Airway emergency during anaesthesia using a metered‐dose inhaler ‐ I

Kusurkar, A.

doi:10.1111/j.1365-2044.2011.06771_1.x

Cited by 3 publications

(1 citation statement)

References 3 publications

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“…A variety of commercially manufactured adaptors exist for pMDI use in intubated patients. These include the Spirale DDS system (Armstrong Medical, Coleraine, Northern Ireland), which includes a collapsible spacer chamber designed to remain in the circuit , a variety of inline spacers from Trudell/Monaghan (Trudell Medical International, London, ON, Canada), a simple pMDI actuator without a chamber that can be introduced into the ventilator circuit (Intersurgical, Wokingham, UK) , and a single swivel tube inhaler (Jackson Allison Medical and Surgical Ltd., Auckland, New Zealand) . There is little in the literature regarding the performance of these devices in clinical practice and no data directly pertaining to children.…”

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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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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Inhaled and intravenous treatment in acute severe and life-threatening asthma

Sellers

2013

British Journal of Anaesthesia

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Management of life-threatening acute severe asthma in children and adults may require anaesthetic and intensive care. The inhaled route for drug delivery is not appropriate when only small respiratory gas volumes are shifted; the i.v. route may be associated with greater side-effects. Magnesium sulphate i.v. has a place in acute asthma management because it is a mild bronchodilator, and has a stabilizing effect on the atria which may attenuate tachycardia occurring after inhaled and i.v. salbutamol. If intubation and ventilation are required, a reduction in bronchoconstriction by any means before and during these procedures should reduce morbidity. This narrative review aims to show strengths and weakness of the evidence, present controversies, and forward opinions of the author. The review contains a practical guide to the setting up, use and efficiency of nebulizers, metered dose inhalers, and spacers (chambers). It also presents a commonsense approach to the management of severe asthmatics in whom delay in bronchodilatation would cause clinical deterioration. When self-inhaled agents have had no effect, i.v. drugs may help avoid intubation and ventilation. The review includes suggestions for the use of inhaled anaesthetics, anaesthetic induction, and brief notes on subsequent ventilation of the lungs.

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Proceedings of the Anaesthetic Research Society Meeting

2013

British Journal of Anaesthesia

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Airway emergency during anaesthesia using a metered‐dose inhaler ‐ I

Cited by 3 publications

References 3 publications

Current options in aerosolised drug therapy for children receiving respiratory support

Current options in aerosolised drug therapy for children receiving respiratory support

Inhaled and intravenous treatment in acute severe and life-threatening asthma

Proceedings of the Anaesthetic Research Society Meeting

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