IAP ALS Update on Resuscitation Guidelines During COVID-19 Pandemic

Corona virus disease 2019 (COVID-19) pandemic has posed significant risk for health care workers. Various steps of cardiopulmonary resuscitation involve aerosol-generating procedures and have significant risk of spread of corona virus. Indian Academy of Pediatrics Advanced Life Support Basic Life Support (IAP ALS BLS) group had constituted a guideline update team to suggest modifications in existing resuscitation guidelines in view of COVID-19 pandemic. The GRADE approach was used to develop recommendations on shortlisted clinical practice questions on resuscitation during COVID pandemic as modifications.

Formulation and evaluation of nifedipine injection

An attempt has been made to formulate a stable, aqueous injection of nifedipine (1) using the technique of hydrotropic solubilization. Sodium benzoate (2; 30% w/v) and sodium salicylate (3; 30% w/v) have been employed as the vehicle to prepare the injection of 1 in 1 mg/5 ml and 1 mg/2 ml concentration in either case. An accelerated stability study for 4 weeks at 8 degrees C, room temperature, 40 and 50 degrees C indicates maximum stability at 8 degrees C, suggesting the need of storage with refrigeration. Light stability study in the specially designed chamber indicates that covering the ampoules with black chart paper affords adequate stability to the 1 injection. The injections are also stable to autoclaving. Preliminary in vivo study in rats shows that the injection is effective.

Hydrotropic solubilization of nifedipine

Nifedipine (1), a drug practically insoluble in water, has been solubilized employing sodium benzoate (2) and sodium salicylate (3) as hydrotropes. In 30% w/v 2 solution the solubility of 1 increased 85 and 76 fold at 25 +/- 1 degree C and at 37 +/- 1 degree C respectively. The corresponding increase in solubility of 1 in 30% w/v 3 solution was 135 and 107 fold respectively. To study the mechanism of hydrotropic solubilization of 1, the solution properties of 2 and 3 over a concentration range of 1 to 30% w/v were undertaken. The probable mechanism involves a complexation type of interaction at a low concentration of hydrotrope, aggregation of the hydrotropic molecules and inclusion of 1 in these aggregates at high concentration; and structural changes in water caused by hydrotropes.