Asish Panda

Solid-Nanoemulsion Preconcentrate for Oral Delivery of Paclitaxel: Formulation Design, Biodistribution, and γ Scintigraphy Imaging

Aim of present study was to develop a solid nanoemulsion preconcentrate of paclitaxel (PAC) using oil [propylene glycol monocaprylate/glycerol monooleate, 4 : 1 w/w], surfactant [polyoxyethylene 20 sorbitan monooleate/polyoxyl 15 hydroxystearate, 1 : 1 w/w], and cosurfactant [diethylene glycol monoethyl ether/polyethylene glycol 300, 1 : 1 w/w] to form stable nanocarrier. The prepared formulation was characterized for droplet size, polydispersity index, and zeta potential. Transmission electron microscopy (TEM), differential scanning calorimetry (DSC), X-ray diffraction (XRD), and Fourier transform infrared spectroscopy (FTIR) were used to assess surface morphology and drug encapsulation and its integrity. Cumulative drug release of prepared formulation through dialysis bag and permeability coefficient through everted gut sac were found to be remarkably higher than the pure drug suspension and commercial intravenous product (Intaxel), respectively. Solid nanoemulsion preconcentrate of PAC exhibited strong inhibitory effect on proliferation of MCF-7 cells in MTT assay. In vivo systemic exposure of prepared formulation through oral administration was comparable to that of Intaxel in γ scintigraphy imaging. Our findings suggest that the prepared solid nanoemulsion preconcentrate can be used as an effective oral solid dosage form to improve dissolution and bioavailability of PAC.

Ondansetron-induced headache in a parturient mimicking postdural puncture headache.

To the Editor, Ondansetron is widely used for prophylaxis and treatment of perioperative nausea and vomiting. We present an unusual case where postoperative headache was initially attributed to spinal anesthesia while, in retrospect, it was likely caused by ondansetron. Written consent was obtained from the patient to publish this case. A 26-yr-old primigravida was admitted to our hospital in labour. She was booked for emergency Cesarean delivery in view of cephalopelvic disproportion. Her history and physical examination were unremarkable and hematological investigations were within normal limits. The patient requested spinal anesthesia, and ranitidine 50 mg and metoclopramide 10 mg were given intravenously. Under aseptic conditions, a 27-G Whitacre spinal needle was inserted following a single attempt at the L3–L4 level, and 0.5% hyperbaric bupivacaine 10 mg was injected intrathecally. A sensory block to the T6 dermatome level was achieved. The surgery was completed uneventfully over the next 45 min, and the patient was sent to the postanesthesia care unit for further management. Postoperative analgesia was provided using intramuscular diclofenac. The patient’s vital signs remained stable, but at 12 hr postoperatively, she complained of nausea and vomiting. Ondansetron 6 mg iv was administered every 12 hr. Nausea and vomiting decreased, but at 14 hr postoperatively, she complained of severe headache with aggravation triggered by postural change. Her headache was in the frontal region; there was no associated fever or neck rigidity, and her total leukocyte count was normal. A provisional diagnosis of postdural puncture headache (PDPH) was made, and the patient was advised to lie supine and take plenty of oral fluids. Ondansetron was continued. However, she continued to complain of headache, and there was a marked aggravation of headache during the morning and the evening hours. A computed tomography scan of the patient’s head ruled out any intracranial pathology. We thought it might be an early and atypical presentation of PDPH. Caffeine tablets were prescribed but proved ineffective, and there was no symptomatic relief to the patient even at 90 hr postoperatively. Just before we decided to perform an epidural blood patch, her case was reviewed to rule out other causes of headache. Considering the aggravation of symptoms in the morning and evening coincident with administration of ondansetron, the drug was suspected as a possible cause. Therefore, ondansetron administration was discontinued. The patient improved dramatically within hours and recovered completely over the next 24 hr. She was discharged from the hospital after two days. Ondansetron is a selective antagonist at 5-HT3 receptors. Headache is one of the most common side effects of ondansetron, being reported in 3–17% of cases. Studies indicate that ondansetron-induced headache is dose dependent and responds well to discontinuation of the drug. Severe migraine-type headache has also been reported with use of ondansetron. The cause of headache is not known but has been postulated to be related to 5hydroxytryptamine dysfunction in the brain. In this case, the presentation and timing of headache made the diagnosis difficult and we confused it with PDPH. We therefore suggest that ondansetron-induced headache should be ruled out before making a diagnosis of PDPH and going ahead R. Sharma, MD (&) ESI Hospital, Rohini, New Delhi, India e-mail: rajeevkrsharmaji@gmail.com

Using a central venous pressure guidewire and suction catheter to facilitate oral to nasal tracheal tube change in a child with a difficult airway.

To the Editor:Oral to nasal tracheal tube change has been described using various techniques.1–3 We describe a simple and effective technique for oral to nasal tracheal tube change in a small child using a guidewire from a central venous pressure set and a suction catheter.A 1-yr-old, ASA Physical S

Sheath of guidewire of ureteric stent as an aid to extubation in difficult pediatric airway.

and the lightwand (3,8) are also useful selections to airway rescue. If the facemask ventilation is difficult or a patent airway can not be maintained after the failed laryngoscopic intubation, a laryngeal mask airway must firstly inserted and then the fiberoptic intubation is performed through it (9,10). 7 The SVL is not suitable for the patients with severe limited mouth opening. Because of a larger handle and integration of handle-blade, moreover, difficulty with insertion of the SVL blade into the mouth may occur in the patients with a severe limitation of head extension, especially when a Macintosh SVL blade is used.

Laryngeal web in an infant with ventricular septal defect: a case of misdiagnosed congestive heart failure

1 Gislason T, Benediktsdottir KR. Snoring, apneic episodes and nocturnal hypoxemia among children 6 months to 6 years old. Chest 1995; 107: 963–966. 2 Carroll JL, Mc Colley SA, Marcus CL et al. Inablitity of clinical history to distinguish primary snoring from obstructive sleep apnea in children. Chest 1995; 108: 610–618. 3 Ward SLD, Marcus CL. Obstructive sleep apnea in infants and young children. J Clin Neurophysiol 1996; 13: 198–207.

Anesthetic management of a patient with congenital diaphragmatic eventration

Congenital diaphragmatic eventration is uncommon in adults and is caused by paralysis, aplasia or atrophy of the muscular fibers of the diaphragm. It may cause severe dyspnea, orthopnea and hypoxia in adult patients. Most symptomatic patients may be managed efficiently without the need for surgical correction, although any event that leads to an increase in intra-abdominal pressure puts them at the risk of spontaneous diaphragmatic rupture. This case report presents the successful anesthetic management of an adult female with congenital diaphragmatic eventration undergoing diagnostic laparoscopy and hysteroscopy using a total intravenous anesthesia technique. Essential steps to prevent any rise in intrathoracic and intra-abdominal pressures along with care to minimize intragastric volume were taken.