- 関
- intrathecal
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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/04/25 20:52:56」(JST)
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Intrathecal administration is a route of administration for drugs via an injection into the spinal canal, or into the subarachnoid space so that it reaches the cerebrospinal fluid (CSF) and is useful in spinal anaesthesia, chemotherapy, or pain management applications. This route is also used to introduce drugs that fight certain infections, particularly post-neurosurgical. The drug needs to be given this way to avoid the blood brain barrier. The same drug given orally must enter the blood stream and may not be able to pass out and into the brain. Drugs given by the intrathecal route often have to be made up specially by a pharmacist or technician because they cannot contain any preservative or other potentially harmful inactive ingredients that are sometimes found in standard injectable drug preparations.
The route of administration is sometimes simply referred to as "intrathecal"; however, the term is also an adjective that refers to something occurring in or introduced into the anatomic space or potential space inside a sheath, most commonly the arachnoid membrane of the brain or spinal cord[1] (under which is the subarachnoid space). For example, intrathecal immunoglobulin production is production of antibodies in the spinal cord.[2] The abbreviation "IT" is best not used; instead, "intrathecal" is spelled out to avoid medical mistakes.
| Subarachnoid space |
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Diagrammatic representation of a section across the top of the skull, showing the membranes of the brain, etc. ("Subarachnoid cavity" visible at left.)
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Diagrammatic transverse section of the medulla spinalis and its membranes. (Subarachnoid cavity colored blue.)
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| Details |
| Identifiers |
| Latin |
Spatium subarachnoideum,
cavum subarachnoideale |
| MeSH |
A08.186.566.166.686 |
Dorlands
/Elsevier |
s_16/12746651 |
| Anatomical terminology
[edit on Wikidata]
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Contents
- 1 Intrathecal administration of analgesic agents
- 2 Intrathecal chemotherapy
- 3 Intrathecal baclofen
- 4 See also
- 5 References
Intrathecal administration of analgesic agents
Main article: Spinal anaesthesia
- Very popular for a single 24-hour dose of analgesia (opioid with local anesthetic)
- Caution because of late onset hypoventilation
- Severe pruritus and urinary retention may limit the use of intrathecal morphine
- Pethidine has the unusual property of being both a local anaesthetic and opioid analgesic which occasionally permits its use as the sole intrathecal anaesthetic agent
Intrathecal chemotherapy
- Currently, only four agents are licensed for intrathecal chemotherapy
- They are methotrexate, cytarabine (Ara-C), hydrocortisone, and, rarely, thiotepa.[3]
- Administration of other chemotherapeutic agents such as vincristine via the intrathecal route can lead to fatal outcomes.[4][5]
Intrathecal baclofen
Main article: Intrathecal pump
Often reserved for spastic cerebral palsy, intrathecally-administered baclofen is done through an intrathecal pump implanted just below the skin of the stomach, (or behind the chest wall, depending on the surgeon implanting the device, and patient preferences), with a tube (called the 'catheter') connected directly to the base of the spine, where it bathes the spinal cord using a dose about one thousand times smaller than that required by orally-administered baclofen. Intrathecal baclofen also carries none of the side effects, such as sleepiness, that typically occur with oral baclofen. However, intrathecal baclofen pumps carry serious clinical risks, such as infection or a possibly fatal sudden malfunction, that oral baclofen does not.
A tremendous amount of care is taken to ensure the optimal location of the pump and catheter, based upon medical considerations and patient requirements.
See also
- Thecal sac
- Theca
- History of neuraxial anesthesia
References
- ^ "Route of Administration". Data Standards Manual. Food and Drug Administration. Retrieved 11 March 2011.
- ^ Meinl, E; Krumbholz, M; Derfuss, T; Junker, A; Hohlfeld, R (2008). "Compartmentalization of inflammation in the CNS: a major mechanism driving progressive multiple sclerosis". Journal of the neurological sciences 274 (1–2): 42–4. doi:10.1016/j.jns.2008.06.032. PMID 18715571.
- ^ Grossman SA, Finklestein DM, Ruckdeschel JC, et al. (March 1993). "Randomized prospective comparison of intraventricular methotrexate and thiotepa with previously untreated neoplastic meningitis. Eastern Cooperative Oncology Group.". Journal of Clinical Oncology 11 (3): 561–9. PMID 8445432.
- ^ Schulmeister L (September 2004). "Preventing vincristine sulfate medication errors". Oncology Nursing Forum 31 (5): E90–8. doi:10.1188/04.ONF.E90-E98. PMID 15378106.
- ^ Qweider M, Gilsbach JM, Rohde V (March 2007). "Inadvertent intrathecal vincristine administration: a neurosurgical emergency. Case report". Journal of Neurosurgery. Spine 6 (3): 280–3. doi:10.3171/spi.2007.6.3.280. PMID 17355029.
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Routes of administration / Dosage forms
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| Oral |
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Digestive tract (enteral)
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Solids
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- Pill
- Tablet
- Capsule
- Pastille
- Time release technology
- Osmotic delivery system (OROS)
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Liquids
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- Decoction
- Elixir
- Electuary
- Emulsion
- Extended-release syrup
- Effervescent powder or tablet
- Herbal tea
- Hydrogel
- Molecular encapsulation
- Powder
- Softgel
- Solution
- Suspension
- Syrup
- Syrup Concentrate for dilution and/or addition of carbonated water
- Tincture
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Buccal (Sublabial) Sublingual
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Solids
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- Orally disintegrating tablet (ODT)
- Film
- Lollipop
- Sublingual drops
- Lozenges
- Effervescent buccal tablet
- Chewing gum
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Liquids
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- Mouthwash
- Toothpaste
- Ointment
- Oral spray
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Respiratory
tract
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Solids
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- Smoking device
- Dry-powder inhaler (DPI)
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Liquids
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- Anaesthetic vaporizer
- Vaporizer
- Nebulizer
- Metered-dose inhaler (MDI)
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Gas
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- Oxygen mask and Nasal cannula
- Oxygen concentrator
- Anaesthetic machine
- Relative analgesia machine
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Ophthalmic /
Otologic / Nasal |
- Nasal spray
- Ear drops
- Eye drops
- Ointment
- Hydrogel
- Nanosphere suspension
- Insufflation
- Mucoadhesive microdisc (microsphere tablet)
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| Urogenital |
- Ointment
- Pessary (vaginal suppository)
- Vaginal ring
- Vaginal douche
- Intrauterine device (IUD)
- Extra-amniotic infusion
- Intravesical infusion
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| Rectal (enteral) |
- Ointment
- Suppository
- Enema
- Murphy drip
- Nutrient enema
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| Dermal |
- Ointment
- Topical cream
- Topical gel
- Liniment
- Paste
- Film
- DMSO drug solution
- Electrophoretic dermal delivery system
- Hydrogel
- Liposomes
- Transfersome vesicles
- Cream
- Lotion
- Lip balm
- Medicated shampoo
- Dermal patch
- Transdermal patch
- Contact (rubbed into break in the skin)
- Transdermal spray
- Jet injector
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Injection /
Infusion
(into tissue/
blood) |
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Skin
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- Intradermal
- Subcutaneous
- Transdermal implant
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Organs
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- Intracavernous
- Intravitreal
- Intra-articular injection
- Transscleral
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Central nervous system
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- Intracerebral
- Intrathecal
- Epidural
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Circulatory / Musculoskeletal
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- Intravenous
- Intracardiac
- Intramuscular
- Intraosseous
- Intraperitoneal
- Nanocell injection
- Patient-Controlled Analgesia pump
- PIC line
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Category Commons WikiProject
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UpToDate Contents
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English Journal
- Association of serum Epstein-Barr nuclear antigen-1 antibodies and intrathecal immunoglobulin synthesis in early multiple sclerosis.
- Pfuhl C1, Oechtering J2, Rasche L1, Gieß RM1, Behrens JR3, Wakonig K1, Freitag E1, Pache FC1, Otto C4, Hofmann J5, Eberspächer B6, Bellmann-Strobl J7, Paul F7, Ruprecht K8.
- Journal of neuroimmunology.J Neuroimmunol.2015 Aug 15;285:156-60. doi: 10.1016/j.jneuroim.2015.06.012. Epub 2015 Jun 25.
- Multiple sclerosis (MS) is associated with Epstein-Barr virus (EBV) infection. A characteristic feature of MS is an intrathecal synthesis of immunoglobulin (Ig)G. In 90 patients with clinically isolated syndromes/early relapsing-remitting MS, serum antibodies to Epstein-Barr nuclear antigen-1, but n
- PMID 26198934
- A systematic review of the effects of adding neostigmine to local anesthetics for neuraxial administration in obstetric anesthesia and analgesia.
- Cossu AP1, De Giudici LM2, Piras D2, Mura P2, Scanu M3, Cossu M3, Saba M2, Finco G2, Brazzi L4.
- International journal of obstetric anesthesia.Int J Obstet Anesth.2015 Aug;24(3):237-46. doi: 10.1016/j.ijoa.2015.05.002. Epub 2015 May 19.
- BACKGROUND: Drugs used in obstetric patients must accomplish two goals: efficacy and safety for both mother and fetus. Neostigmine has been co-administered epidurally and intrathecally with local anesthetics and other adjuncts in the obstetric setting. The aim of this meta-analysis was to assess the
- PMID 26119258
- Minocycline attenuates pain by inhibiting spinal microglia activation in diabetic rats.
- Sun JS1, Yang YJ2, Zhang YZ1, Huang W1, Li ZS1, Zhang Y3.
- Molecular medicine reports.Mol Med Rep.2015 Aug;12(2):2677-82. doi: 10.3892/mmr.2015.3735. Epub 2015 May 6.
- The mechanisms associated with diabetes‑induced neuropathic pain are complex and poorly understood. In order to understand the involvement of spinal microglia activity in diabetic pain, the present study investigated whether minocycline treatment is able to attenuate diabetic pain using a rat mode
- PMID 25955348
Japanese Journal
- CAN a P-gp modulator assist in the control of methotrexate concentrations in the rat brain? −inhibitory effects of rhodamine 123, a specific substrate for P-gp, on methotrexate excretion from the rat brain and its optimal route of administration
- Intrathecal Injection of 3-Methyladenine Reduces Neuronal Damage and Promotes Functional Recovery via Autophagy Attenuation after Spinal Cord Ischemia/Reperfusion Injury in Rats
- The Bisphosphonates Clodronate and Etidronate Exert Analgesic Effects by Acting on Glutamate- and/or ATP-Related Pain Transmission Pathways
Related Links
- intrathecal [in″trah-the´kal] 1. within a sheath. 2. through the theca of the spinal cord into the subarachnoid space. in·tra·the·cal (in'tră-thē'kăl), ... in vitro (2), was given intrathecally and intravenously (20 mg/2 mL intrathecally + 1,000 ...
- :introduced into or occurring in the space under the arachnoid membrane of the brain or spinal cord <intrathecal chemotherapy and cranial irradiation—Journal of ... Seen and Heard What made you want to look up intrathecal? Please ...
Related Pictures
★リンクテーブル★
[★]
- 英
- intrathecal、intrathecally
- 関
- くも膜下腔内
[★]
- 英
- intrathecal、intrathecally
- 関
- 髄腔内
[★]
- thecal
- 関
- intrathecally、epidural 硬膜外の