Skip to main content
SpringerLink
Log in

Transmucosal and Other New Drug Delivery Technologies

  • Chapter
Anesthesia for the New Millennium

Part of the book series: Developments in Critical Care Medicine and Anesthesiology ((DCCA,volume 34))

Abstract

Anesthesiologists, more than any other physicians, rely on a variety of techniques to administer pharmacologic compounds to care for their patients. More traditional drug delivery methods, such as intramuscular, intravenous, oral and rectal drug administration, while useful in most patients, may not be as suitable in others. Certainly, non-invasive drug delivery systems have several other potential advantages over traditional techniques of drug administration. When compared with orally administered drugs, transdermal and transmucosal administration systems bypass hepatic first-pass metabolism and avoid gastrointestinal degradation. Long-term transdermal or iontophoresis drug delivery systems reduce the variability of serum drug concentration profiles, eliminate peak and trough concentrations and allow for improved drug safety by reducing high plasma concentrations which often occur with intramuscular or intravenous drug administration. The latter reduces dosing frequency and simplifies dosing schedules. In addition, patient compliance is improved by decreasing the pain involved with drug delivery. Finally, some non-invasive drug delivery systems allow for “titration to effect” and thus enable rapid onset and cessation of drug administration. In this report we discuss current and future delivery systems being studied and developed for sedative/hypnotic, amnestic, anti-emetic, anesthetic and analgesic drug administration.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Duthie DJR, Rowbotham DJ, Wyld R, et al: Plasma fentanyl concentrations during transdermal delivery of fentanyl to surgical patients. Br J Anaesth 60:614–8, 1988

    Article  PubMed  CAS  Google Scholar 

  2. Gourlay GK, Kowalski SR, Plummer JL, et al: The transdermal administration of fentanyl in the treatment of postoperative pain: pharmacokinetics and pharmacodynamic effects. Pain 37:193–202, 1989

    Article  PubMed  CAS  Google Scholar 

  3. Holley FO, van Steennis C: Transdermal administration of fentanyl for postoperative analgesia (abstract). Anesthesiology 65:A548, 1986

    Article  Google Scholar 

  4. Streisand JB, Stanley TH: Opioids: new techniques in routes of administration. Current Opinion in Anaesthesiology 2:456–62, 1989

    Article  Google Scholar 

  5. Caplan RA, Matsen III FA, Ready LB, et al: Transdermal fentanyl for postoperative pain management. JAMA 261:1036–9, 1989

    Article  PubMed  CAS  Google Scholar 

  6. Gourlay GK, Kowalski SR, Plummer JL, et al: The efficacy of transdermal fentanyl in the treatment of postoperative pain: a double-blind comparison of fentanyl and placebo systems. Pain 40:21–7, 1990

    Article  PubMed  CAS  Google Scholar 

  7. Rolf D: Chemical and physical methods of enhancing transdermal drug delivery. Pharm Tech 130:40, 1988

    Google Scholar 

  8. Delacerda FG: A comparative study of three methods of treatment for shoulder girdle myofascial syndrome. J Orthopaedic and Sports Physic Ther 4:51–4, 1982

    CAS  Google Scholar 

  9. Harris PR: Iontophoresis: clinical research in musculoskeletal inflammatory conditions. J Orthopaedic and Sports Physic Ther 4:103–8, 1982

    Google Scholar 

  10. Glass JM, Stephen RL, Jacobson SC: The quantity and distribution of radio labeled dexamethasone delivered to tissue by iontophoresis. Int J Derm 19:519–35, 1980

    Article  PubMed  CAS  Google Scholar 

  11. Petelenz T, Petelenz AI, Iwinski TJ, et al: Mini set for iontophoresis for topical analgesia before injection. Int J Clin Pharmacol Ther Toxicol 22:152–5, 1984

    PubMed  CAS  Google Scholar 

  12. Bezzant JL, Pentelenz TJ, Jacobson SC: Painless cauterization of spider veins using iontophoretic local anesthesia. J Am Acad Derm 19:869–75, 1988

    Article  PubMed  CAS  Google Scholar 

  13. Ashburn MA, Stephen RL, Petelenz TJ, et al: Controlled iontophoretic delivery of morphine HCl for post-operative pain relief (abstract). Anesthesiology 69: 348, 1988

    Article  Google Scholar 

  14. Weinberg AL, Freestone DS: The administration of drugs and vaccines by the intranasal route. Br J Clin Phar 3:827–30, 1976

    Article  Google Scholar 

  15. Henderson JM, Brodsky DA, Fisher DM, et al: Pre-induction of anesthesia in pediatric patients with nasally administered sufentanil. Anesthesiology 68:671–5, 1988

    Article  PubMed  CAS  Google Scholar 

  16. Leigh J, Pandit UA, Rosen D, et al: Intranasal midazolam premedication in pre-school children does not cause respiratory depression or delay recovery. Proceedings of 9th World Congress of Anaesthesiologists (abstracts) II:A0823, 1988

    Google Scholar 

  17. Russell LJ, Aldrete JA: Intranasal ketamine: preliminary pharmacokinetics. Proceedings of 9th World Congress of Anaesthesiologists II:A0864, 1988

    Google Scholar 

  18. Squire: Br Med Bull 31:169–75, 1975

    Google Scholar 

  19. Bell MD, Murray GR, Mishra P, et al: Buccal morphine-a new route for analgesia? Lancet 1:71–3, 1985

    Article  PubMed  CAS  Google Scholar 

  20. Fisher AP, Fung C, Hanna M: Absorption of buccal morphine. Anaesthesia 43:552–3, 1988

    Article  PubMed  CAS  Google Scholar 

  21. Fisher AP, Vine P, Whitlock J: Buccal morphine premedication. Anaesthesia 41:1104–11, 1986

    Article  PubMed  CAS  Google Scholar 

  22. Hirsh JD: Sublingual morphine sulfate in chronic pain management. Clinical Pharmacy 3:585–6, 1984

    PubMed  CAS  Google Scholar 

  23. Weinberg DS, Inturrisi CE, Reidenberg B, et al: Sublingual absorption of selected opioid analgesics. Clin Pharmacol Ther, Sept 1988:1988

    Google Scholar 

  24. Edge WG, Cooper GM, Morgan M: Analgesic effects of sublingual buprenorphine. Anaesthesia 34:463–7, 1979

    Article  PubMed  CAS  Google Scholar 

  25. Bullingham RES, McQuay HJ, Porter EJB, et al: Sublingual buprenorphine used postoperatively: ten hour plasma drug concentration analysis. Br J Clin Pharmacol 13:665–73, 1982

    Article  PubMed  CAS  Google Scholar 

  26. Streisand JB, Ashburn MA, LeMaire L, et al: Bioavailability and absorption or oral transmucosal fentanyl citrate. Anesthesiology 71:A230, 1989

    Article  Google Scholar 

  27. Ashburn MA, Streisand JB, Tarver SD, et al: Oral transmucosal fentanyl citrate for premedication in paediatric outpatients. Can J Anaesth 37:856–866, 1990

    Google Scholar 

  28. Nelson PS, Streisand JB, Mulder SM, et al: Comparison of oral transmucosal fentanyl citrate and an oral solution of meperidine, diazepam, and atropine for premedication in children. Anesthesiology 70: 616–21, 1989

    Article  PubMed  CAS  Google Scholar 

  29. Stanley TH, Hague B, Mock DL, et al: Oral transmucosal fentanyl citrate (lollipop) premedication in human volunteers. Anesth Analg 69:21–7, 1989

    PubMed  CAS  Google Scholar 

  30. Lind GH, Marcus MA, Ashburn MA, et al: Oral transmucosal fentanyl citrate for analgesia and anxiolysis in the emergency room. Anesth Analg 70:S241, 1990

    Article  Google Scholar 

  31. Ashburn MA, Fine PG, Stanley TH: Oral transmucosal fentanyl citrate for the treatment of breakthrough cancer pain: a case report. Anesthesiology 71:615–7, 1989

    Article  PubMed  CAS  Google Scholar 

  32. Ashburn MA, Olson L, Fine PF, et al: The clinical evaluation of the compassionate use of oral transmucosal fentanyl citrate (OTFC) for the treatment of breakthrough cancer pain (abstract). Pain 5:S353, 1990

    Article  Google Scholar 

  33. Bangham Ad: Introduction. In Liposomes: From Physical Structure to Therapeutic Applications, Knight (ed), Elsevier North-Holland Biomedical Press. The Hague, Chpt 1. 1981

    Google Scholar 

  34. Bangham AD: Liposomes in Nuce. Biol Cell 47:1–10, 1983

    CAS  Google Scholar 

  35. Bartholini G, Pletocher A: Cerebral accumulation and metabolism of C14-Copa after selective inhibition of peripheral decarboxylase. J Pharmacol Exp Ther 161:14–220, 1968

    PubMed  CAS  Google Scholar 

  36. Cammon D, Hendee WR, Davis KA: Clinical applications of magnetic resonance imaging — current status. W J Med 143:793–803, 1985

    Google Scholar 

  37. Chan L: The current status of magnetic resonance spectroscopy-Basic and clinical aspects. W J Med 143:773–81, 1985

    CAS  Google Scholar 

  38. Chen G, Ensoi CR, Bohner B: Drug effects on the disposition of active biogenic amines in the CNS. Life Sci 7:1063–74, 1968

    Article  PubMed  CAS  Google Scholar 

  39. De Castro J, Van de Water A, Wouters L, Xhonneux R, Reneman R, Kay B: Comparative study of cardiovascular neurological and metabolic side effects of eight narcotics in dogs. Acta Anaesthesiology Belg 30:5–99, 1979

    Google Scholar 

  40. Dixon JA, Gilbertson JJ: Cutaneous laser therapy. W J Med 143:745–50, 1985

    Google Scholar 

  41. Haigler HJ, Adhojanian GK: Serotonin receptors in the brain. Fed Proc 36:2159–64, 1977

    PubMed  CAS  Google Scholar 

  42. Haveman U, Kuschinsky K: Neurochemical aspects of the opioid induced catatonia. Neurochem Inter 4:199–215, 1982

    Article  Google Scholar 

  43. Haveman U, Turski L, Schwaz M, Kuschinsky K: On the role of GABA-ergic mechanisms in striatum and substantia nigra in mediating muscular rigidity. Naunyn-Schmiedeberg’s Arch Pharmac 322 (Suppl):373, 1983

    Google Scholar 

  44. Hause L, Sances A, Larson S: Polarization changes induced in the pyramidal cell and other neural elements by externally applied fields. In the Nervous System and Electrical Currents, Wielfsohn NL and Sances A (ed), Plenum Press, New York, pp 93–95, 1971

    Chapter  Google Scholar 

  45. Kirkpatrick A, Johansson, Fiserova-Bergerova Y: Ultra-long local anesthesia with lecithin-coated methoxyflurane. Anesthesiology 63:A218, 1985

    Article  Google Scholar 

  46. Knigge KM, Joseph SA, Norton J: Topography of the ACTH-immunoreactive neurons in the basal hypothalamus of the rat brain. Brain Res 216: 333–44, 1981

    Article  PubMed  CAS  Google Scholar 

  47. Kuhan MJ, Pasternak GW: Analgesics: Neurochemical behavioral and clinical perspectives. New York, Raven Press, 1984

    Google Scholar 

  48. Ledue S: L’electrisation cerebral. Arch Elec Med 11:403–10, 1903

    Google Scholar 

  49. Leysen JE, Laduron PM: Receptor binding properties in vitro and in vivo of some long-acting opiates. Arch Int Pharmaco Ther 232:343–6, 1978

    CAS  Google Scholar 

  50. Leysen JE, Tollenoere JP, Koch MHJ, Laduran P: Differentiation of opiate and neurolept receptor binding in rat brain. Eur J Pharmacol 43:253–67, 1977

    Article  PubMed  CAS  Google Scholar 

  51. Martin W: Multiple opioid receptors. Life Sci 28:1547–54, 1981

    Article  PubMed  CAS  Google Scholar 

  52. Moore RY, Bloom FE: Central catecholamine neuron systems: anatomy and physiology. Ann Rev Neurosci 1:129–69, 1978

    Article  PubMed  CAS  Google Scholar 

  53. Moo-Young GA: Lasers in ophthalmology. W J Med 143:745–50, 1985

    CAS  Google Scholar 

  54. Myers RD, Oeltgen PR, Spurrier WA: Hibernation ‘trigger’ injected into brain induces hypothermia and hypophagia in the monkey. Brain Res Bul 7:691–5, 1981

    Article  CAS  Google Scholar 

  55. Niemegeers CJE, Schellekens KHL, Van Bever WFM, Janssen PAG: Sufentanil a very potent and extremely safe intravenous morphinelike compound in mice, rats and dogs. Drug Res 26:1551–6, 1976

    CAS  Google Scholar 

  56. Pasternak GW, Childers SR: Opiates, opioid peptides and their receptors. Neurology 31:1311–5, 1981

    Article  PubMed  CAS  Google Scholar 

  57. Passternak GW, Childers SR, Snyder SH: Opiate analgesia: evidence for mediation by a subpopulation of opiate receptors. Science May 2:208(4443):514–6, 1980

    Google Scholar 

  58. Pasternak GW, Childers SR, Snyder SH: Naloxazone, a long acting opiate antagonist: effects of analgesia in intact animals and opiate receptor binding in vitro. J Pharmacol Exp Ther 214:455–62, 1980

    PubMed  CAS  Google Scholar 

  59. Poznansky MJ, Juliano RL: Biological approaches to the control delivery drugs: a critical review. Pharmacological Rev 36:277–336, 1984

    CAS  Google Scholar 

  60. Regan JD, Parrish JA: The Science of Photomedicine. Plenum Press, New York, 1982

    Book  Google Scholar 

  61. Scherzinger AL, Hendee WR: Basic principles of magnetic resonance imaging. An update. W J Med 143:782–92, 1985

    CAS  Google Scholar 

  62. Scoggin: The new biomedical technology. West J Med 143:819–24, 1985

    PubMed  CAS  Google Scholar 

  63. Sjolund B, Eriksson M: Electro-acupuncture and endogenous morphines. Lancet 2:1085, 1976

    Article  PubMed  CAS  Google Scholar 

  64. Snyder SH, Goodman RR: Multiple neurotransmitter receptors. J Neurochem 35:5–15, 1981

    Article  Google Scholar 

  65. Standaert FG: Magic bullets, science and medicine. Anesthesiology 63:577–8, 1985

    Article  PubMed  CAS  Google Scholar 

  66. Stanley TH, Cazaloa JA, Limoge A, Louville Y: Transcutaneous cranial electrical stimulation increases the potency of N2O in man. Anesthesiology 57:293–7, 1982

    Article  PubMed  CAS  Google Scholar 

  67. Van Bever WFM, Niemegeers CJE, Schellekens KHL, Janssen PAJ: N-4 substituted 1(2–14ylethyl)-4-piperidinyl-N-phenylanamides, a novel series of extremely potent analgesics with unusually high safety margin. Drug Res 26:1548–51, 1976

    Google Scholar 

  68. Vander Ark GD, McGrath KA: Transcutaneous electrical stimulation in treatment of postoperative pain. Am J Surg 130:338–40, 1975

    Article  CAS  Google Scholar 

  69. Verschraegen R, Rossell MT, Bogaert M, Roly G: Maptazind. In: Use in postoperative pain. Acta Anaestheio Belg 27 (Suppl):123–32, 1976

    Google Scholar 

  70. Wofsy D: Strategies for treating autoimmune disease with monoclonal antibodies. W J Med 143:804–9, 1985

    CAS  Google Scholar 

  71. Wood PL, Richard JW, Thakur M: Mu opiate isoreceptors: differentiation with kappa agonists. Life Sci 31: 2313–7, 1982

    Article  PubMed  CAS  Google Scholar 

Download references

Authors
  1. Theodore H. Stanley
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Anesthesiology, The University of Utah Medical School, Salt Lake City, Utah, USA

    Theodore H. Stanley  & Talmage D. Egan  & 

Rights and permissions

Reprints and permissions

Copyright information

© 1999 Springer Science+Business Media Dordrecht

About this chapter

Cite this chapter

Stanley, T.H. (1999). Transmucosal and Other New Drug Delivery Technologies. In: Stanley, T.H., Egan, T.D. (eds) Anesthesia for the New Millennium. Developments in Critical Care Medicine and Anesthesiology, vol 34. Springer, Dordrecht. https://doi.org/10.1007/978-94-011-4566-4_15

Download citation

  • DOI: https://doi.org/10.1007/978-94-011-4566-4_15

  • Publisher Name: Springer, Dordrecht

  • Print ISBN: 978-94-010-5935-0

  • Online ISBN: 978-94-011-4566-4

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation