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      Newer drug delivery systems in anesthesia

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          Abstract

          A paradigm shift in drug delivery systems have been noted recently. The focus nowadays is to obtain maximum benefit with lower side effects. It is a monetary burden to launch newer molecules hence the industry is concentrating on improving the efficacy of existing molecules. Thus controlled release, target controlled infusion and closed loop infusion have entered the scene. Applying pharmacokinetic principles, instead of mathematically calculating drug dose could improve safety and maintain steady drug levels in the body. When computers are applied to an efficient operating system, it will only magnify the efficiency. Most of these technologies which were earlier limited to research only have entered clinical practice. This has made it mandatory for the practicing clinician to familiarize themselves with these technologies. Our focus in this review has been to discuss newer drug delivery systems available for anesthesiology practice.

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          Most cited references91

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          Transdermal drug delivery.

          Transdermal drug delivery has made an important contribution to medical practice, but has yet to fully achieve its potential as an alternative to oral delivery and hypodermic injections. First-generation transdermal delivery systems have continued their steady increase in clinical use for delivery of small, lipophilic, low-dose drugs. Second-generation delivery systems using chemical enhancers, noncavitational ultrasound and iontophoresis have also resulted in clinical products; the ability of iontophoresis to control delivery rates in real time provides added functionality. Third-generation delivery systems target their effects to skin's barrier layer of stratum corneum using microneedles, thermal ablation, microdermabrasion, electroporation and cavitational ultrasound. Microneedles and thermal ablation are currently progressing through clinical trials for delivery of macromolecules and vaccines, such as insulin, parathyroid hormone and influenza vaccine. Using these novel second- and third-generation enhancement strategies, transdermal delivery is poised to significantly increase its impact on medicine.
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            Inhaling medicines: delivering drugs to the body through the lungs.

            Remarkably, with the exception of anaesthetic gases, the ancient human practice of inhaling substances into the lungs for systemic effect has only just begun to be adopted by modern medicine. Treatment of asthma by inhaled drugs began in earnest in the 1950s, and now such 'topical' or targeted treatment with inhaled drugs is considered for treating many other lung diseases. More recently, major advances have led to increasing interest in systemic delivery of drugs by inhalation. Small molecules can be delivered with very rapid action, low metabolism and high bioavailability; and macromolecules can be delivered without injections, as highlighted by the recent approval of the first inhaled insulin product. Here, we review these advances, and discuss aspects of lung physiology and formulation composition that influence the systemic delivery of inhaled therapeutics.
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              Challenges and opportunities in dermal/transdermal delivery.

              Transdermal drug delivery is an exciting and challenging area. There are numerous transdermal delivery systems currently available on the market. However, the transdermal market still remains limited to a narrow range of drugs. Further advances in transdermal delivery depend on the ability to overcome the challenges faced regarding the permeation and skin irritation of the drug molecules. Emergence of novel techniques for skin permeation enhancement and development of methods to lessen skin irritation would widen the transdermal market for hydrophilic compounds, macromolecules and conventional drugs for new therapeutic indications. As evident from the ongoing clinical trials of a wide variety of drugs for various clinical conditions, there is a great future for transdermal delivery of drugs.
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                Author and article information

                Journal
                J Anaesthesiol Clin Pharmacol
                J Anaesthesiol Clin Pharmacol
                JOACP
                Journal of Anaesthesiology, Clinical Pharmacology
                Medknow Publications & Media Pvt Ltd (India )
                0970-9185
                2231-2730
                Apr-Jun 2017
                : 33
                : 2
                : 157-163
                Affiliations
                [1]Department of Anaesthesiology, Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai, Maharashtra, India
                Author notes
                Address for correspondence: Dr. Sona Dave, 4C Bindiya, Reclamation Area, Bandra (West), Mumbai - 400 050, Maharashtra, India. E-mail: sonadave@ 123456gmail.com
                Article
                JOACP-33-157
                10.4103/joacp.JOACP_63_16
                5520586
                28781439
                4e9748fa-25c1-4b67-984a-5a3e3738aebd
                Copyright: © 2017 Journal of Anaesthesiology Clinical Pharmacology

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

                History
                Categories
                Review Article

                Anesthesiology & Pain management
                controlled released,newer drug delivery system,target control release

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