Airway emergency during anaesthesia using a metered‐dose inhaler

Featherstone, Peter J; Abdelaal, Abdelrahman; Duane, Derek

doi:10.1111/j.1365-2044.2010.06570.x

Cited by 6 publications

(5 citation statements)

References 1 publication

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“…8 Additionally, creating in-line adapters via off-label use, such as placement of a pMDI canister inside a 50 ml syringe (Figure 2G) should be abandoned, as it can risk patient safety. 29…”

Section: "Mini-spacers" or "Universal/general Adaptors"-actuatorsmentioning

confidence: 99%

“…For example, the placement of a pMDI canister into a 50 ml syringe, which can risk patient safety, if the syringe was to fracture and fragments be inhaled. 29 Furthermore, use of a 50 ml syringe to deliver aerosol has been shown to be ineffective, as the valve cannot function as designed to produce the labeled claim dose. 8 To reduce this risk, increasingly, medications intended for use with nebulizers must specify which nebulizer they were tested with and many deviceonly products are recently being reclassified.…”

Section: Tre Atmentmentioning

confidence: 99%

“…In vitro testing showed no benefit of using a dual‐spray adapter or “mini‐spacer” when compared to a unidirectional spray adapter, and both devices were less efficient when compared to use of small‐volume in‐line spacers 8 . Additionally, creating in‐line adapters via off‐label use, such as placement of a pMDI canister inside a 50 ml syringe (Figure 2G) should be abandoned, as it can risk patient safety 29 …”

Section: Anesthetized Patientsmentioning

confidence: 99%

“…Therefore, a delivery device should not involve “off label” use of a drug‐device product, that is the use of the drug component of a drug‐device combination product with a different device to that it was packaged with or vice versa. For example, the placement of a pMDI canister into a 50 ml syringe, which can risk patient safety, if the syringe was to fracture and fragments be inhaled 29 . Furthermore, use of a 50 ml syringe to deliver aerosol has been shown to be ineffective, as the valve cannot function as designed to produce the labeled claim dose 8 …”

Section: Treatmentmentioning

confidence: 99%

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Aerosolized drug delivery in awake and anesthetized children to treat bronchospasm

Anderson

Clarke

Ungern‐Sternberg

2021

Pediatric Anesthesia

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Bronchospasm is a common respiratory adverse event in pediatric anesthesia. Firstline treatment commonly includes inhaled salbutamol. This review focuses on the current best practice to deliver aerosolized medications to awake as well as anesthetized pediatric patients and discusses the advantages and disadvantages of various administration techniques. Additionally, we detail the differences between various airway devices used in anesthesia. We highlight the unmet need for innovation of orally inhaled drug products to deliver aerosolized medications during pediatric respiratory critical events such as bronchospasm. It is therefore important that clinicians remain up to date with the best clinical practice for aerosolized drug delivery in order to prevent and efficiently treat pediatric patients experiencing life-threatening respiratory emergencies.

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“…8 Additionally, creating in-line adapters via off-label use, such as placement of a pMDI canister inside a 50 ml syringe (Figure 2G) should be abandoned, as it can risk patient safety. 29…”

Section: "Mini-spacers" or "Universal/general Adaptors"-actuatorsmentioning

confidence: 99%

Section: Tre Atmentmentioning

confidence: 99%

Section: Anesthetized Patientsmentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

See 2 more Smart Citations

Aerosolized drug delivery in awake and anesthetized children to treat bronchospasm

Anderson

Clarke

Ungern‐Sternberg

2021

Pediatric Anesthesia

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“…Not only is there no evidence that such approaches might achieve clinically useful drug delivery, there may also be risks. For example, the off‐label use of a Luer lock system in one patient resulted in damage to the device with fragments deposited within the patient's airway . In vitro , 19‐G catheters have been used attached to a 60‐ml syringe via a Luer lock in order to deliver steroids via pMDI, which allowed more than 50% of the volume of drugs (beclomethasone and triamcinolone) to exit the distal catheter tip .…”

Section: Impact Of Respiratory Support Equipment On Drug Deliverymentioning

confidence: 99%

Current options in aerosolised drug therapy for children receiving respiratory support

et al. 2017

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Inhalation of aerosolised medications are the mainstay of treatment for a number of chronic lung diseases and have several advantages over systemically-administered medications. These include more rapid onset of action for drugs such as β-adrenergic agonists when compared with oral medication, high luminal doses for inhaled antibiotics when used to treat endobronchial infection, and an improved therapeutic index compared with systemic delivery for these and other classes of drugs such as corticosteroids. The use of aerosolised drugs to treat patients whose tracheas are intubated is less well established, in part because systemic delivery via the intravenous route can be a simpler alternative for many drugs. Consequently, research in this area is largely limited to a number of in vitro studies and very few clinical trials. Unfortunately, a lack of focus in this area has resulted in a number of practices which at best are ineffective, and at worst dangerous for the patient. Although there have been some attempts to re-invigorate research in order to improve delivery systems, current devices are, to a great extent, based on long-standing technology developed more than 50 years ago. In this review, we explore current knowledge and provide guidance as to when and how the inhaled route may be of value when treating patients whose tracheas are intubated, and we set out the challenges facing those attempting to advance the topic. We conclude by reviewing current areas of interest that may lead to more effective and widespread use of aerosols in the treatment of intubated patients.

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