Intra-arterial injections

Much like the experience with IV thrombolysis, the majority of the early work in lAT has been reported in nonrandomized case series. Reports of successful lAT go back to the late 1950s, when Sussmann and Fitch described the recanalization of an acutely occluded ICA with an intra-arterial injection of plasmin. Nonetheless, it was not until the early 1990s that this approach was studied in a more systematic manner. 

In a report from the Boston Collaborative Drug Surveillance Program, pediatric nurses have reported a much higher frequency of complications from IM injections than that observed in the adult population. Twenty-three percent of pediatric nurses surveyed had observed complications (local pain, abscess, hematoma) versus a rate of 0.4% reported in adult patients [86]. Serious complications, such as paralysis from infiltration of the sciatic nerve, quadriceps myofibrosis, and accidental intra-arterial injection, are usually the... 

Stimulation of the motoneuron releases acetylcholine onto the muscle endplate and results in contraction of the muscle fiber. Contraction and associated electrical events can be produced by intra-arterial injection of ACh close to the muscle. Since skeletal muscle does not possess inherent myogenic tone, the tone of apparently resting muscle is maintained by spontaneous and intermittent release of ACh. The consequences of spontaneous release at the motor endplate of skeletal muscle are small depolarizations from the quantized release of ACh, termed miniature endplate potentials (MEPPs) [15] (seeCh. 10). Decay times for the MEPPs range between l and 2 ms, a duration similar to the mean channel open time seen with ACh stimulation of individual receptor molecules. Stimulation of the motoneuron results in the release of several hundred quanta of ACh. The summation of MEPPs gives rise to a postsynaptic excitatory potential (PSEP),... 

Miscellaneous Intra-arterial injection —> crystallization Fit threshold Toxic in children (metabolic acidosis and bradycardia) Salivation dissociative anaesthesia Adrenal suppression... 

PROMETHAZINE HYDROCHLORIDE The preferred parenteral route of administration is deep IM injection properly administered IV doses are well tolerated, but this method is associated with increased hazard. IV administration should not exceed 25 mg/mL at a rate no more than 25 mg/min. Avoid subcutaneous and intra-arterial injection. Use contraindicated in patients younger than 2 years of age. 

Administration For deep IM administration only avoid subcutaneous, IV or intra-arterial injection. Tissue necrosis has been associated with subcutaneous or... 

For IV use only Mitoxantrone is not indicated for subcutaneous, IM, or intra-arterial injection. 

Intra-arterial injection of thiopentone is a serious complication as crystals of the thiobarbiturate can form in the arterioles and capillaries, causing intense pain, vasoconstriction, thrombosis, and even tissue necrosis. Accidental intra-arterial injections should be treated promptly with intra-arterial administration of a vasodilator (papaverine 20 mg) and lignocaine (lidocaine) Note leave the needle/cannula in the artery), as well as a regional anaesthesia-induced sympathectomy (stellate ganglion block, brachial plexus block) and anticoagulation with intravenous heparin. The risk of ischaemic damage is much higher with a 5% solution and the use of this concentration is not recommended. 

Epileptiform EEG activity has been described in epileptic subjects. Tissue damage after perivenous extravasation is uncommon. Intra-arterial injection of 1% methohexitone may cause gangrene but the risk is much less than that with 2.5% thiopentone. Allergic reactions occur but are uncommon. Indications... 

The nicotinic receptors on the neuromuscular end plate apparatus are similar but not identical to the receptors in the autonomic ganglia (Table 7-1). Both types respond to acetylcholine and nicotine. (However, as noted in Chapter 8, the receptors differ in their structural requirements for nicotinic blocking drugs.) When a nicotinic agonist is applied directly (by iontophoresis or by intra-arterial injection), an immediate depolarization of the end plate results, caused by an... 

Mottu F, Stelling MJ, Rufenacht DA, Doelker E. Comparative hemolytic activity of undiluted organic water-miscible solvents for intravenous and intra-arterial injection. PDA J Pharm Sci Technol 2001(Jan-Feb) 55(1) 16-23. 

Primary routes of entry of toxicants to the human body are dermal, gastrointestinal, and respiratory. Methods for studying these different routes are numerous, but they are perhaps best developed for the study of dermal absorption because this route is subject to more direct methodology, whereas methods for studying respiratory or gastrointestinal absorption require more highly specialized instrumentation. Additional routes encountered in experimental studies include intraperitoneal, intramuscular, and subcutaneous routes. When direct entry into the circulatory system is desired, intravenous (IV) or intra-arterial injections can be used to bypass the absorption phase. Information from this more direct route of entry (e.g., IV) should, however, be used in addition to data from the extravascular route of interest to adequately assess the true extent of absorption of a toxicant. 

The pressor response to ephedrine is due in part to peripheral constriction and in part to myocardial stimulation. Vasoconstriction can be demonstrated by intra-arterial injection, but compared to epinephrine, ephedrine is only about one thousandth as active. This would imply that the cardiac effect is predominant in increasing the arterial pressure. This, however, is difficult to demonstrate. In perfused hearts, ephedrine produces only minor stimulation and cardiac depression appears if the drug is repeated. 

DA, antagonists are studied in the same phenoxybenzamine-pretreated dog preparation as DA, agonists. We compare relative potencies of DA, antagonists by making simultaneous intra-arterial injections of Da with the antagonist under study. When administered intra-arterially in this way, most antagonists have a very short duration of action and many compounds can be studied in one experiment. The intra-arterial route of administration also permits estimation of responses prior to recirculation (1,4,17). 

Various characteristics of the molecule influence its chances of reaching its target receptor since they influence the nature and extent of the body s effect on it. A drug s pharmacokinetic profile therefore determines the extent of the drug s opportunity to exert its pharmacodynamic effect. While there are various routes for human drug administration (oral rectal intravenous, subcutaneous, intramuscular, and intra-arterial injections topical and direct inhalation into the lungs), the most common for small-molecule drugs is oral administration, and discussions in the first part of this chapter therefore focus on oral administration. (In contrast, biopharmaceuticals are typically administered by injection, often directly into the bloodstream.)... 

Cases of inadvertent intra-arterial injection of diazepam have been reported. 

Inadvertent intra-arterial injection of diazepam (2.5 mg in 0.5 ml) has been reported in an 8-year-old girl (4). Gangrene resulted and amputation of the 4th and 5th fingers was required. 

Gangrene has been previously reported with intra-arterial injection of diazepam and is also well known with other classes of drugs, such as barbiturates and phenothiazines. It appears to be caused by the drug rather than the solvent used in the intravenous formulations. 

Joist A, Tibesku CO, Neuber M, Frerichmann U, Joosten U. Fingergangran nach akziden teller intraarteriel-ler Injektion von Diazepam. [Gangrene of the fingers caused by accidental intra-arterial injection of diazepam.] Dtsch Med Wochenschr 1999 124(24) 755-8. 

Inadvertent intra-arterial injection of temazepam can cause tissue damage. 

Merine, D., Takayasu, K., Wakao, F. Detection of hepatocellular carcinoma comparison of CT during arterial portography with CT after intra-arterial injection of iodised oil. Radiology 1990 175 707-710... 

Boucher, E., Corbinais, S., Holland, Y., Bourguet, P., Guyader, D., Boudjema, K., Meunier, B., Raoul, J.L. Adjuvant intra-arterial injection of iodine-131-labelled lipiodol after resection of hepatocellular carcinoma. Hepatology 2003 38 1237-1241... 

Raoul, J.L., Messner, M., Boucher, E., Bretagne, JJi., Campion, J.P., Boudjema, K. Preoperative treatment of hepatocellular carcinoma with intra-arterial injection of (131)J-lahelled hpiodol. Brit. J. Surg. 2003 90 1379-1383... 

Intra-arterial injection is used to deliver drugs directly to organs, for example, in cancer chemotherapy, and in the use of vasopressin for GI bleeding. Intra-arterial carmustine is effective to treat brain tumors and pelvic intra-arterial actinomycin D is used for malignant trophoblastic disease. ... 

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