Perioperative Rectal Administration of Nonopioid Analgesics

Pasero, Chris

doi:10.1016/j.jopan.2010.01.005

Cited by 3 publications

(2 citation statements)

References 22 publications

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“…A new device, the catheter, offers an alternative route via rectal mucosal absorption, which is a route long-known to be effective and easy to access [1][2][3][4][5][6][7][8][9][10][11] . Absorption through the rectal mucosa is generally rapid, with blood levels of many drugs attaining therapeutic levels rapidly, in part as a result of avoiding the first-pass effect.…”

Section: Introductionmentioning

confidence: 99%

A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings

Honasoge

Lyons

Hesse

et al. 2016

JoVE

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The available routes of administration commonly used for medications and fluids in the acute care setting are generally limited to oral, intravenous, or intraosseous routes, but in many patients, particularly in the emergency or critical care settings, these routes are often unavailable or time-consuming to access. A novel device is now available that offers an easy route for administration of medications or fluids via rectal mucosal absorption (also referred to as proctoclysis in the case of fluid administration and subsequent absorption). Although originally intended for the palliative care market, the utility of this device in the emergency setting has recently been described. Specifically, reports of patients being treated for dehydration, alcohol withdrawal, vomiting, fever, myocardial infarction, hyperthyroidism, and cardiac arrest have shown success with administration of a wide variety of medications or fluids (including water, aspirin, lorazepam, ondansetron, acetaminophen, methimazole, and buspirone). Device placement is straightforward, and based on the observation of expected effects from the medication administrations, absorption is rapid. The rapidity of absorption kinetics are further demonstrated in a recent report of the measurement of phenobarbital pharmacokinetics. We describe here the placement and use of this device, and demonstrate methods of pharmacokinetic measurements of medications administered by this method.

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Section: Introductionmentioning

confidence: 99%

A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings

Honasoge

Lyons

Hesse

et al. 2016

JoVE

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“…Absorption of fluids and medications by the rectal mucosa is well described, and has a long history of use, dating back to at least the early 1900s (Murphy, 1909 ; Trout, 1912 ; Nabil et al , 1982 ; Bruera et al , 1994 ; Needham, 1995 ; Zweig et al , 2006 ; Fouad et al , 2010 ; Pasero, 2010 ; Chiang et al , 2011 ). Because no sterility, complex training, or follow-up X-ray confirmation is required, this approach has also been utilized in both emergent and remote settings (Tremayne, 2010 ).…”

mentioning

confidence: 99%

First Use of a New Device for Administration of Buspirone and Acetaminophen to Suppress Shivering During Therapeutic Hypothermia

Honasoge

Parker

Wesselhoff

et al. 2016

Therapeutic Hypothermia and Temperature Management

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Therapeutic hypothermia or targeted temperature management has been used after cardiac arrest to improve neurological outcomes and mortality. However, a side effect of temperature modulation is a centrally mediated shivering response. The Columbia Anti-Shivering Protocol sets up a systematic method of intravenous (IV) and oral medication escalation to suppress this response and preserve the benefits of this therapy. We present the case of a 59-year-old male who began shivering after therapeutic hypothermia for cardiac arrest, leading to a persistent rise in core temperature despite adequate sedation. He was also found to have gastric contents similar to coffee grounds through nasogastric tube suction. The shivering was effectively suppressed and the rising core temperature plateaued using rectal acetaminophen and buspirone administered by means of a novel device, the Macy Catheter. Also, when used in conjunction with other protocol-driven medications, the patient was able to achieve a core temperature of 33°C. The Macy Catheter appears to be a useful approach to rectally administer buspirone and acetaminophen, using an easy-to-place, nonsterile atraumatic device that requires no radiographic confirmation of placement.

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An alternative for rapid administration of medication and fluids in the emergency setting using a novel device

Lyons¹,

Nejak²,

Lomotan³

et al. 2015

The American Journal of Emergency Medicine

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Routes of administration for medications and fluids in the acute care setting have primarily focused on oral, intravenous, or intraosseous routes, but, in many patients, none of these routes is optimal. A novel device (Macy Catheter; Hospi Corp) that offers an easy route for administration of medications or fluids via rectal mucosal absorption (proctoclysis) has recently become available in the palliative care market; we describe here the first known uses of this device in the emergency setting. Three patients presenting to the hospital with conditions limiting more typical routes of medication or fluid administration were treated with this new device; patients were administered water for hydration, lorazepam for treatment of alcohol withdrawal, ondansetron for nausea, acetaminophen for fever, aspirin for antiplatelet effect, and methimazole for hyperthyroidism. Placement of the device was straightforward, absorption of administered medications (judged by immediacy of effects, where observable) was rapid, and use of the device was well tolerated by patients, suggesting that this device may be an appealing alternative route to medication and fluid administration for a variety of indications in acute and critical care settings.

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Perioperative Rectal Administration of Nonopioid Analgesics

Cited by 3 publications

References 22 publications

A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings

A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings

First Use of a New Device for Administration of Buspirone and Acetaminophen to Suppress Shivering During Therapeutic Hypothermia

An alternative for rapid administration of medication and fluids in the emergency setting using a novel device

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