Limited evidence from case reports suggests that coronavirus disease 2019 (COVID-19) vaccination may interact with the treatment outcomes of psychiatric medications. Apart from clozapine, reports on ...the effect of COVID-19 vaccination on other psychotropic agents are scarce. This study aimed to investigate the impact of COVID-19 vaccination on the plasma levels of different psychotropic drugs using therapeutic drug monitoring.
Plasma levels of psychotropic agents, including agomelatine, amisulpride, amitriptyline, escitalopram, fluoxetine, lamotrigine, mirtazapine, olanzapine, quetiapine, sertraline, trazodone, and venlafaxine, from inpatients with a broad spectrum of psychiatric diseases receiving COVID-19 vaccinations were collected at 2 medical centers between 08/2021 and 02/2022 under steady-state conditions before and after vaccination. Postvaccination changes were estimated as a percentage of baseline.
Data from 16 patients who received COVID-19 vaccination were included. The largest changes in plasma levels were reported for quetiapine (+101.2%) and trazodone (-38.5%) in 1 and 3 patients, respectively, 1 day postvaccination compared with baseline levels. One week postvaccination, the plasma levels of fluoxetine (active moiety) and escitalopram increased by 31% and 24.9%, respectively.
This study provides the first evidence of major changes in the plasma levels of escitalopram, fluoxetine, trazodone, and quetiapine after COVID-19 vaccination. When planning COVID-19 vaccination for patients treated with these medications, clinicians should monitor rapid changes in bioavailability and consider short-term dose adjustments to ensure safety.
Background
Balloon‐tipped bronchial blocker catheters are widely used in pediatric thoracic anesthesia to establish single‐lung ventilation. In clinical practice, their balloons demonstrate sudden ...expansion when inflated with air. In addition, there are concerns related to the high inflation pressures required to expand the balloons.
Methods
This in vitro study assessed inflation volume‐ and inflation pressure‐balloon diameter characteristics of the Fogarty arterial embolectomy catheters and Arndt endobronchial blockers. Balloon diameters were photographically assessed during unrestricted volume‐ and pressure‐guided inflation, using air up to the maximum allowed inflation volume as indicated by the manufacturers. Inflation pressures required to open the blocker balloons and inflation pressures needed to expand them to maximum indicated diameter were measured.
Results
Volume‐guided inflation demonstrated a late acute rise in diameter in Fogarty blocker balloons, whereas in the Arndt endobronchial blocker balloons almost linear inflation volume‐to‐diameter characteristics were observed. Pressure‐guided inflation on the other hand demonstrated low‐volume, high‐pressure characteristics in the Fogarty blocker balloons, with inflation pressures required to expand the balloons to maximum diameters ranging from (mean (SD)) 636 (75) to 947 (152) cmH2O. The inflation pressures required to open the Fogarty blocker balloons were even >1000 cmH2O. Inflation pressures required to expand the 5 F, 7 F, and 9 F Arndt endobronchial blocker balloons to maximum indicated diameter were much lower, namely at 218 (15), 252 (28), and 163 (8) cmH2O.
Conclusion
Based on these study findings, the balloons of Fogarty arterial embolectomy catheters represent high‐pressure devices and do not permit stepwise controlled bronchial blockage. The Arndt endobronchial blockers have some advantages over the Fogarty blocker devices, but also represent high‐pressure equipment and must be used with caution and limited duration. Manufacturers are asked to design pediatric endobronchial blocker catheters with truly high‐volume, low‐pressure balloons in accordance to age‐related pediatric airway dimensions.
Background
Age‐related recommendations for size selection of bronchial blocker devices are based on a few dated anatomical autopsy and radiological studies determining lower airway dimensions in ...children. These recommendations are based on anterior‐posterior internal bronchial diameters, which are smaller than the more relevant lateral internal bronchial diameters.
Methods
Outer diameters of bronchial blocker balloons inflated with the maximum recommended volume of air were compared to age‐related lateral internal bronchial diameters of left and right proximal mainstem bronchi using five different recommendations for age‐related size selection of bronchial blocker equipment in children published in the literature.
Results
The ratio of outer bronchial blocker diameters inflated with the maximal recommended volume of air to the median lateral internal diameters of the proximal mainstem bronchus ranged from 71.4% to 181.8% for the left side and from 61.7% to 162.6% for the right side. There were many settings where the blocker diameters did not reach the median lateral internal diameters of the proximal mainstem bronchus. This was more often observed for the right than for the left side (37 vs 22 settings).
Conclusion
This analysis demonstrates that irrespective of the recommendation for size selection used, neither the two balloon‐tipped vascular catheters included nor the Arndt endobronchial blockers are ideal for lung isolation in children are compared with the age‐related relevant dimensions of pediatric airway anatomy. A redesign of bronchial blocker equipment with age‐related anatomically based high‐volume, low‐pressure blocker balloons made from ultrathin membranes and with smaller catheters would be desirable.
Based on two cases presented and our recently published experience, we think that for the majority of patients with central venous catheters misplaced in the vertebral artery, stent graft placement ...is the best bailout option.
We recently reported the discovery of a potent, selective, and brain-penetrant V1a receptor antagonist, which was not suitable for full development. Nevertheless, this compound was found to improve ...surrogates of social behavior in adults with autism spectrum disorder in an exploratory proof-of-mechanism study. Here we describe scaffold hopping that gave rise to triazolobenzodiazepines with improved pharmacokinetic properties. The key to balancing potency and selectivity while minimizing P-gp mediated efflux was fine-tuning of hydrogen bond acceptor basicity. Ascertaining a V1a antagonist specific brain activity pattern by pharmacological magnetic resonance imaging in the rat played a seminal role in guiding optimization efforts, culminating in the discovery of balovaptan (RG7314, RO5285119) 1. In a 12-week clinical phase 2 study in adults with autism spectrum disorder balovaptan demonstrated improvements in Vineland-II Adaptive Behavior Scales, a secondary end point comprising communication, socialization, and daily living skills. Balovaptan entered phase 3 clinical development in August 2018.
