A 2018 systematic review evaluated the efficacy of icatibant, ecallantide, and tranexamic acid (TA) for angiotensin-converting enzyme inhibitor (ACEi) induced and idiopathic angioedema (non-hereditary AE). This systematic review included 61 studies with 38 describing treatment in the acute setting, although the majority of evidence was case reports. There were no direct comparisons between icatibant, ecallantide, or TA. For ACEi-induced AE, two randomized controlled studies of ecallantide do not suggest a significant benefit based on response rate versus placebo (10%-16% response rate). Icatibant may have similar efficacy to C1NH and fresh frozen plasma (FFP) with an average response time of less than 2 hours, but the majority of included studies were not controlled and of lower quality. Data for TA in ACEi-induced AE was not available. [1] For idiopathic AE, a single study on TA use observed a 54% response rate (13 to 24 patients). Data for icatibant and ecallantide are limited ...

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A 2015 review article discusses the use of intravenous (IV) medications in the intramuscular (IM) or subcutaneous (SQ) route. Many IV medications are not intended for administration via the IM or SQ routes due to safety concerns. IV medications are formulated for rapid absorption and effect when administered intravenously. If given via other routes, the medication may not be adequately or rapidly absorbed, resulting in suboptimal effect or even failure of the treatment. In some cases, the local vasoconstrictive or other adverse effects of the medication at the injection site could cause tissue damage if not diluted or administered properly via IM or SQ routes. However, for some IV medications, literature evidence has shown the IM or SQ routes can be options with comparable efficacy and safety when administered carefully following proper preparation guidelines (see Table 1). Medications intended for IV use but considered for IM or SQ administration should be carefully diluted accordi...

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Many retrospective studies in recent years have included patients with chronic nonbacterial osteomyelitis/chronic recurrent multifocal osteomyelitis (CRMO) treated with adalimumab. A 2021 retrospective study investigated the dual diagnosis of inflammatory bowel disease (IBD) and CRMO in patients at a children's hospital over 10 years. Most patients were diagnosed with IBD first before later being diagnosed with CRMO. At the time of CRMO diagnosis, some patients' IBD treatment included sulfasalazine, infliximab, or adalimumab. One patient started on subcutaneous methotrexate for CRMO was also started on adalimumab due to ongoing IBD symptoms, with both diseases well controlled on weekly methotrexate and adalimumab. Another patient was started on adalimumab for treatment of both CRMO and IBD, with both conditions well controlled since. The authors conclude that biologics like adalimumab can be used for effective treatment of both conditions while reducing the medication burden of the ...

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A 2019 review evaluated the latest evidence on perioperative fluid therapy for major surgery, focusing on the optimal type and volume of fluids administered. Preoperative fluid management aims to prevent hypovolemia or dehydration before surgery. Guidelines from the American Society of Anesthesiologists recommend unrestricted intake of clear fluids up to 2 hours prior to elective procedures. This is supported by a meta-analysis showing reduced aspiration risk with clear liquid intake compared to overnight fasting. Natural saliva and gastric secretions contribute 500 to 1,250 mL of fluid after an 8-hour fast, and allowing clear fluids dilute gastric acidity, enhancing comfort and safety without increasing gastric volume. Some guidelines have shifted from “allow” to “encourage” clear fluids, though this needs further validation. Clear liquids include water, fruit juice (without pulp), carbonated drinks, and black coffee. Enhanced Recovery After Surgery (ERAS) protocols often include c...

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Papaverine, an opium alkaloid, is a potent vasodilator and antispasmodic commonly used for the management of vascular spasms or cardiac extrasystole either as an intravenous (IV) bolus or intramuscular injection in adult patients. Although clinical evidence for papaverine use is limited in pediatric populations, a 2008 review of papaverine discussed the pharmacology, dosing, and evidence for use in peripheral arterial lines for neonatal treatment. Papaverine continuous IV infusions have been utilized to manage peripheral arterial catheter (PAC) patency, reducing catheter failure risk and increasing the duration of catheter function; catheter failure is associated with vasospasm events, resulting in an inability to draw blood or drip from PAC. Despite the overall clinical benefit for catheter retention, papaverine use in premature infants within the first few days following birth should be administered with caution as these patients are at a heightened risk for intraventricular hemor...

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