Chromophores in operative surgery: Current practice and rationalized development

BackgroundChromophore-containing molecules feature extensively in surgical practice, with synthetic dyes gaining popularity over endogenous optical adjuncts. New applications for chromophores in diagnostics and operative treatment exploit unique chemical structures suited for illuminating target tissues beyond the visual spectrum, ranging from ultraviolet (UV) to near-infrared (NIR). This review outlines the rationale for surgical chromophore application, the weaknesses and risks in each class of these compounds, and areas of foreseeable potential for employment of specialized contrast agents.MethodAn English-language literature search applied the following Boolean Search String: “dye OR Lake OR Stain OR chromophore” AND “tox$OR terato* OR carcino$ OR Allerg$OR surg$ OR clinic” using EMBASE, PUBMED, PUBMED central and OVIDSp, with back-referencing through Web of Knowledge™.ResultsBased on the primary literature, this study proposes a surgically relevant classification system of chromophores in current use, which facilitates risk/benefit consideration for the surgeon who employs them, and which facilitates clinically oriented development.ConclusionsThe next stage of development for optically active surgical adjuncts must address practical constraints whilst minimizing risks of adverse effects. Exploiting the technology's full potential also requires improvements in the usefulness of imagery equipment

Aseptic compounding in New Zealand and the use of still air boxes

Toward the end of the 1980s, the care of terminally ill patients in New Zealand moved from state-owned hospitals into community hospice settings. As a result, responsibility for the management of medicines for patients receiving palliative care also transferred to the community hospice environment. To meet the requirements of palliative care patients and to facilitate the compounding of sterile preparations, community pharmacists began to compound certain aseptic preparations with a Still Air Box, a unique apparatus that is an alternative to the more expensive and bulky laminar airflow cabinets

Quality, safety and efficacy in the 'off-label' use of medicines

Suitable dosage forms are not always available for specific patient populations and must be extemporaneously compounded. Extemporaneous preparation is the manipulation of drugs and excipients for a particular patient using traditional compounding techniques; these are referred to as 'off-label' and 'unlicensed' medicines. Off-label use can include altered doses, dosage forms or indications for use. Registered medicines are produced to internationally recognized standards of Good Manufacturing Practices. Within the pharmaceutical manufacturing industry, quality, safety and efficacy are enforced by regulatory legislations. In contrast, the responsibility for acceptable standards for the compounding of 'off-label' medicines falls on the prescriber, pharmacist or hospital nurse. Studies have been conducted by researchers from Australia and throughout Europe, highlighting the frequency of off-label use for paediatrics, with one study reporting that most extemporaneous preparations (29.6%) were for drugs required to treat metabolic diseases. Risks include compounding errors, adverse reactions to ingredients and excipients, and non-validated stability of the product. Sterile compounded products, including products for ophthalmic and palliative care, carry additional risks in these vulnerable patients. This paper provides an overview of off-label medicines highlighting biopharmaceutical, quality, safety and efficacy issues important to medical and allied health professionals