Nasogastric Medication for Perioperative Parkinson's Rigidity during Anaesthesia Emergence

Stagg, Phil; T, Grice

doi:10.1177/0310057x1103900623

Cited by 16 publications

(6 citation statements)

References 8 publications

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“…A case-report described successful treatment of rigidity associated with Parkinson's disease with perioperative administration of crushed Sinemet â (Merck & Co., Inc., Whitehouse Station, NJ, USA) and amantadine via NGT during emergence from anaesthesia. 19 However, there is no head-to-head investigation of NGT dosing vs. oral dosing for Sinemet â .…”

Section: Resultsmentioning

confidence: 99%

Therapeutic concerns when oral medications are administered nasogastrically

Zhu

Zhou

2013

J Clin Pharm Ther

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Summary What is known and Objective Administering oral medications to patients with nasogastric tube (NGT) is a challenging patient‐care issue. Inappropriate prescribing behaviour and incorrect procedure for extemporaneous preparation of oral suspensions given via NGT may result in significant harm to patients. There are many drugs which have not been tested regarding oral absorption profile and bioavailability derived from NGT dosing. Although several studies and case‐reports have been reported, there is no up‐to‐date review of drug administration via NGT. The aim of this review is to increase awareness of rational drug administration via NGT and to encourage relevant research in this area. Methods Full prescribing information from each currently available oral medication was reviewed for any data indicating that the medication could not be crushed or opened. Literature was identified by searching PubMed (1988 to Aug 2012). Results and Discussion There is evidence to show that NGT dosing of some medications may bring both benefits (e.g. cost saving) and disadvantages (e.g. decrease in efficacy and/or safety). For medications with package inserts that warn that they should not be crushed or opened, alternatives are usually recommended. However, in some cases, there is evidence to support NGT dosing. Sometimes special procedures are required to avoid problems such as instability, interaction with enteral nutrition, adsorption, tube obstruction and low recovery when preparing extemporaneous oral suspensions. What is new and Conclusion Physicians, pharmacists and nurses should know the procedures for drug administration by NGT, as well as the latest evidence on such administrations. There may not be bioequivalence between oral and nasogastric administrations. Care must be taken to avoid compromising the physicochemical, biopharmaceutical and pharmacological properties of drugs given by NGT to ensure their safety and efficacy.

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Section: Resultsmentioning

confidence: 99%

Therapeutic concerns when oral medications are administered nasogastrically

Zhu

Zhou

2013

J Clin Pharm Ther

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“…A case report described successful administration of crushed Sinemet ® and amantadine via NGT for perioperative Parkinson’s rigidity during emergence from anesthesia 17. However, a head-to-head investigation on NGT versus oral dosing is not as yet available for Sinemet.…”

Section: Discussionmentioning

confidence: 99%

Appropriateness of administration of nasogastric medication and preliminary intervention

Zhu¹,

Xu²,

Hui-qin³

et al. 2012

TCRM

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A utilization study was performed in a 2200-bed tertiary care teaching hospital. Data mining was performed on all nasogastric medication prescriptions for patients hospitalized in 2011. Nurses were interviewed by questionnaire. A PDCA (Plan-Do-Check-Act) cycle was used for continuous quality improvement. The proportion of patients with nasogastric tubes (NGT) was 3.2%. A large number of medical orders (n = 6261) involved nasogastric medications with a package insert particularly noting that they should not be crushed or opened (group 1) or medications without a specific formulation recommendation in the package insert but having evidence discouraging NGT dosing (group 2). Of the nasogastrically administered sustained-release or controlled-release formulations, a sustained-release sodium valproate tablet formulation was the most prescribed drug and a sustained-release 2.5 mg felodipine tablet was prescribed with the highest proportion of NGT dosing [NGT/(NGT + oral) = 12.3%]. Among the nasogastrically administered enteric-coated formulations, a myrtol-standardized enteric-coated capsule formulation was the most prescribed drug and a pantoprazole tablet formulation was prescribed with the highest proportion of NGT dosing [NGT/(NGT + oral) = 19.3%]. Proportions of NGT dosing for amiodarone and carbamazepine (group 2) were 4.8% and 6.3%, respectively. The percentage of nurses with adequate knowledge about pharmaceutical dosage formulations was 60%. The rate of answering correctly as to whether medications in group 1 could be crushed or opened was only 30%. Awareness of evidence discouraging NGT dosing of medications in group 2 was zero. Most nurses (90%) left physicians and pharmacists with the entire responsibility for knowledge and decision-making concerning route of drug administration. After a 3-month preliminary intervention, irrational medical orders involving nasogastric administration of medications in group 1 were successfully abolished. The rate of answering correctly as to whether medications in group 1 could be crushed or opened increased to 100%. This utilization study indicates poor awareness concerning nasogastric administration of medication on the part of physicians and nurses, and preliminary intervention measures were efficient in improving knowledge through team cooperation and effort.

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“…Transdermal, intravenous, and NG routes have been reported effective in the perioperative setting in surgical and anesthesia literature [13][14][15]. Nausea and hypotension from IV levodopa (not readily available) should be expected, but are both preventable by pretreatment with a peripheral decarboxylase inhibitor (like carbidopa) [16].…”

Section: Vignettementioning

confidence: 99%