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Pharmacology Update: Perftoran – Perfluorocarbon-Based Oxygen Carrier
Perftoran is both a product and a company name. The company was formed in 1997 by the Ministry of Public Health and Medical Institute of Russian Federation. Perftoran is a perfluorocarbon-based oxygen carrier (PBOC), consisting of perfluorodecalin, perfluoromethylcyclohexylpiperidine and proxanol. Perftoran is similar to Fluosol®, the first PBOC to be used in the late 1970’s, with the exception that the emulsifier is new and improved. Fluosol® was associated with several problems, including cumbersome preparation procedures, side-effects and modest oxygen transport characteristics. However, the incidence of side-effects associated with Perftoran is considerably lower; this is probably related to the emulsifier (less complement activation). Perftoran has a small particle size, i.e. 0.07 mm. Smaller particles evade the reticuloendothelial system more easily, which results in longer intravascular persistence and lesser side-effects. In addition, smaller particles traverse the microcirculation with less resistance.
Perftoran is marketed as "a multipurpose substance able to correct various type of hypoxia." Several clinical studies have been conducted using Perftoran in patients undergoing neurosurgery for cranial trauma and kidney transplantation, revealing improved morbidity and mortality. 757 wounded and critically ill patients were treated with Perftoran. The indications included hypovolemia, DIC, bronchopulmonary lavage, regional perfusion of extremities, to mention a few. Results were compared to a control group of 976 patients. Perftoran performed extremely well as an oxygen transport medium. Hemodynamic function improved in hypovolemic patients while hepatic function recovery was accelerated. The need for allogeneic blood decreased, while the incidence of ARDS was less in patients treated with Perftoran. Perftoran was also used during cardiac surgery as a blood substitute during cardiopulmonary bypass and in cardioplegic solutions. The results were similarly impressive - decreased hemolysis of red blood cells, rapid restoration of cardiac activity.
These dramatic results are attributed to a variety of responses that are related to not only improved gas transport, but also blood viscosity and cellular membrane function. Perftoran must be stored frozen and has a shelf-life of 2 years. It may be thawed and refrozen 5 times. As a "new and improved" first-generation PBOC, these initial results suggest that Perftoran has considerable clinical efficacy in a variety of settings. However, Perftoran has not been used in conjunction with ANH. Its potential application to this technique is an important question that will require additional research. It is uncertain whether Perftoran will be available on a worldwide basis – the company maintains a web site at [Link niet meer beschikbaar].