Mucosal Atomization Device Research Articles

A Comparative Study of Parent and Child Perspectives on Using the Intranasal Mucosal Atomization Device for Behavior Management in Pediatric Dental Sedation.

Background Dental anxiety in children often necessitates sedation for effective treatment. Different methods of sedation have proved to be beneficial. However, intranasalsedation provides a needleless, rapid drug delivery method that bypasses hepatic metabolism. Intranasal sedative drugs can be delivered using a mucosal atomization device (MAD). This study aimed to find the opinions, beliefs, and existing knowledge of parents and children regarding intranasal sedation and the method of drug delivery through MAD. Materials and methods The study comprised 50 parents, aged 20 to 50, who came in with a single child, aged five to nineyears. In separate rooms, parents and kids were each shown a video about the use of the intranasal sedation technique with MAD as a pharmaceutical help during routine dental procedures. After the video presentation, each participant was required to complete a pretested self-made questionnaire with 21 questions and multiple-choice options. The chi-square test was used in the statistical analysis of the completed questionnaires (P < 0.05). Paired t-test was used for behavior assessment of the children before and after intranasal sedation. Results A significant correlation between parental socioeconomic status and acceptance of intranasal sedation was observed. Parents with higher education levels exhibited a greater level of acceptance (P = 0.000). Parents whose children had prior dental experiences were more likely to view intranasal sedation as a safe option (P = 0.038). Additionally, a significant proportion of previously sedated children expressed willingness to undergo treatment using intranasal sedation. Evaluation of children's behavior before and after treatment revealed a notable improvement, indicating the effectiveness of intranasal sedation (P = 0.000). Conclusion The study thoroughly investigated how parents and children view intranasal sedation via MAD. It revealed a positive perception of safety and trust among parents regarding this method for pediatric dental procedures.

Intranasal Lidocaine Administration via Mucosal Atomization Device: A Simple and Successful Treatment for Postdural Puncture Headache in Obstetric Patients.

(1) Background: Postdural puncture headache (PDPH) remains a serious complication in obstetric patients. While the epidural blood patch represents the current gold standard in therapy, a growing number of alternative measures are thought to be beneficial for clinical management. The purpose of this study was to retrospectively analyze the efficacy of intranasal lidocaine administration to treat PDPH in obstetrics at our university hospital; (2) Methods: A retrospective analysis of the medical records of patients with PDPH has been performed focusing on the techniques of administration, dosing, treatment duration, impact on pain intensity as well as side effects of intranasal lidocaine; (3) Results: During the study period, 5610 obstetric patients received neuraxial anesthesia, of whom 43 (0.77%) developed PDPH. About one third of the patients with PDPH after spinal anesthesia (n = 8), epidural anesthesia (n = 5) or both (n = 2) were treated with intranasal lidocaine. Lidocaine was administered either via gauze compresses (GC, n = 4), a mucosal atomization device (MAD, n = 8) or with a second-line mucosal atomization device due to low gauze compress efficacy (n = 3). All patients treated with lidocaine refused the epidural blood patch. Nebulization of lidocaine resulted in a significant reduction in pain intensity after the first dose (p = 0.008). No relevant side effects developed except sporadic temporal pharyngeal numbness. The utilization of the mucosal atomization device averted the necessity for an epidural blood patch, whether employed as the primary or secondary approach; (4) Conclusions: Our data imply that the mucosal atomization device enhances the efficacy of intranasal lidocaine administration in obstetric patients suffering from PDPH.

Evaluation of the use of intranasal atipamezole to reverse the sedative effects of xylazine in dogs.

To assess the ability of intranasal atipamezole to reverse sedative effects of xylazine in dogs. Prospective proof-of-concept study. University research laboratory. Six healthy, staff-owned dogs. Dogs were sedated with 1.1mg/kg of xylazine intravenously. The sedation score of each dog was recorded every 5minutes until they achieved a sedation score of >13/21 for 3 readings. Once achieved, 0.3mg/kg of atipamezole was administered intranasally using a mucosal atomization device. Sedation scores continued to be recorded every 5minutes until successful reversal was achieved (<4/21). Average times to standing and normal wakefulness after administration of intranasal atipamezole were 6minutes, 30seconds and 7minutes, 20seconds, respectively. Intranasal atipamezole successfully reversed the sedation effects of xylazine. The findings of this study provide justification for future controlled prospective studies into the potential use of intranasal atipamezole in a variety of settings including exposure to xylazine in operational canines as well as bioavailability studies for optimal dosing.

169 Effects of Intranasal Prebiotics, Probiotics and Synbiotics on the Nasopharyngeal Microbiota of Feedlot Cattle

Abstract The emergence of antibiotic-resistant pathogens associated with bovine respiratory disease (BRD) presents a significant challenge to the beef industry, as antibiotic administration is commonly used to prevent and control BRD in feedlot cattle. Alternatives to antibiotics are therefore needed as part of new management strategies to reduce antibiotic use and BRD. We recently developed probiotics comprised of six Lactobacillus strains that inhibited the BRD pathogen Mannheimia haemolytica, and conferred longitudinal modulation of the nasopharyngeal microbiota in calves when a single dose was administered intranasally. In the present study, we evaluated the effects of a prebiotic (lactulose) alone and in combination with probiotic bacteria on the nasopharyngeal microbiota of feedlot calves. The probiotic bacteria consisted of 6 strains of Lactobacillus originated from the nasopharyngeal microbiota of healthy feedlot cattle. The calves were assigned to one of five treatments (n = 8 calves per treatment) and house individually: 1) Syringe-Probiotic group received intra-nasal probiotic cocktail via syringe that was attached to a 25-cm long catheter; 2) MAD-Probiotic group received an intra-nasal probiotic cocktail with a mucosal atomization device; 3) MAD-Synbiotic group received an intra-nasal probiotic cocktail containing prebiotic lactulose (0.5%, suspended in PBS) with a mucosal atomization device; 4) MAD-Prebiotic group received intra-nasal prebiotic lactulose (0.5%, suspended in PBS) with a mucosal atomization device; and 5) MAD-PBS (Control) group received only PBS with a mucosal atomization device. Utilization of a syringe versus mucosal atomization device was tested to determine if mode of probiotic bacteria delivery had an impact on the respiratory microbiota. Deep nasopharyngeal swab samples were collected on day 0 (24 h prior to treatment administration), 2 (24h post intranasal treatment), 3, 6, 9 and 14 days. Genomic DNA was extracted from the swabs and processed for nasopharyngeal microbiota characterization by sequencing 16S rRNA gene amplicon sequencing. When administered to calves intranasally, lactulose had no effect on the diversity or community structure of bacteria (PERMANOVA, P &amp;gt; 0.05) and had limited prolonged effect on specific genera. In addition, when administered as a synbiotic with a multi-strain cocktail of Lactobacillus probiotic bacteria, colonization was not enhanced. However, probiotic bacteria did affect the bacterial structure of NP bacteria (P &amp;lt; 0.05) and increased microbial network interactions. The strongest effect was observed when probiotic bacteria were administered alone, using an atomization device. Overall, this study showed that the bovine respiratory microbiota can be altered by administration of probiotics and may therefore provide new opportunities to enhance microbiome-mediated respiratory resistance against BRD pathogens. While colonization and growth of probiotic bacteria in the respiratory tract are unlikely to be modified by prebiotics delivered in PBS solution, the delivery method and time of application are important factors that need to be evaluated to have optimal efficacy of biologicals.

Intranasal Atomization of Ketamine, Medetomidine and Butorphanol in Pet Rabbits Using a Mucosal Atomization Device

A non-invasive method of drug delivery, intranasal atomization, has shown positive results in human medicine and in some animal species. The objective of this study was to evaluate the effects of intranasal atomization, compared to intramuscular administration, of a mix of anesthetic drugs in pet rabbits. In total, 104 mixed-breed pet rabbits, undergoing various types of surgery, received a combination of ketamine, medetomidine, and butorphanol (20, 0.4, and 0.2 mg/kg) by intranasal atomization using a Mucosal Atomization Device (Group MAD) or intramuscular administration (Group IM). When required, isoflurane was dispensed through a face mask. At the end of the procedures, atipamezole was administered using the same routes in the respective Groups. There were no differences in time to loss of righting reflex between the groups, while differences were found for the need for isoflurane (higher in Group MAD) and recovery time, occurring earlier in Group MAD. The results suggest that intranasal atomization of a combination of ketamine, medetomidine, and butorphanol produces a lighter depth of anesthesia in pet rabbits, compared to intramuscular administration. Intranasal atomization can be performed to administer sedative and anesthetic drugs, avoiding the algic stimulus related to the intramuscular inoculation of drugs.

Adenoviral vector vaccines are effective mucosal booster modalities to elevate systemic and establish mucosal immunity against SARS-CoV-2

Abstract Licensed SARS-CoV-2 vaccines induce robust systemic immune responses, but mucosal immunity in the respiratory tract in form of secretory immunoglobulin A (IgA) or tissue-resident memory T cells (TRM) is not established. Inducing such front-line immunity by mucosal boosting might reduce the individual risk of breakthrough infections and thereby likely mitigate infection dynamics on population level as well. The following project evaluates preclinical and licensed adenoviral vector (Ad) platforms as mucosal SARS-CoV-2 boosters. We show that nasal instillation of Ad5- and Ad19a-Spike following a systemic DNA or mRNA priming results in strong systemic and mucosal immunity in mice. In contrast to two intramuscular injections with a licensed mRNA vaccine, the mucosal boost with Ad vectors induced CD103 +CD69 +tissue-resident memory CD8 +T cells and high levels of Spike-specific IgA in the respiratory tract as well as an enhanced mucosal neutralization of variants of concern. Moreover, the protective efficacy of the mRNA prime/intranasal Ad5 boost strategy was not inferior to two intramuscular mRNA immunizations. In a more translational approach, we employed Janssen’s Ad26.COV2.S as a mucosal booster delivered by a medical mucosal atomization device after a systemic mRNA prime of mice. Concerning systemic responses, the mucosal boost was similarly immunogenic compared to an intramuscular boost with the same vaccine. However, only a mucosal delivery provoked TRM and IgA in the respiratory tract as well as a robust mucosal neutralization of Omicron variants. In conclusion, a mucosal booster immunization is a promising approach to establish mucosal immunity in addition to systemic responses in an mRNA vaccine-primed population.

Effect of Age and Head Position on Total and Regional Aerosol Deposition in Three-Dimensional Models of Human Intranasal Airways Using a Mucosal Atomization Device.

Background: This study examined the effect of age and head position on total and regional deposition of aerosol delivered by a mucosal atomization device (MAD™) in three-dimensional (3D) models of the intranasal airways of an 18-, 5-, and 2-year-old human. Models consisted of four pieces: anterior nose and nasal cavity that was divided horizontally into upper, middle, and lower thirds. Methods: Models were tested six times at supine, supine with head backward at 45° (supine45), and sitting with head backward at 45° (sitting45). The MAD delivered saline/fluorescein aerosol into model nostrils, during static airflow. Model pieces were tested for fluorescence using a fluorometer, and deposition calculated as percent fluorescence per piece relative to its reference. Total deposition (four pieces combined) and regional deposition (four pieces separately) were calculated. Results: Age and head position had little effect on total deposition. In contrast, deposition in the upper and middle third supine45 and in the lower third sitting45 was significantly different in the 2-year-old model, compared with the two older models. In addition, some head positions significantly increased deposition in the upper, middle, and lower thirds within each model, compared with other positions. Upper deposition was significantly greater at supine45, compared with sitting45 (18-year-old) and supine45, compared with supine and sitting45 (5-year-old). Middle deposition was significantly greater at supine and supine45, compared with sitting45 (2-year-old). Lower deposition was significantly greater at sitting45, compared with supine45 (18-year-old); supine and sitting45, compared with supine45 (5-year-old); and sitting45, compared with supine45 and supine (2-year-old). Conclusions: Age and head position significantly affected regional deposition of aerosol delivered by the MAD in these 3D models. Such models might be used to study other methods for targeting intranasal regions with aerosolized medications in children and adults.

Repurposing mucosal delivery devices for live attenuated tuberculosis vaccines.

Tuberculosis (TB) remains one of the most lethal infectious diseases globally. The only TB vaccine approved by the World Health Organization, Bacille Calmette-Guérin (BCG), protects children against severe and disseminated TB but provides limited protection against pulmonary TB in adults. Although several vaccine candidates have been developed to prevent TB and are undergoing preclinical and clinical testing, BCG remains the gold standard. Currently, BCG is administered as an intradermal injection, particularly in TB endemic countries. However, mounting evidence from experimental animal and human studies indicates that delivering BCG directly into the lungs provides enhanced immune responses and greater protection against TB. Inhalation therapy using handheld delivery devices is used for some diseases and allows the delivery of drugs or vaccines directly into the human respiratory tract. Whether this mode of delivery could also be applicable for live attenuated bacterial vaccines such as BCG or other TB vaccine candidates remains unknown. Here we discuss how two existing inhalation devices, the mucosal atomization device (MAD) syringe, used for influenza vaccines, and the Respimat® Soft Mist™ inhaler, used for chronic obstructive pulmonary disease (COPD) therapy, could be repurposed for mucosal delivery of live attenuated TB vaccines. We also outline the challenges and outstanding research questions that will require further investigations to ensure usefulness of respiratory delivery devices that are cost-effective and accessible to lower- and middle-income TB endemic countries.

The most common route of administration used during COVID-19

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is the virus that caused the COVID-19 pandemic. Initial symptoms include fever, cough, and dyspnea. Symptoms include nausea, vomiting, and abdominal pain, GIT involvement is also possible. The COVID-19 outbreak has increased the need for alternative medicine administration routes, particularly in public places. Buccal, sublingual, and rectal administration are all considered transmucosal methods. They are self-administration options for non-invasive systemic distribution. In addition, they are great for use in palliative and end-of-life care because of their quick onset of action and decreased first-pass metabolism. A mucosal atomization device allows for the intranasal administration of a parenteral formulation through nasal spray. Rectal mucosal absorption is comparable to that of the oral route, making the rectal route an extremely versatile and useful method of drug administration for a wide variety of medications. Covid-19 illness is treated with a variety of drugs, including anti-malaria medication (hydroxychloroquine), glucocorticoids (dexamethasone), antibiotics (azithromycin), and antiviral medications (favipiravir). This article discusses the route of drug administration for COVID-19, as well as symptoms, treatments, and the various ways it can be spread

Sedative and cardiorespiratory effects of intranasal atomized alfaxalone in Japanese White rabbits

ObjectiveTo investigate the sedative and cardiorespiratory effects of intranasal atomization (INA) of alfaxalone using a mucosal atomization device in Japanese White rabbits. Study designRandomized, prospective, crossover study. AnimalsA total of eight healthy female rabbits, weighing 3.6–4.3 kg and aged 12–24 months. MethodsEach rabbit was randomly assigned to four INA treatments administered 7 days apart: Control treatment, 0.15 mL 0.9% saline in both nostrils; treatment INA0.3, 0.15 mL 4% alfaxalone in both nostrils; treatment INA0.6, 0.3 mL 4% alfaxalone in both nostrils; treatment INA0.9, 0.3 mL 4% alfaxalone in left, then right, then left nostril. Sedation was scored 0–13 using a composite measure scoring system for rabbits. Simultaneously, pulse rate (PR), respiratory rate (fR), noninvasive mean arterial pressure (MAP), peripheral hemoglobin oxygen saturation (SpO2) and arterial blood gases were measured until 120 minutes. The rabbits breathed room air during the experiment and were administered flow-by oxygen when hypoxemia (SpO2 <90% or PaO2 <60 mmHg; 8.0 kPa) developed. Data were analyzed using the Fisher's exact test and the Friedman test (p < 0.05). ResultsNo rabbit was sedated in treatments Control and INA0.3. All rabbits in treatment INA0.9 developed loss of righting reflex for 15 (10–20) minutes [median (25th–75th percentile)]. Sedation score significantly increased from 5 to 30 minutes in treatments INA0.6 and INA0.9 with maximum scores of 2 (1–4) and 9 (9–9), respectively. fR decreased in an alfaxalone dose-dependent manner and one rabbit developed hypoxemia in treatment INA0.9. No significant changes were observed in PR and MAP. Conclusions and clinical relevanceINA alfaxalone resulted in dose-dependent sedation and respiratory depression in Japanese White rabbits to values considered not clinically relevant. Further investigation of INA alfaxalone in combination with other drugs is warranted.

Choosing nasal devices: a dilemma in clinical practice.

Upper airway diseases are frequent and recognize different etiopathogenetic mechanisms, including infection, inflammation, and allergy. Therefore, topical treatments are preferable in comparison with systemic medications. Several delivery devices are available on the market, including nasal drops, syringes, sprays, nebulizers, and douches. However, it is clinically relevant to know the better way to use it. The present experience compared five different devices that were tested: i) a nasal dropper, ii) a standard nasal spray device, iii) a mucosal atomization device with a nozzle tip, iv) a nebulizer device, and v) a nasal douche. Saline solution with methylene blue was the marker to evaluate the intranasal distribution. The findings showed an apparent difference in area distribution among these delivery devices. Conclusion The present experience showed that doctors should choose the most appropriate device for the current disease in clinical practice.

The sedative effect of intranasal administration of medetomidine using a mucosal atomization device in Japanese White rabbits.

To prevent aspiration in Japanese White (JW) rabbits, the maximum single volume of medetomidine administered intranasally is 0.3 mL per nostril using a mucosal atomization device (MAD). This study aimed to examine the sedative effect of intranasal administration of medetomidine using MAD in eight healthy female JW rabbits. Each rabbit received intranasal atomization (INA) of saline (Control treatment) along with three doses of 1 mg/mL medetomidine (0.3 mL to one nostril [MED0.3 treatment]; 0.3 mL each to both nostrils [MED0.6 treatment]; 0.3 mL twice to both nostrils [MED1.2 treatment]), with a washout period of at least 7 days between treatments. The actual doses of medetomidine were 82 (75-84) μg/kg (median [25th-75th percentile]), 163 (156-168) μg/kg, and 323 (295-343) μg/kg for the MED0.3, MED0.6, and MED1.2 treatments, respectively. A medetomidine-dose dependent sedative effect was detected, and the loss of righting reflex (LRR) was achieved in one rabbit at 18 min, seven rabbits at 11 (9-18) min, and eight rabbits at 7 (4-18) min after the MED0.3, MED0.6, and MED1.2 treatments, respectively. The LRR was maintained for 63 (29-71) min and 83 (68-101) min after the MED0.6 and MED1.2 treatments, respectively. Additionally, the INA of medetomidine produced a significant dose-dependent cardiorespiratory depression including a decrease in pulse rate, respiratory rate, percutaneous oxygen saturation, and arterial partial pressure of oxygen, and an increase in arterial partial pressure of carbon dioxide in the rabbits.

Pharmacokinetic Study of Intranasal Dexamethasone and Methylprednisolone Compared with Intravenous Administration: Two Open-Label, Single-Dose, Two-Period, Two-Sequence, Cross-Over Study in Healthy Volunteers

Dexamethasone (DXM) and methylprednisolone (MEP) are potent glucocorticoids used to control several inflammatory conditions. Evidence of delayed DXM reaching the central nervous system (CNS) as well as tachyphylaxis and systemic, undesirable side effects are the main limitations of peripheral delivery. Intranasal administration offers direct access to the brain as it bypasses the blood-brain barrier. The Mucosal Atomization Device is an optimal tool that can achieve rapid absorption into the CNS and the bloodstream across mucosal membranes. This study was designed to evaluate and compare the bioavailability of DXM and MEP after intranasal versus intravenous administration. Two open-label, balanced, randomized, two-treatment, two-period, two-sequence, single-dose, crossover studies were conducted, which involved healthy male and female adult volunteers. After intranasal administration, DXM and MEP were detected in plasma after the first sampling time. Mean peak concentrations of DXM and MEP were 86.61 ng/mL at 60 min and 843.2 ng/mL at 1.5 h post-administration, respectively. DXM and MEP showed high absolute bioavailability, with values of 80% and 95%, respectively. No adverse effects were observed. DXM and MEP systemic bioavailability by intranasal administration was comparable with the intravenous one, suggesting that the intranasal route can be used as a non-invasive and appropriate alternative for systemic drug delivery.

Emergency medical care of patients with psychiatric disorders - challenges and opportunities: Results of a multicenter survey

BackgroundPre-clinical psychiatric emergencies are generally treated by emergency medical staff. The subsequent clinical treatment is often conditioned by interaction problems between emergency medical staff and psychiatric clinical staff.ObjectivesTo identify problems affecting interaction between emergency medical and psychiatric care of mentally ill patients and pinpoint aspects of optimized emergency care.MethodsTo shed light on the interaction problems an anonymous, questionnaire-based, nonrepresentative survey of 98 emergency physicians (EM) and 104 psychiatrists (PS) practicing in acute psychiatry was conducted between March 1, 2021 and October 1, 2021.ResultsThe chi-square test for multiple response sets revealed consistently significant differences (p < 0.001) between EM and PS with respect to the questions analyzed. Approximately 36% of EM reported not to be adequately qualified to handle psychiatric emergencies (p = 0.0001), while around 50% of respondents were neutral in their assessment in how to deal with psychiatric emergencies. 80% of EM reported a negative interaction (rejection of patients) with PS when referring a psychiatric emergency patient to the acute psychiatric unit. The most common reasons for refusal were intoxication (EM: 78.8%, PS: 88.2%), emergency physician therapy (EM: 53.8%, PS: 63.5%), and not resident in the catchment area of the hospital (EM 68.8%, PS: 48.2%). In the casuistry presented, most respondents would choose “talk down” for de-escalation (EM: 92.1%, PS: 91.3%). With respect to drug therapy, benzodiazepine is the drug of choice (EM: 70.4%, PS: 78.8%). More EM would choose an intravenously (i.v.) or a Mucosal Atomization Device (MAD) administration as an alternative to oral medication (i.v.: EM: 38.8%, PS: 3.8%, p = 0.001, MAD: EM: 36.7%, PS: 10.6%, p = 0.006). Significantly more EM would seek phone contact with the acute psychiatric hospital (EM: 84.7%, PS: 52.9%, p = 0.0107). A psychiatric emergency plan was considered useful in this context by more than 90% of respondents. The need for further training for EM with regard to treating psychiatric clinical syndromes was considered important by all respondents. In particular, the topics of “psychogenic seizure,“ “intoxication,“ and “legal aspects of psychiatric emergencies” were considered important (Mann-Whitney U test, p < 0.001).ConclusionThe interaction-related problems identified in the emergency medical care of pre-clinical psychiatric patients relate to non-modifiable, structural problems, such as insufficient admission capacity and non-existent or inadequate monitoring capabilities in acute psychiatric hospitals. However, factors such as the education and training of EM and communication between EM and PS can be improved. Developing personalized emergency care plans for psychiatric patients could help to optimize their care.

Safety and immunogenicity of live, attenuated intranasal Bordetella pertussis vaccine (BPZE1) in healthy adults

BackgroundBPZE1 is a live, attenuated pertussis vaccine derived from B. pertussis strain Tohama I modified by genetic removal or inactivation of 3 B. pertussis toxins: pertussis toxin, dermonecrotic toxin, and tracheal cytotoxin. This Phase 2a study evaluated the safety and immunogenicity of liquid or lyophilized BPZE1 vaccine administered intranasally by needleless tuberculin syringe or mucosal atomization device (VaxINatorTM) at two dose levels. MethodsFifty healthy male and non-pregnant female participants 18–49 years of age were enrolled. Participants were randomized 3:3:3:1 to a single lyophilized dose of 107 colony forming units (CFU) BPZE1, 109 CFU BPZE1, placebo via VaxINator device, or a single liquid dose of 109 CFU BPZE1 via tuberculin syringe. Reactogenicity was assessed for 14 days. Blood was obtained pre-vaccination; on Day 8 (safety); and on Days 15, 29, and 181 (immunogenicity). Nasal wick and swab samples were obtained at baseline and on Days 29 and 181 for assessment of mucosal antibody responses and clearance of BPZE1. ResultsAcross all groups, 35/50 (70 %) experienced at least one local adverse event (AE) and 31/50 (62 %) experienced at least one systemic AE, with similar AE frequencies observed between the highest 109 CFU BPZE1 and placebo groups. There were no severe or serious AEs during the study. At Day 29, seroconversion (≥2-fold rise from baseline in serum IgG or IgA) to at least 2 pertussis antigens was observed in 73 % in the 109 CFU BPZE1 VaxINator group, 60 % in the 109 CFU BPZE1 group delivered via tuberculin syringe, 27 % of participants in the 107 CFU BPZE1 VaxINator group, and 20 % in the placebo VaxINator group. No participants were colonized with BPZE1 at Day 29 post vaccination. DiscussionLyophilized BPZE1 vaccine was well tolerated and immunogenic at the highest dose (109 CFU) delivered intranasally by VaxINator device and was not associated with any SAEs or prolonged shedding of BPZE1. Further evaluation of BPZE1 is warranted.

Comparison of the sedative effects of intranasal or intramuscular dexmedetomidine at low doses in healthy dogs: a randomized clinical trial

ObjectiveTo compare the sedative effects of dexmedetomidine administered either intranasally or intramuscularly to healthy dogs. Study designProspective, randomized, blinded, clinical trial. AnimalsA group of 16 client-owned healthy dogs. MethodsDogs were randomly allocated to one of two groups that were administered dexmedetomidine 5 μg kg–1 via either the intranasal route (INDex), through a mucosal atomization device in one nostril, or the intramuscular route (IMDex), into the epaxial muscles. Ease of intranasal administration, sedation score, onset of sedation, cardiopulmonary variables, mechanical nociceptive thresholds (MNTs) and response to venous catheterization were recorded at 0 (baseline), 5, 10, 15, 20, 25, 30, 35, 40 and 45 minutes, following drug administration. Data were compared with the one-way anova, Mann-Whitney U test, and chi-square test, where appropriate. ResultsGroups were not different for age, sex, weight, body condition score or temperament. Sedation scores, MNTs and response to intravenous catheter placement were not different when dexmedetomidine was administered by either route (p = 0.691; p = 0.630 and p = 0.435, respectively). Onset of sedation was not different between groups INDex and IMDex reaching a score of 4.2 ± 0.9 and 5.5 ± 1.2 at 9 ± 5 and 8 ± 4 minutes, respectively (p = 0.467). The highest sedation score was achieved at 30 and 35 minutes and sedation scores were 9.7 ± 2.0 and 9.5 ± 2.3 in groups INDex and IMDex, respectively (p = 0.799). Respiratory rate was higher in group INDex (p = 0.014), while there were no differences between routes in heart rate (p = 0.275), systolic (p = 0.957), diastolic (p = 0.837) or mean arterial pressure (p = 0.921). Conclusions and clinical relevanceIntranasal administration of dexmedetomidine at 5 μg kg–1 provides effective sedation in healthy dogs.

A randomized study of midazolam versus dexmedetomidine for premedication in children via intranasal mucosal atomization device

Many drugs have been tried for premedication in children[1] amongst which midazolam and dexmedetomidine are commonly used and are reportedly safe and effective for usage during both separation as well as induction of anaesthesia. Hence, we planned to carry out a study of midazolam versus dexmedetomidine for premedication in children via intranasal Mucosal Atomization Device. To compare the efficacy of midazolam and dexmedetomidine as premedication in children of 2 to 6 years of age via intranasal Mucosal Atomization Device. This randomized study was done at Dhiraj hospital, Piparia, Vadodara, Gujarat on 60 children belonging to American Society of Anaesthesiologists (ASA) physical status I or II of age 2-6 years of either gender undergoing elective surgeries under general anaesthesia. Children were separated into: Group M - Midazolam 0.2 mg/kg (preservative free) Group D - Dexmedetomidine 1µg/kg. Drug was administered 30 minutes prior to surgery and following parameters were assessed: Acceptance of drug, Sedation Score, behaviour during parental separation and mask acceptance. Dexmedetomidine was statistically significantly better in aspect of drug acceptance, sedation after 30 minutes of drug administration, parental separation and mask acceptance than midazolam.

Maximum volume of nasal administration using a mucosal atomization device without aspiration in Japanese White rabbits.

Recently, a mucosal atomization device (MAD) has been applied in veterinary medicine. In the present study, the maximum volume of nasal atomization without aspiration using MAD was examined in eight healthy female Japanese White (JW) rabbits. Each rabbit had their head and neck examined by computed tomography before and after nasal atomization with four different doses (0.15, 0.3, 0.45, and 0.6 ml per nostril) of diluted contrast medium (1:2 mixture of iohexol and saline). This was done under general anesthesia by an intramuscular administration of alfaxalone 2.5 mg/kg, medetomidine 40 μg/kg, and butorphanol 0.4 mg/kg, with a 7-day washout period between each treatment. The diluted contrast medium was distributed in the nasal cavity, external nares, and/or oral cavity in all rabbits receiving each treatment. The intranasal distribution volumes of the contrast medium were 287 (250–333) mm3 [median (interquartile range)] for 0.15 ml, 433 (243–555) mm3 for 0.3 ml, 552 (356–797) mm3 for 0.45 ml, and 529 (356–722) mm3 for 0.6 ml of treatment. The intranasal distribution volume for 0.15 ml treatment tended to be lower than that for 0.6 ml treatment (P=0.083). The contrast medium was deposited in the trachea in one rabbit (12.5%) and four rabbits (50%) receiving treatments of 0.45 and 0.6 ml per nostril, respectively. The maximum volume of nasal atomization without aspiration into the trachea was 0.3 ml per nostril for the JW rabbits.

Evaluation of the intranasal route for porcine reproductive and respiratory disease modified-live virus vaccination

BackgroundIn pigs, modified live virus (MLV) vaccines against porcine reproductive and respiratory syndrome virus (PRRSV) are commonly used and administered by intramuscular (IM) injection. In contrast, PRRSV, as a primary respiratory pathogen, is mainly transmitted via the intranasal (IN) route. The objective of this study was to evaluate the efficacy of a commonly used commercial PRRSV MLV delivered IN compared to the IM route. MethodsFifty-four pigs were divided into five treatment groups. All vaccinated groups received the same MLV vaccine but administered via different routes. Group IN-JET-VAC was vaccinated with an automated high pressure prototype nasal jet device (IN-JET-VAC, n = 12), group IN-MAD-VAC was vaccinated with a mucosal atomization device (IN-MAD-VAC, n = 12), group IM-VAC was vaccinated intramuscularly (IM-VAC; n = 12) according to label instructions, while the NEG-CONTROL (n = 6) and the POS-CONTROL (n = 12) groups were both unvaccinated. At 28 days post vaccination all vaccinated groups and the POS-CONTROL pigs were challenged with a pathogenic US PRRSV isolate. Blood and nasal swabs were collected at regular intervals, and all pigs were necropsied at day 10 post challenge (dpc) when gross and microscopic lung lesions were assessed. ResultsPrior to challenge most vaccinated pigs had seroconverted to PRRSV. Clinical signs (fever, inappetence) were most obvious in the POS-CONTROL group from dpc 7 onwards. The vaccinated groups were not different for PRRSV viremia, seroconversion, or average daily weight gain. However, IN-JET-VAC and IN-MAD-VAC had significantly higher neutralizing antibody levels against the vaccine virus at challenge. ConclusionsComparable vaccine responses were obtained in IN and IM vaccinated pigs, suggesting the intranasal administration route as an alternative option for PRRSV vaccination.

Life‐threatening pharyngeal oedema secondary to severe perianaesthetic regurgitation in a French bulldog: Management with topical adrenaline and nasotracheal tube

AbstractPostoperative upper airway obstructions in brachycephalic dogs (BDs) mainly occur following brachycephalic airway surgery. Tracheostomy is the most frequently reported technique to relieve upper airway obstructions. A 10‐year‐old French bulldog presented repeated regurgitation during anaesthesia for orthopaedic surgery. Oesophageal and pharyngeal lavage were performed. Seven hours after recovery, the dog displayed severe stertor and hypoxemia, which were not relieved with oxygen flow‐by and sedation. Emergency anaesthesia and tracheal intubation were performed. Laryngoscopy revealed severe pharyngeal inflammation. A nasotracheal tube (NTT) was placed while the dog remained intubated, and diluted adrenaline was sprayed on the pharynx using a mucosal atomization device. Mild sedation and oxygenotherapy through NTT were maintained for 3 days. The dog was discharged after 5 days. This report describes an uncommon complication of perianaesthetic repeated regurgitation in a BD, and an unusual technique for managing an upper airway obstruction.