Stability of commonly nebulized drugs in heated and humid condition

Placement of nebulizer prior to heated humidifier has been reported to improve efficiency of aerosol delivery during ventilator support. Drugs nebulized in this position must travel through humidifier, rainout in reservoir and may be subjected to extended periods of heat up to 50°C. Toxic degradation may develop, posing potential risk to patient. The aim of this study was to evaluate chemical stability of commonly inhaled drugs administered to mechanically ventilated patients subjected to extended period of 50°C. Formulations of 8 comonly inhaled drugs were diluted to 50 mL total volume in water and exposed to 50oC for 7 days to simulate effect of heat in humidifier. High Performance Liquid Chromatography (HPLC) was performed before and after heating to determine drug stability and degradation. Drug integrity, color or pH changes were noted. Epinephrine, levalbuterol, tobramycin and colistin demonstrated>10% reduction in concentration but only acetylcysteine had additional peaks in HPLC chromatogram demonstrating potential degradation and possible production of by product. Changes in color were observed with epinephrine and acetylcysteine. All drugs retained their integrity after subjecting them to 50oC for 7 days except acetylcysteine. Acetylcysteine changed color and had new peak in HPLC chromatogram. Color change with epinephrine was not associated with any new peak in HPLC chromatogram. Further studies should determine whether acetylcysteine changes would result in any off gassing of vapor that might harm the patient. [Med-Science 2018; 7(2.000): 269-76

Investigating the Efficacy and Safety of Silymarin in Management of Hyperbilirubinemia in Neonatal Jaundice

Unconjugated hyperbilirubinemia (UCB) is one of the most common conditions in neonates. Conventional treatment consists of phototherapy and exchange ‎transfusion. Phototherapy is safe and effective but it has several disadvantages. Exchange ‎transfusion is associated with a significant morbidity and even mortality. That indicates the need to ‎develop an alternative pharmacological treatment strategies. It should be less invasive and at least as ‎effective and safe as phototherapy. Herbal therapy has recently received special attention. Silymarin herbal drug has laxative, antioxidant, anti-inflammatory, hepatic protective, regenerative and enhancing of glucoronidation activities. The study presented here aimed to investigate effect of Silymarin on duration of phototherapy. A prospective cohort trial performed on 170 full term healthy neonates with UCB, 85 received oral 3.75mg/kg of Silymarin twice daily plus phototherapy and 85 neonates received only phototherapy. Total serum bilirubin (TSB) was measured every 24h, Aspartate aminotransferase (AST), Alanine aminotransferase (ALT) and albumin were measured before and after therapy for both groups. The mean duration of phototherapy was found to be significantly reduced from 5.3 ± 0.82 days in the control group to 4.2 ± 0.76 days in Silymarin-treated group (p=0.001). ALT, AST are improved to normal levels significantly (p=.001) also albumin (p=0.005). Silymarin dose of 3.75mg/kg twice daily along with phototherapy was more effective than phototherapy alone in treating full term healthy neonates with UCB. [Med-Science 2013; 2(2.000): 575-90

Conscious sedation compared to general anesthesia for intracranial mechanical thrombectomy: A meta‐analysis

Abstract Introduction Endovascular therapy is the standard of care for severe acute ischemic stroke caused by large‐vessel occlusion in the anterior circulation, but there is a debate on the optimal anesthetic approach during this therapy. Meta‐analyses of observational studies suggest that general anesthesia increases disability and death compared with conscious sedation However, their results are conflicting. This meta‐analysis study was performed to assess the relationship between the effects of general anesthesia compared to conscious sedation during endovascular therapy for acute ischemic stroke. Methods Through a systematic literature search up to August 2020, 18 studies included 4,802 subjects at baseline with endovascular therapy for acute ischemic stroke and reported a total of 1,711 subjects using general anesthesia and 1,961 subjects using conscious sedation were found. They recorded relationships between the effects of general anesthesia compared to conscious sedation during endovascular therapy for acute ischemic stroke. Odds ratio (OR) or Mean differences (MD) with 95% confidence intervals (CIs) were calculated between the effect of general anesthesia compared to conscious sedation during endovascular therapy for acute ischemic stroke using the dichotomous or contentious methods with a random or fixed‐effect model. Results No significant difference were found between general anesthesia and conscious sedation during the endovascular therapy for acute ischemic stroke in functional independence at 90 days (OR, 0.78; 95% CI, 0.44–1.40, p = 40); successful recanalization at 24 hr (OR, 1.23; 95% CI, 0.62–2.41, p = 55); mortality at 90 days (OR, 1.36; 95% CI, 0.83–2.24, p = .22); interventional complication (OR, 1.24; 95% CI, 0.76–2.02, p = .40); symptomatic intracranial hemorrhage (OR, 0.64; 95% CI, 0.41–0.99, p = .05); aspiration pneumonia (OR, 0.96; 95% CI, 0.58–1.58, p = .87); and National Institute of Health Stroke Scale score after 24 hr (MD, 0.38; 95% CI, −1.15–1.91, p = .62); with relative relationship favoring general anesthesia only in decreasing the symptomatic intracranial hemorrhage. Conclusions General anesthesia has no independent relationship compared to conscious sedation during the endovascular therapy for acute ischemic stroke with a relative relationship favoring general anesthesia only in decreasing the symptomatic intracranial hemorrhage. This relationship encouraged us to recommend either anesthetic strategy during the endovascular therapy for acute ischemic stroke with no possible fear of higher complication

Wentylacja nieinwazyjna u pacjentów w zmienionym stanie świadomości. Przegląd kliniczny i uwagi praktyczne

Wentylacja nieinwazyjna odgrywa coraz większą rolę w leczeniu ostrej hipoksemicznej lub hiperkapnicznej niewydolności oddychania i ma wiele zalet w porównaniu z inwazyjną wentylacją mechaniczną. Do zalet tych zalicza się zachowanie mechanizmów obronnych dróg oddechowych, zmniejszoną potrzebę sedacji i zmniejszenie ryzyka powikłań związanych z intubacją dotchawiczą. Mimo niewątpliwych walorów wentylacji nieinwazyjnej istnieją również pewne przeciwwskazania do stosowania tej metody, jak na przykład ciężka encefalopatia. W niniejszym artykule przeglądowym przeanalizowano podstawy teoretyczne, dowody naukowe i wady stosowania wentylacji nieinwazyjnej u pacjentów z hiperkapnią lub bez hiperkapni, znajdujących się w stanie zaburzonej świadomości