmetabolic rate of oxygen (from 11.3 +/- 3.6 to 7.1 +/- 3.2 mL min(-1); P < 0.01) and an 8% decrease in mesenteric artery blood flow (0.22 +/- 0.07 to 0.20 +/- 0.07 L min(-1); P < 0.05) in a dose-dependent fashion. Heart rate, cardiac output, systemic vascular resistance, mesenteric vascular resistance, mesenteric oxygen extraction fraction and portal lactate concentration were not significantly altered by xenon. CONCLUSIONS Xenon inhalation in the propofol-sedated pig had no measurable effects on mesenteric vascular resistance. This finding may partly explain the well-known cardiovascular stability observed in patients anaesthetized with xenon. Although mesenteric artery blood flow and mesenteric oxygen delivery decreased during xenon administration, unchanged mesenteric oxygen extraction fraction and portal lactate suggest that metabolic regulation of the splanchnic circulation remained unaltered.
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Affiliation(s)
- R Bogdanski
- Technische Universität München, Klinik für Anaesthesiologie, Munich, Germany
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Karasawa F, Okuda T, Tsutsui M, Matsuoka N, Yamada S, Kawatani Y, Satoh T. Dopamine stabilizes milrinone-induced changes in heart rate and arterial pressure during anaesthesia with isoflurane. Eur J Anaesthesiol 2003; 20:120-3. [PMID: 12622495 DOI: 10.1017/s026502150300022x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVE Phosphodiesterase-III inhibitors and dobutamine effectively improve cardiac function in patients with cardiac failure, but they are limited by possible hypotensive effects. We tested the hypothesis that dopamine contributes to stabilizing milrinone-induced haemodynamic changes. METHODS Nine patients undergoing major surgery were anaesthetized using nitrous oxide and oxygen supplemented with isoflurane 1-2%. After baseline haemodynamics were recorded, milrinone (25 or 50 microg kg(-1)) was administered over 10min, followed by a continuous infusion (0.5 microg kg(-1) min(-1). The second set of haemodynamic values was measured 50 min after beginning the continuous infusion of milrinone. Dopamine (4 microg kg(-1) min(-1)) was then administered with milrinone. RESULTS Milrinone significantly increased the heart rate from 81 +/- 8 to 102 +/- 16beats min(-1), but it decreased the mean arterial pressure from 83 +/- 10 to 66 +/- 10 mmHg and systemic vascular resistance (P < 0.05 for each). The pulmonary capillary wedge pressure, cardiac index and pulmonary vascular resistance did not change significantly. The addition of dopamine to the milrinone infusion significantly decreased the heart rate (94 +/- 12 beats min(-1)) and increased the mean arterial pressure (82 +/- 11 mmHg). Dopamine and milrinone, but not milrinone alone, significantly increased the cardiac index and the rate-pressure product. CONCLUSIONS The combination regimen of milrinone and dopamine improved cardiac function, and changes in heart rate and mean arterial pressure induced by milrinone were attenuated by dopamine. The results suggest that a combination regimen of milrinone and dopamine rather than milrinone alone should be used to maintain arterial pressure.
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Affiliation(s)
- F Karasawa
- National Defense Medical College, Department of Anaesthesiology, Saitama, Tokorozawa, Japan.
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Kraut L, Fauser AA. Anti-emetics for cancer chemotherapy-induced emesis: Potential of alternative delivery systems. Drugs 2002; 61:1553-62. [PMID: 11577793 DOI: 10.2165/00003495-200161110-00003] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Currently, the most commonly used routes of administration of antiemetics in chemotherapeutic regimens are oral and intravenous. Patient compliance and thus efficacy of conventional drug schedules and formulations are often impaired by difficulties associated with oral or intravenous uptake of the administered chemotherapy. Alternative or new drug delivery systems should overcome these problems by improving patient compliance. Several new drug delivery systems are available and development of these new systems is ongoing, in particular to meet delivery requirements of modern biological therapeutics and the application of gene therapy. However, at the present time, the implementation of new techniques of alternative antiemetic drug administration for chemotherapy-induced emesis is very limited. The challenge for clinical investigations to further develop new delivery systems, in particular for antiemetic therapies, remains.
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Affiliation(s)
- L Kraut
- Clinic of Bone Marrow Transplantation and Haematology/Oncology, Idar-Oberstein, Germany
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