ABSTRACT
Objective@#We used paclitaxel and cisplatin, known to be effective in intraperitoneal chemotherapy, in a novel prototype of rotational intraperitoneal pressurized aerosol chemotherapy (RIPAC) and evaluated the pharmacokinetics, tissue concentrations, and toxicities in a pig model. @*Methods@#We developed RIPAC, including the nozzle with the conical pendulum motion, and used 10% of intravenous doses of paclitaxel and cisplatin. We used high-performance liquid chromatography followed by tandem mass spectrometry to analyze serum and tissue concentrations. We applied a non-compartment model to study pharmacokinetics to analyze the time-dependent serum concentrations measured before RIPAC to 48 hours. We evaluated the difference in tissue concentrations between twelve peritoneal regions by the modified peritoneal cancer index. For evaluating toxicities, we observed hepatic and renal function until 4 days after RIPAC. @*Results@#Six pigs underwent RIPAC using paclitaxel (n=3) and cisplatin (n=3). The peak serum concentration (Cmax) and the area under the curve were higher for cisplatin, while the time to the peak serum concentration (Tmax) was longer for paclitaxel. Moreover, the parietal peritoneum showed higher tissue concentrations than the visceral peritoneum, and the ratio of tissue to serum concentrations using Cmax was higher for paclitaxel (172.2–6,237.9) than for cisplatin (0.1–9.3). However, there were no renal and hepatic toxicities after RIPAC with paclitaxel or cisplatin. @*Conclusion@#Delayed absorption of paclitaxel sprayed by RIPAC into the peritoneum to the bloodstream may lead to higher tissue concentrations at different regions and lower serum concentrations than cisplatin.
ABSTRACT
BACKGROUND: Neck flexion risks endobroncheal intubation when the tracheal tube is not in the proper position. So accurate knowledge of upper airway length is required to prevent malpositioning of endotracheal tubes. Therefore we evaluated the length of various portions of upper airway in Korean adults (n=500) who had no abnormality of upper airway. METHODS: Five hundred patients, composed of 198 males and 302 females who underwent elective surgery, were included in this study. After endotracheal tube was placed under general anesthesia, we measured the distance from tube machine-end to upper incisor (value 1), from tube machine-end to inferior margin of cricothyroid membrane (value 2), and from tube machine-end to carina (value 3) by means of fiberoptic bronchoscopy. RESULTS: The mean length between upper incisor and inferior margin of cricothyroid membrane (value 2 - value 1) was 12.7 cm in males and 11.6 cm in females, while the mean length between superior margin of cricoid cartilage and carina (value 3 - value 2) was 12.9 cm in males and 11.3 cm in females. So the mean length between upper incisor and the mid portion of trachea was nearly 19.6 cm in males and 17.7 cm in females. CONCLUSIONS: We believe that, based on the findings in this study, the safety length for endotracheal tube fixation is 20 cm in Korean adult males and 18 cm in Korean adult females.