Infusion pumps advantages

When the oral route is unavailable opioids may be administered by continuous infusion (pump) and when appropriate under control by the patient - advantage constant therapeutic plasma level disadvantage indwelling catheter. When constipation becomes intolerable morphin can be applied near the spinal cord permitting strong analgesic effect at much lower total dosage. 

Although expert teams at specialized centers can safely and effectively apply 5-FUDR, this hepatic arterial treatment via infusion pumps has shown no advantage in comparison to 5-FU + folinic acid i.a. or i.v. in a German multicenter trial in terms of survival, and may be associated with potentially lethal hepato-toxicity, which increases the risk for resection after downstaging (Lorenz and Muller 2000 Kemeny et al. 1994 Kemeny et al. 1999 Hohn et al. 1988 Hodgson 1986 Patt et al. 1987). With regard to the 5-FUDR induced hepatotoxicity, we had stopped this treatment protocol in favor of 5-FU + folinic acid, and developed this new protocol by translational in vitro... 

However, one disadvantage associated with the use of most recombinant molecules is their rapid clearance. Because of this rapid clearance, recombinant molecules require repeated administration to achieve biological efficacy. Initially, continuous infusion was used to address this pharmacological deficiency. Continuous infusion has the advantage of delivering drugs in a controlled manner and is particularly appropriate when it is important to maintain constant plasma drug concentrations. However, the requirement for continuous venous access and the use of ambulatory pumps limits its use. 

An improved metabolic control with intensified insulin therapy compared with a conventional treatment was reported by Wolf et al. (1987). A continuous insulin infusion with insulin pump therapy, monitored over 1 year, however, did not exhibit a clear advantage. The management of even preschool children with insulin pump therapy was not associated with an increased frequency or an accelerated rate of development of ketosis (Flores et al., 1984 Brambilla et al., 1987). However, Marshall et al. (1987) reported more abscesses and ketoacidosis in children on CS1I, and an increased risk of developing cutaneous infections was also noted in patients treated by CSII in the Oslo Study (Dahl-Jorgensen et al., 1985). 

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