title: Stability of Drugs Used in Helicopter Air Medical Emergency Services: An Exploratory Study.
abstract: OBJECTIVE
  Transportation by air exposes drugs used in emergency medical services to vibrations. The aim of the study was to determine whether or not vibrations caused by a helicopter induce the degradation of 5 drugs used in this setting.
  
  
  METHODS
  A longitudinal study in an operating medical helicopter along with a worst case was conducted. The studied drugs were 3 drugs labeled for refrigeration (cisatracurium, lorazepam, and succinylcholine) and 2 albumin solutions (human albumin 4% and 20%). These drugs were stored for 4 months according to the following conditions: inside a helicopter, worst case with exposure to extreme vibrations, at room temperature, and according to manufacturers' recommendations. Samples were analyzed with validated high-performance liquid chromatography assay methods. A drug was considered stable if the remaining drug content was above 90% of the label claim. Except for the albumin solutions, visual inspection was used to determine instability by the formation of aggregates.
  
  
  RESULTS
  Only the samples stored at room temperature became unstable after 4 months. No difference in extreme foaming was observed in the albumin solutions.
  
  
  CONCLUSIONS
  These data suggest that the effect of degradation of drugs caused by vibrations is negligible. Temperature was observed as the main cause of drug degradation.
authors.affiliation: Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, University of Leuven, University Hospitals Leuven, Leuven, Belgium. Electronic address: sabrina.dewinter@uzleuven.be.
authors.forename: Sabrina
authors.initials: S
authors.lastname: De Winter
authors.affiliation: Department of Emergency Medicine, KU Leuven, University of Leuven, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Koen
authors.initials: K
authors.lastname: Bronselaer
authors.affiliation: Department of General Internal Medicine, KU Leuven, University of Leuven, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Peter
authors.initials: P
authors.lastname: Vanbrabant
authors.affiliation: Department of Pharmaceutical and Pharmacological Sciences, Pharmaceutical Analysis, KU Leuven, University of Leuven, Leuven, Belgium.
authors.forename: Bart
authors.initials: B
authors.lastname: Blanchaert
authors.affiliation: Department of Pharmaceutical and Pharmacological Sciences, Pharmaceutical Analysis, KU Leuven, University of Leuven, Leuven, Belgium.
authors.forename: Marwa F
authors.initials: MF
authors.lastname: Mansour
authors.affiliation: Department of Mechanical Engineering, Production Engineering, Machine Design and Automation (PMA) Section, KU Leuven, University of Leuven, Leuven, Belgium.
authors.forename: Daniele
authors.initials: D
authors.lastname: Brandolisio
authors.affiliation: Faculty of Engineering Technology, KU Leuven, GROEP T, Leuven, Belgium.
authors.forename: Stijn
authors.initials: S
authors.lastname: De Jonge
authors.affiliation: Department of Mechanical Engineering, Production Engineering, Machine Design and Automation (PMA) Section, KU Leuven, University of Leuven, Leuven, Belgium; Faculty of Engineering Technology, KU Leuven, GROEP T, Leuven, Belgium.
authors.forename: Peter
authors.initials: P
authors.lastname: Slaets
authors.affiliation: Department of Mechanical Engineering, Production Engineering, Machine Design and Automation (PMA) Section, KU Leuven, University of Leuven, Leuven, Belgium.
authors.forename: Paul
authors.initials: P
authors.lastname: Sas
authors.affiliation: Department of Pharmaceutical and Pharmacological Sciences, Pharmaceutical Analysis, KU Leuven, University of Leuven, Leuven, Belgium.
authors.forename: Ann
authors.initials: A
authors.lastname: Van Schepdael
authors.affiliation: Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, University of Leuven, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Isabel
authors.initials: I
authors.lastname: Spriet
mesh_terms: D017732:Air Ambulances; D000418:Albumins / Q000737:chemistry*; D001279:Atracurium / Q000031:analogs & derivatives* / Q000737:chemistry; D002851:Chromatography, High Pressure Liquid; D004355:Drug Stability; D004632:Emergency Medical Services; D006801:Humans; D008137:Longitudinal Studies; D008140:Lorazepam / Q000737:chemistry*; D013390:Succinylcholine / Q000737:chemistry*; D013696:Temperature; D014732:Vibration
chemical_list: D000418:Albumins; D001279:Atracurium; D013390:Succinylcholine; D008140:Lorazepam; C101584:cisatracurium