The Effect of Topical Tranexamic Acid in Endoscopic Sinus Surgery: A Triple Blind Randomized Clinical Trial.

OBJECTIVE: Our aim is to evaluate the effect of topical tranexamic acid (TA) on bleeding and surgical quality field in the functional endoscopic sinus surgery (FESS). METHODS: A total of 74 patients who underwent FESS due to chronic rhinosinusitis were included. The patients were randomized into 2 groups. TA group (n = 37) received a topical cotton pledget soaked with TA and placebo (PL) group (n = 37) received a pledget soaked with saline solution. RESULTS: A significant effect was noted for the TA group versus the PL group in the grade 1 of the Boezaart scale at 35 minutes (4 for TA group and no case for PL group). This effect was absent for higher grades. We did not notice a significant effect between the 2 groups at 5 minutes. Blood loss was 359 ml in the TA group versus 441 ml in the PL group. No significant change was observed between the 2 groups concerning the blood parameters. No side effects were reported. CONCLUSION: Despite its safety when administrated locally and its low cost, TA provides limited effect on quality of surgical field after 35 minutes of the start of FESS in the patients with chronic rhinosinusitis. This effect was absent at the start of the intervention and when analyzing the blood loss and hematologic parameters.

Effect of age factors on pharmacodynamics of intranasal dexmedetomidine for sedation in pediatric patients undergoing transthoracic echocardiography / 中华麻醉学杂志

Objective:To evaluate the effect of age factors on the pharmacodynamics of intranasal dexmedetomidine for sedation in the pediatric patients undergoing transthoracic echocardiography(TTE).Methods:American Society of Anesthesiologists Physical Status classification Ⅰ-Ⅲ pediatric patients, aged 1-24 months, undergoing TTE from August 2019 to May 2022, were selected. This trial was performed in two parts. Part Ⅰ Pediatric patients were divided into 4 age groups: 1-6 month group, 7-12 month group, 13-18 month group and 19-24 month group. The initial dose of dexmedetomidine was 2.0 μg/kg in 0.1 μg/kg increment/decrement. The dose of dexmedetomidine was determined by using modified Dixon′s up-and-down method. The ED 50 and 95% confidence interval of intranasally administered dexmedetomidine for sedation were calculated by the Dexon-Massey method. Part Ⅱ One hundred patients were divided into 4 age groups ( n= 25 each): 1-6 month group, 7-12 month group, 13-18 month group and 19-24 month group. The 4 groups were further divided into 5 subgroups ( n=5 each) according to the dose of dexmedetomidine: 2.1 μg/kg subgroup, 2.2 μg/kg subgroup, 2.3 μg/kg subgroup, 2.4 μg/kg subgroup, and 2.5 μg/kg subgroup. Part Ⅰ and part Ⅱ trials were combined, and the ED 95 and 95% confidence interval of intranasally administered dexmedetomidine for sedation were calculated using the probit method. Results:A total of 220 pediatric patients were enrolled. There was no significant difference in ED 50 and ED 95 of dexmedetomidine intranasally administered for sedation among groups ( P>0.05). Conclusions:The pharmacodynamics of intranasal dexmedetomidine for sedation shows no significant difference in age in the pediatric patients aged 1-24 months undergoing TTE.

Comparison of Sinus Deposition from an Aqueous Nasal Spray and Pressurised MDI in a Post-Endoscopic Sinus Surgery Nasal Replica.

BACKGROUND: Optimising intranasal distribution and retention of topical therapy is essential for effectively managing patients with chronic rhinosinusitis, including those that have had functional endoscopic sinus surgery (FESS). This study presents a new technique for quantifying in vitro experiments of fluticasone propionate deposition within the sinuses of a 3D-printed model from a post-FESS patient. METHODS: Circular filter papers were placed on the sinus surfaces of the model. Deposition of fluticasone on the filter paper was quantified using high-performance liquid chromatography (HPLC) assay-based techniques. The deposition patterns of two nasal drug delivery devices, an aqueous nasal spray (Flixonase) and metered dose inhaler (Flixotide), were compared. The effects of airflow (0 L/min vs. 12 L/min) and administration angle (30° vs. and 45°) were evaluated. RESULTS: Inhaled airflow made little difference to sinus deposition for either device. A 45° administration angle improved frontal sinus deposition with the nasal spray and both ethmoidal and sphenoidal deposition with the inhaler. The inhaler provided significantly better deposition within the ethmoid sinuses (8.5x) and within the maxillary sinuses (3.9x) compared with the nasal spray under the same conditions. CONCLUSION: In the post-FESS model analysed, the inhaler produced better sinus deposition overall compared with the nasal spray. The techniques described can be used and adapted for in vitro performance testing of different drug formulations and intranasal devices under different experimental conditions. They can also help validate computational fluid dynamics modelling and in vivo studies.

Development and Optimization of Chitosan Nanoparticle-Based Intranasal Vaccine Carrier.

Chitosan is a natural polysaccharide, mainly derived from the shell of marine organisms. At present, chitosan has been widely used in the field of biomedicine due to its special characteristics of low toxicity, biocompatibility, biodegradation and low immunogenicity. Chitosan nanoparticles can be easily prepared. Chitosan nanoparticles with positive charge can enhance the adhesion of antigens in nasal mucosa and promote its absorption, which is expected to be used for intranasal vaccine delivery. In this study, we prepared chitosan nanoparticles by a gelation method, and modified the chitosan nanoparticles with mannose by hybridization. Bovine serum albumin (BSA) was used as the model antigen for development of an intranasal vaccine. The preparation technology of the chitosan nanoparticle-based intranasal vaccine delivery system was optimized by design of experiment (DoE). The DoE results showed that mannose-modified chitosan nanoparticles (Man-BSA-CS-NPs) had high modification tolerance and the mean particle size and the surface charge with optimized Man-BSA-CS-NPs were 156 nm and +33.5 mV. FTIR and DSC results confirmed the presence of Man in Man-BSA-CS-NPs. The BSA released from Man-BSA-CS-NPs had no irreversible aggregation or degradation. In addition, the analysis of fluorescence spectroscopy of BSA confirmed an appropriate binding constant between CS and BSA in this study, which could improve the stability of BSA. The cell study in vitro demonstrated the low toxicity and biocompatibility of Man-BSA-CS-NPs. Confocal results showed that the Man-modified BSA-FITC-CS-NPs promote the endocytosis and internalization of BSA-FITC in DC2.4 cells. In vivo studies of mice, Man-BSA-CS-NPs intranasally immunized showed a significantly improvement of BSA-specific serum IgG response and the highest level of BSA-specific IgA expression in nasal lavage fluid. Overall, our study provides a promising method to modify BSA-loaded CS-NPs with mannose, which is worthy of further study.

Efficacy of auricular acupoint pressure therapy combined with intranasal dexmedetomidine for transthoracic echocardiography in pediatric patients / 中华麻醉学杂志

Objective:To evaluate the efficacy of auricular acupoint pressure therapy combined with intranasal dexmedetomidine for transthoracic echocardiography in pediatric patients.Methods:A total of 117 pediatric patients with congenital heart disease, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, aged 3-36 months, weighing 5-20 kg, scheduled for elective transthoracic echocardiography under outpatient sedation, were selected.Transthoracic echocardiography was performed under sedation using intranasally administered dexmedetomidine or using auricular acupoint pressure therapy combined with intranasal dexmedetomidine.The interval between the two sedation methods was at least 1 week.Intranasal dexmedetomidine: Dexmedetomidine 3 μg/kg was administered to both nostrils via a nebulizer, with 1/2 dose in each nostril.Intranasal dexmedetomidine combined with auricular acupoint pressure: auricular acupressure with Wang Bu Liu Xing (semen vaccariae) seeds was used at the auricular acupoints.After each acupoint was rubbed for about 1 min, dexmedetomidine 3 μg/kg was administered to both nostrils via a nebulizer, with 1/2 dose in each nostril.After the examination, auricular acupoint pressure therapy was continued at home, and pressing-rubbing at the acupoints was manipulated for 3 times daily, one of which was performed at 30 min before going to bed, for 3 consecutive days.When the University of Michigan Sedation Scale score≥2 and body movement score ≥2 within 30 min after giving dexmedetomidine, sedation was considered to be successful.The onset time of sedation, examination time, waiting time, recovery time and the success of sedation were recorded.The incidence of adverse reactions such as bradycardia, hypotension, hypertension, hypoxemia, nausea and vomiting, respiratory depression, restlessness, hyperactivity, action imbalances and allergic reaction were recorded within 24 h after administration of dexmedetomidine.Time to recovery and improvement of sleep quality at night were recorded.Results:Compared with intranasal dexmedetomidine, the successful rate of sedation and incidence of improvement of sleep quality at night were significantly increased ( P<0.05), and no significant change was found in adverse reactions using intranasal dexmedetomidine combined with auricular acupoint pressure ( P>0.05). Conclusion:Intranasal dexmedetomidine combined with auricular acupoint pressure therapy can increase the successful rate of sedation and improve the sleep quality at night in pediatric patients undergoing transthoracic echocardiography when compared to intranasal dexmedetomidine.

Efficacy of combination of intranasal dexmedetomidine and esketamine for preoperative sedation in pediatric patients with congenital heart diseases / 中华麻醉学杂志

Objective:To evaluate the efficacy of combination of intranasal dexmedetomidine and esketamine for preoperative sedation in pediatric patients with congenital heart disease.Methods:Fifty American Society of Anesthesiologists physical status Ⅱ or Ⅲ pediatric patients, aged 1-3 yr, undergoing elective cardiac surgery for left-to-right shunt type congenital heart diseases, were divided into dexmedetomidine group (group D, n=25) or dexmedetomidine combined with esketamine group (group DK, n=25) using a random number table method.Dexmedetomidine 3.9 μg/kg was intranasally delivered in group D. Dexmedetomidine 3.3 μg/kg combined with esketamine 2 mg/kg was intranasally administered in group DK.The Children′s Hospital of Wisconsin Sedation Scale score, SpO 2, HR, and pulmonary artery systolic pressure (PAP) were recorded before and at 30 min after administration, and the rate of decrease in SpO 2, HR and PAP after administration was calculated.The onset time of sedation and occurrence of adverse effects such as nausea and vomiting, bradycardia and respiratory depression during sedation were recorded. Results:Inadequate sedation and over-sedation were not observed in either group.Compared with group D, Children′s Hospital of Wisconsin Sedation Scale scores were significantly decreased at 30 min after administration, the onset time of sedation was shortened, and the decrease rate of HR was decreased in group DK ( P<0.05), and there were no significant changes in HR, SpO 2 and PAP before and after administration ( P>0.05). In group DK, nausea and vomiting occurred in 2 cases, but the symptoms were mild and no medication intervention was needed.No other adverse effects such as bradycardia and respiratory depression were found in either group. Conclusion:Combination of intranasal dexmedetomidine and esketamine can optimize the efficacy of preoperative sedation in pediatric patients with congenital heart disease, esketamine may induce nausea and vomiting, and the fasting time should be strictly controlled during sedation.

Topical intranasal fluorescein to localize a cerebrospinal fluid leak: a demonstration.

BACKGROUND: Intrathecal fluorescein is commonly used to localize cerebrospinal fluid leaks. This technique is invasive and associated with several potential adverse effects. The purpose of this video presentation is to demonstrate an alternative technique, the intranasal use of dilute topical fluorescein, to localize a cerebrospinal fluid leak intraoperatively. METHODS: A 45-year-old male with a history of benign intracranial hypertension and 2 months of right-sided rhinorrhea underwent surgical repair of a cerebrospinal fluid leak. Topical fluorescein was applied intraoperatively to localize the defect. RESULTS: At 1- and 3-month follow-ups the patient was without cerebrospinal fluid rhinorrhea and the middle turbinate flap was intact. CONCLUSION: Topical application of dilute intranasal fluorescein is a feasible and efficient tool for localizing cerebrospinal fluid leaks.

Sedation and analgesia effect of intranasal drip with dexmedetomidine in induced abortion / 中国医师进修杂志

Objective To study the sedation and analgesia effect of intranasal drip with dexmedetomidine in induced abortion.Methods Three hundred patients scheduled underwent induced abortion from April 2014 to January 2015 in the Second Affiliated Hospital of Dalian Medical University were selected.The patients were divided into P group,DP group and SP group by random digits table method with 100 cases in each group.The patients of P group received 0.9％ sodium chloride intranasal drip and 0.9％ sodium chloride and propofol intravenous injection,the patients of DP group received dexmedetomidine intranasal drip and 0.9％ sodium chloride and propofol intravenous injection,the patients of SP group received 0.9％ sodium chloride intranasal drip and sufentanil and propofol intravenous injection.The operation time,oxytocin dose,recovery time,recovery to leave the operating bed time,recovery to discharge time,blood loss,quality of aspirated tissue,propofol additional dose,propofol total dose,uterine contraction pain score,adverse reactions,satisfaction rate of doctors,satisfaction rate of patients and satisfaction rate of hand operation conditions were compared among 3 groups.Results There were no statistical differences in operation time,recovery time,recovery to leave the operating bed time,recovery to discharge time,quality of aspirated tissue and incidence of adverse reactions among 3 groups (P＞0.05).The blood loss,oxytocin dose,propofol additional dose and propofol total dose in DP group were significantly lower than those in P group and SP group:(5.0 ± 3.2) ml vs.(7.5 ± 3.8) and (10.0 ± 3.4) ml,(7.0 ± 3.3) U vs.(10.0 ± 3.1) and (12.0 ± 2.9) U,(0.52 ± 0.02) mg/kg vs.(0.81 ± 0.04) and (0.75 ± 0.02) mg/kg,(1.5 ± 0.3) mg/kg vs.(2.8 ± 0.4) and (2.6 ± 0.5) mg/kg,there were statistical differences (P＜0.05).The uterine contraction pain score immediate postoperative,postoperative 15 min and postoperative 30 min in DP group was significantly lower than that in P group and SP group:(3.1 ± 0.2) scores vs.(5.1 ± 0.9) and (3.9 ± 0.3) scores,(3.0 ± 0.6) scores vs.(5.0 ± 0.7) and (3.8 ± 0.8) scores,(2.8 ± 0.3) scores vs.(5.0 ± 0.5)and (3.3 ± 0.4) scores,the score in SP group was significantly lower than that in P group,and there were statistical differences (P＜0.05).The satisfaction rate of doctors,satisfaction rate of patients and satisfaction rate of hand operation conditions in DP group were significantly higher than those in P group and SP group:95.0％ (95/100) vs.10.0％ (10/100) and 60.0％ (60/100),75.0％ (75/100) vs.15.0％ (15/100) and 65.0％ (65/100),90.0％ (90/100) vs.30.0％ (30/100) and 80.0％ (80/100),the satisfaction rates in SP were significantly higher than those in P group,and there were statistical differences (P＜0.05).Conclusions Sedation with intranasal drip dexmedetomidine (1 μg/kg) provides effective antianxiety,reduces dose of propofol and blood loss in induced abortion.Compared with propofol or propofol combined with sulfentanil,dexmedetomidine intranasal drip combined with propofol intravenous injection has higher satisfaction scores of patients and doctors,and no obvious adverse reactions.

Magnetic resonance imaging evaluation of the distribution of spray and irrigation devices within the sinonasal cavities.

BACKGROUND: Optimizing intranasal distribution and retention of nasal sprays is essential in the management of patients with chronic rhinosinusitis (CRS), including those that have had functional endoscopic sinus surgery (FESS). Despite multiple existing distribution studies, there remains a need for a technique that allows regionalization of particle deposition within a patient's unique 3-dimensional (3D) geometry without exposing the patient to radiation. METHODS: Seven participants delivered normal saline containing a gadolinium-based contrast agent (GBCA) by either saline irrigation or nasal sprays on 1 side of the nasal cavity. The saline irrigation group included 2 participants (both healthy) while the nasal spray group included 5 participants (2 healthy, 2 post-FESS patients, 1 CRS patient without any sinus surgery). The distribution of new signal enhancement was assessed on each participant using magnetic resonance imaging (MRI). Serial scans were performed over an interval of 4 minutes in the nasal spray group to assess changes in intranasal distribution over time. RESULTS: Signal enhancement was widespread within the nasal cavities and maxillary sinuses of participants (both healthy) that underwent sinus irrigation. For the nasal spray participants, the hotspots for signal enhancement were similar regardless of disease status or previous history of surgery. These included the internal nasal valve, anterior septum, inferior surface of the inferior turbinate, nasal floor, and nasopharynx. No signal enhancement was detected with nasal sprays in either unoperated or operated paranasal sinuses. CONCLUSION: A technique has been developed using MRI evaluation of radioopaque contrast to characterize the temporospatial distribution of topical drug delivery within the sinonasal cavities.

Pre-hospital intranasal analgesia for children suffering pain: a rapid evidence review.

INTRODUCTION: Pre-hospital analgesic treatment of injured children is suboptimal, with very few children in pain receiving analgesia. Studies have identified a number of barriers to pre-hospital pain management in children which include the route of analgesia administration. The aim of this review is to critically evaluate the pre-hospital literature, exploring the safety and efficacy of intranasal (IN) analgesics for children suffering pain. METHODS: We performed a rapid evidence review, searching from inception to 17 December 2018, CINAHL, MEDLINE and Google Scholar. We included studies of children < 18 years suffering pain who were administered any IN analgesic in the pre-hospital setting. Our outcomes were effective pain management, defined as a pain score reduction of ≥ 2 out of 10, safety and rates of analgesia administration. Screening and risk of bias assessments were performed in duplicate. We performed a narrative synthesis. RESULTS: From 310 articles screened, 23 received a full-text review resulting in 10 articles included. No interventional studies were found. Most papers reported on the use of intranasal fentanyl (INF) (n = 8) with one reporting IN ketamine and the other IN S-ketamine. Narrative synthesis showed that INF appeared safe and effective at reducing pain; however, its ability to increase analgesia administration rates was unclear. The effectiveness, safety and ability of IN ketamine and S-ketamine to increase analgesia administration rates were unclear. There was no evidence for IN diamorphine for children in this setting. CONCLUSION: Interventional studies are needed to determine with a higher confidence the effectiveness and safety of IN analgesics (fentanyl, ketamine, S-ketamine, diamorphine) for children in the pre-hospital setting.

Intranasal Administration of Oxytocin Attenuates Stress Responses Following Chronic Complicated Stress in Rats

BACKGROUND/AIMS: Gastrointestinal (GI) symptoms may develop when we fail to adapt to various stressors of our daily life. Central oxytocin (OXT) can counteract the biological actions of corticotropin-releasing factor (CRF), and in turn attenuates stress responses. Administration (intracerebroventricular) of OXT significantly antagonized the inhibitory effects of chronic complicated stress (CCS) on GI dysmotility in rats. However, intracerebroventricular administration is an invasive pathway. Intranasal administration can rapidly deliver peptides to the brain avoiding stress response. The effects of intranasal OXT on hypothalamus-pituitary-adrenal axis and GI motility in CCS conditions have not been investigated. METHODS: A CCS rat model was set up, OXT 5, 10, or 20 μg were intranasal administered, 30 minutes prior to stress loading. Central CRF and OXT expression levels were analyzed, serum corticosterone and OXT concentrations were measured, and gastric and colonic motor functions were evaluated by gastric emptying, fecal pellet output, and motility recording system. RESULTS: Rats in CCS condition showed significantly increased CRF expression and corticosterone concentration, which resulted in delayed gastric emptying and increased fecal pellet output, attenuated gastric motility and enhanced colonic motility were also recorded. OXT 10 μg or 20 μg significantly reduced CRF mRNA expression and the corticosterone concentration, OXT 20 μg also helped to restore GI motor dysfunction induced by CCS. CONCLUSION: Intranasal administration of OXT has an anxiolytic effect and attenuates the hypothalamus-pituitary-adrenal axis in response to CCS, and gave effects which helped to restore GI dysmotility, and might be a new approach for the treatment of stress-induced GI motility disorders.

Applications of dexmedetomidine by nasal spray during pediatric anesthesia / 中国医师杂志

Dexmedetomidine (DEX) is an α2 adrenalin-receptor agonist with potent sedation,analgesia,anti-anxiety and anti-sympathetic effect.Moreover,DEX exert no inhibition of respiratory function with high safety and has considerable clinical application prospect.Children often experience emergency agitation (EA) and other uncomfortable symptom which is associated with special physical and mental state.Thus,an ideal pediatric anesthetic premedication is getting a lot of attention.DEX is superior to other premedication in sedation with high safety.Compared with others,DEX by nasal spray is an ideal drug delivery method to reduce the side effects and facilitate the implementation of the drug.The relevant research progress of the effective dose,efficacy and safety will be reviewed.

Applications of dexmedetomidine by nasal spray during pediatric anesthesia / 中国医师杂志

Dexmedetomidine (DEX ) is an α2 adrenalin-receptor agonist with potent sedation, analgesia, anti-anxiety and anti-sympathetic effect. Moreover, DEX exert no inhibition of respiratory function with high safety and has considerable clinical application prospect. Children often experience emergency agitation (EA) and other uncomfortable symptom which is associated with special physical and mental state. Thus, an ideal pediatric anesthetic premedication is getting a lot of attention. DEX is superior to other premedication in sedation with high safety. Compared with others, DEX by nasal spray is an ideal drug delivery method to reduce the side effects and facilitate the implementation of the drug. The relevant research progress of the effective dose, efficacy and safety will be reviewed.

Effect of Intranasal Sedation Using Ketamine and Midazolam on Behavior of 3-6 Year-Old Uncooperative Children in Dental Office: A Clinical Trial.

OBJECTIVES: The aim of the present study was to compare the effects of intranasal ketamine and midazolam on behavior of 3-6 year-old children during dental treatments. MATERIALS AND METHODS: In this randomized cross-over clinical trial, 17 uncooperative children requiring at least two dental treatments were selected and randomly received ketamine (0.5mg/kg) or midazolam (0.2mg/kg) prior to treatment. The other medication was used in the next visit. The children's behavioral pattern was determined according to the Houpt's scale regarding sleep, movement, crying and overall behavior. Physiological parameters were also measured at different time intervals. The data were subjected to Wilcoxon Signed Rank test and two-way repeated measures ANOVA. RESULTS: The frequency of crying decreased significantly following ketamine administration compared to midazolam (P=0.002); movement of children decreased with fewer incidence of treatment interruption (P=0.001) while their sleepiness increased (P=0.003). Despite higher success of sedation with ketamine compared to midazolam, no significant differences were found between the two regarding patients' overall behavior (P>0.05). The patients had higher heart rate and blood pressure with ketamine; however, no significant difference was found regarding respiratory rate and oxygen saturation (P>0.05). CONCLUSIONS: Ketamine (0.5mg/kg) led to fewer movements, less crying and more sleepiness compared to midazolam (0.2mg/kg). No significant differences were found between the two drugs regarding children's overall behavior and sedation efficiency. Both drugs demonstrated positive efficacy for sedation of children during dental treatments.

Intranasal sedation using ketamine and midazolam for pediatric dental treatment (NASO): study protocol for a randomized controlled trial.

BACKGROUND: Uncooperative children may need to receive dental treatment under sedation, which is indicated when nonpharmacological behavior guidance is unsuccessful. There are randomized controlled trials (RCTs) comparing different sedative protocols for dental procedures; however, the evidence for superiority of one form over another is weak. The primary aim of this study is to investigate the efficacy of intranasally administered ketamine plus midazolam for the dental treatment of children. METHODS: We have designed a three-armed, parallel RCT to assess intranasal sedation using ketamine/midazolam in terms of the following measures: efficacy, safety, and cost-effectiveness. Two- to 6-year-old healthy children, referred for dental treatment in a dental sedation center in Brazil due to uncooperative behavior and requiring restorative dental procedures, will be recruited. Each child will be randomly assigned to one of the three groups: A - Intranasal administration of ketamine (4.0 mg/kg, maximum 100 mg) and midazolam (0.2 mg/kg, maximum 5.0 mg); B - Oral administration of ketamine (4.0 mg/kg, maximum 100 mg) and midazolam (0.5 mg/kg, maximum 20 mg); and C - Oral administration of midazolam (1.0 mg/kg, maximum 20 mg). The primary outcome is the child's behavior assessed through an observational scale using digital videos of the restorative dental treatment under sedation. The secondary outcomes are as follows: acceptance of sedative administration; memory of intraoperative events; the child's stress; adverse events; the child's pain during the procedure; the parent's, dentists', and child's perceptions of sedation; and economic analysis. Measures will be taken at baseline and drug administration and during and after the dental procedure. The necessary sample size was estimated to be 84 children after a blinded interim analysis of the first 30 cases. DISCUSSION: This study will provide data that can substantially add to science and pediatric dentistry as it examines the effect of sedative regimes from different perspectives (outcomes). TRIAL REGISTRATION: ClinicalTrials.gov, identifier: NCT02447289 . Registered on 11 May 2015, named "Midazolam and Ketamine Effect Administered Through the Nose for Sedation of Children for Dental Treatment (NASO)."

Relationship between obstructive sleep apnea hypopnea syndrome and inflammation in children / 解放军医学杂志

Objective To investigate the clinical efficacy of anti-inflammatory therapy (intranasal corticosteroids combined with oral leukotriene receptor antagonist) in pediatric mild to moderate obstructive sleep apnea hypopnea syndrome (OSAHS),and analyze the relationship between OSAHS and inflammation factors.Methods Fifty patients with mild to moderate OSAHS,diagnosed by polysomnography (PSG) during Jan.to Nov.2016,were enrolled in present study.The patients' medical history,data of special physical examination,paryngorhinoscopy,PSG and OSA-18 questionnaire were collected.Patients received the therapy of intranasal corticosteroids combined with oral leukotriene receptor antagonist for 12 weeks.Special physical examination,paryngorhinoscopy,PSG and OSA-18 questionnaire were reviewed and the data before and after treatment were compared.Results Of the 50 subjects,37 were with mild OSAHS and 13 with moderate OSAHS.A total of 19 cases (38％) were cured including 17 mild OSAHS and 2 moderate cases.Other 19 cases (38％) got therapeutic effect but not be cured.Twelve cases (24％) were invalid or aggravated.There were 10 patients (20％) who received surgical treatment after drug treatment.The average values of obstructive apnea index (OAI) and mixed apnea index (MAI) decreased significantly in mild group and only OAI decreased in moderate group.After treatment,the average volumes of adenoids and tonsils were significantly reduced in mild OSAHS children but not in moderate OSAHS children.The OSA-18 questionnaire score declined only in mild group.No obvious correlation existed between the change of tonsil volume and the parameters of PSG.Conclusion Anti-inflammatory therapy of intranasal corticosteroids combined with oral leukotriene receptor antagonist may obviously reduce the volumes of adenoids and tonsils,improve the PSG indexes and the life quality of OSAHS patients,especially for those children with mild OSAHS.

Effects of different doses of dexmedetomidine administered intranasally on EC50 of propofol inhibiting responses to laryngeal mask airway insertion in pediatric patients / 中华麻醉学杂志

Objective To evaluate the effects of different doses of dexmedetomidine administered intranasally on the median effective target plasma concentration (EC50) of propofol inhibiting responses to laryngeal mask airway (LMA) insertion in the pediatric patients.Methods American Society of Anesthesiologists physical status Ⅰ or Ⅱ pediatric patients of both sexes,aged 1-3 yr,with body mass index of 20-26 kg/m2,scheduled for elective surgery under general anesthesia,were divided into 3 groups using a random number table:control group (group C),dexmedetomidine 1 μg/kg group (group D1) and dexmnedetomidine 2 μg/kg group (group D2).At 20 min before induction of anesthesia,dexmedetomidine 1 and 2 μg/kg (diluted to 1 ml in normal saline) were intranasally administered in D1 and D2 groups,respectively,and the equal volume of normal saline was intranasally administered in group C.Children were separated from their parents at 20 min after intranasal administration and admitted to the operating room.The target plasma concentration of propofol was determined by modified Dixon's up-and-down method.The initial target plasma concentration of propofol was set at 5.4 μg/ml.The target plasma concentration of propofol was increased/decreased by 10％ in the next patient according to the response to LMA insertion,and the ratio between the two successive concentrations was 1.1.Patients' sedation status and LMA acceptance were evaluated when patients were separated from their parents.Patient's satisfaction with sedation and with LMA acceptance was recorded.Probit analysis was used to calculate the EC50 of propofol inhibiting responses to LMA insertion.Results Compared with group C,the satisfactory rates of sedation and LMA acceptance were significantly increased,and EC50 of propofol inhibiting responses to LMA insertion was decreased in D1 and D2 groups (P＜0.05).Compared with group D1,the satisfactory rates of sedation and LMA acceptance were significantly increased,and the EC50 of propofol inhibiting responses to LMA insertion was decreased in group D2 (P＜0.05).Conclusion Dexmedetomidine 1 and 2 μg/kg administered intranasally both can decrease the EC50 of propofol inhibiting responses to LMA insertion in the pediatric patients,and 2 μg/kg produces better efficacy.

Intranasally Administered Adjunctive Dexmedetomidine Reduces Perioperative Anesthetic Requirements in General Anesthesia.

PURPOSE: Intranasal dexmedetomidine is an effective sedative for premedication and is regularly used to reduce preoperative tension and anxiety in children. This study aimed to assess the effect of intranasally adjunctive dexmedetomidine on perioperative sedative and analgesic requirements in adults. MATERIALS AND METHODS: Patients were randomly divided into four groups to receive preoperative administration of saline, intranasal dexmedetomidine 1 µg/kg and 2 µg/kg, and intravenous dexmedetomidine 1 µg/kg, respectively. Propofol and remifentanil were target-controlled infused to maintain intraoperative bispectral index at 45-55 and blood pressure at baseline value±20%. Sufentanil was administered to maintain postoperative visual analogue scale ≤3. Perioperative anesthetics requirements were compared using nonparametric tests. RESULTS: Intranasal dexmedetomidine significantly attenuated propofol requirements for anesthesia induction and maintenance in a dose-dependent manner. Patients given intranasal dexmedetomidine 2 µg/kg required less remifentanil for anesthesia maintenance. The first postoperative request for sufentanil analgesia was delayed in patients given intranasal dexmedetomidine 2 µg/kg. The anesthetics-sparing effect of intranasal dexmedetomidine was significantly weaker than intravenous dexmedetomidine at the same dose of 1 µg/kg. The incidences of adverse events, including hemodynamic instability and delayed recovery, were comparable with and without intranasal dexmedetomidine. CONCLUSION: Intranasal administration of dexmedetomidine can reduce perioperative anesthetic requirements, and a dose of dexmedetomidine 2 µg/kg produces a better effect in adults. The anesthetics-sparing effect of intranasal dexmedetomidine 1 µg/kg is less than that with the same intravenous dose of dexmedetomidine.

Effect of treating allergic rhinitis with intranasal corticosteroids on small airway function / 中国耳鼻咽喉头颈外科

OBJECTIVE To observe the effect of administration intranasal corticosteroids on small airway disfunction for allergic rhinitis (AR) patients. METHODS AR patients with small airway disfunction were administrated intranasal corticosteroids for twelve weeks. Before treatment, nasal VAS, RQLQ were recorded, pulmonary function test were given. After therapy, VAS, RQLQ were obtained again at the 4th, 8th and 12th week. Pulmonary function test were performed at the 4th and 12th week. RESULTS VAS, RQLQ were all improved after therapy (P <0.01). The indices of FEV1/FVC%, MMEF pred%, MEF75pred%, MEF50pred%, MEF25pred%were also improved significantly (P<0.05), especially for MMEFpred%, MEF75pred%, MEF50pred% (P<0.01). CONCLUSION Small airway lesions can be obviously improved by the intranasal corticosteroids applied for AR. It has positive significance for preventing AR from developing into asthma.

Effectiveness of intranasal corticosteroid plus antihistamine on allergic rhinitis：a systematic review / 军事医学

Objective To systematically review the efficacy of corticosteroid nasal spray plus antihistamine versus either therapy given alone or placebo in patients with allergic rhinitis (AR).Methods The PubMed, EMbase, Google Scholar and The Cochrane Library were electronically searched for randomized controlled trials ( RCTs ) about the efficacy of corticosteroid plus antihistamine for AR .The duration of the search was from the inception of the databases to April 2015 . After literature selection , data extraction and quality assessment conducted by two reviewers independently , meta-analysis was conducted using RevMan 5.3 software.Results Ten studies involving 6568 patients were finally included .The qualitative analysis showed that the combination therapy had greater efficacy than oral antihistamines alone or placebo on improving symptoms.The results of meta-analysis showed that pooled results of two trials failed to show significant difference in total nasal symptoms between combination therapy and intranasal corticosteroid alone [ WMD =-0.20, 95%CI (-0.38,-0.01),P=0.04].The cumulative meta-analysis of six RCTs showed that the combination therapy was superior to intranasal corticosteroid alone[WMD=-1.16, 95%CI( -1.49,-0.83), P<0.00001], intranasal antihistamine alone[WMD=-1.73, 95%CI( -2.08,-1.38),P<0.00001], and placebo [WMD =-2.81, 95%CI( -3.16,-2.47), P<0.00001].Conclusion Intranasal corticosteroid plus oral antihistamine has similar efficacy to intranasal corticosteroid alone, greater efficacy than oral antihistamines alone or placebo in reducing nasal symptoms for AR patients . Intranasal corticosteroid plus intranasal antihistamine is significantly superior to either therapy given alone or placebo .