FrancophonIA/ELRC3.0 huggingface dataset:
English: They were of the opinion that CO2 should be used instead of air as a safety precaution because of the markedly lower risk of gas embolism due to the high solubility of CO2 in the blood.
Danish: De var af den opfattelse, at der som sikkerhedsforanstaltning bør anvendes CO2 i stedet for luft på grund af den markant lavere risiko for gasemboli som følge af den høje opløselighed af CO2 i blodet.
English: Scientific Discussion
Danish: Videnskabelig drøftelse
English: Evicel was sprayed antero-laterally via pressure regulator with N2 (nitrogen) for a single two-second burst at approximately 2½ to 3 centimetres with reduced pressure of 8 (eight) PSI.
Danish: Evicel blev spraypåført anterolateralt gennem en trykregulator med N2 (nitrogen) i et enkelt pust af to sekunders varighed i en afstand af 2½ til 3 centimeter med et nedsat tryk på 8 (otte) PSI.
English: A single not well documented non-fatal case of a potential air embolism in association with Tisseel was reported in 2009.
Danish: I 2009 blev der indberettet et enkelt, ikke veldokumenteret ikke-fatalt tilfælde af potentiel luftemboli relateret til Tisseel.
English: The CHMP agreed on a Direct Healthcare Professional Communication (DHPC), to communicate the outcome of the present review.
Danish: CHMP bestemte, at der skal udsendes en direkte meddelelse til fagfolk i sundhedssektoren (DHPC) om resultatet af denne gennemgang.
English: Despite risk mitigation activities put in place between August 2010 and early 2011 for Quixil and Evicel, including: 1) a direct healthcare professional communication regarding a change in product labelling, 2) field safety notification for the pressure regulator including change in the instructions for use, and 3) updated customer training programs, two new cases of air embolism (and a third case was received during the referral procedure) have been reported following use of the spray application of Evicel (one non-fatal case in August 2011 and a fatal case in January 2012).
Danish: Trods de risikonedsættelsestiltag, der blev iværksat mellem august 2010 og begyndelsen af 2011 for Quixil og Evicel, herunder: 1) en direkte meddelelse til sundhedspersonale om ændret mærkning af produkterne, 2) en sikkerhedsanvisning om trykregulatoren med ændring af brugsanvisningen, og 3) opdaterede uddannelsesprogrammer for kunderne, blev der indberettet to nye tilfælde af luftemboli efter spraypåføring af Evicel (ét ikke-fatalt tilfælde i august 2011 og ét fatalt tilfælde i januar 2012).
English: This case highlights the problems with the application of sprayable fibrin sealants during endoscopic procedures, where it is not always feasible to accurately judge the distance from the target tissue when spraying.
Danish: Dette tilfælde belyser problemerne ved spraypåføring af fibrinklæbere under endoskopiske procedurer, hvor det i praksis ikke altid er muligt at bedømme afstanden til målvævet nøjagtigt, mens der sprayes.
English: Following this, the UK's Medicines and Healthcare products Regulatory Agency triggered a procedure under Article 31 on 24 May 2012, requesting the CHMP to carry out the same assessment for the other fibrin sealants available in the EU, i.e. Quixil, Tissucol, Tisseel, Artiss, Beriplast P, and associated names (see Annex I).
Danish: Herefter indledte Det Forenede Kongeriges lægemiddelstyrelse den 24. maj 2012 en artikel 31-procedure og anmodede CHMP om at foretage samme vurdering for de øvrige fibrinklæbere, der markedsføres i EU, dvs. Quixil, Tissucol, Tisseel, Artiss, Beriplast P og relaterede navne (jf. bilag I).
English: Clear instructions to surgeons with regard to the distances and pressures recommended and the pressurised gas to be used should be provided and the use should be restricted to experienced surgeons who have been trained in the use of those products.
Danish: Der bør gives tydelige anvisninger til kirurgerne om den anbefalede afstand og tryk og den korrekte gas, og produkterne bør kun anvendes af erfarne kirurger, som er oplært i brugen af disse.
English: They also recommended that appropriate educational materials and training for healthcare professionals to administer the product correctly (at the recommended distance and pressure for spray application) is required.
Danish: De anbefalede endvidere, at der stilles krav om passende uddannelsesmateriale og oplæring af sundhedspersonale i korrekt administration af produktet (spraypåføring i den anbefalede afstand og med det anbefalede tryk).
English: The CHMP therefore concluded that the available evidence supports the efficacy and use of fibrinogen-containing sealants in the approved indications.
Danish: CHMP konkluderede derfor, at den foreliggende dokumentation støtter virkningen og anvendelsen af fibrinogenholdige vævsklæbere til de godkendte indikationer.
English: The CHMP recommended changes the Product Information of Tisseel, Tissucol and Artiss accordingly, to ensure the safe and effective use of those products (see Annex III).
Danish: CHMP anbefalede ændringer i produktinformationen for Tisseel, Tissucol og Artiss med henblik på sikker og effektiv anvendelse af disse produkter (jf. bilag III).
English: An ad-hoc expert advisory group meeting was convened in October 2012 at the request of the CHMP, during which the experts discussed the benefits of sprayable fibrin sealants as well as potential risk minimisation measures, in particular with regard to the risk of air embolism.
Danish: I oktober 2012 indkaldtes på anmodning af CHMP en ad hoc-ekspertgruppe, som drøftede fordelene ved spraypåføring af fibrinklæbere og mulige risikominimeringsforanstaltninger, navnlig hvad angår risikoen for luftemboli.
English: Beriplast P is not sprayed using automated pressure regulator.
Danish: Ved spraypåføring af Beriplast P anvendes ikke automatisk trykregulator.
English: In order to minimise the potential risk of Beriplast P being used with a pressure regulator not recommended for use with this product, the CHMP recommended that the PI of Beriplast be amended to emphasize that Beriplast should only be reconstituted and administered according to the instructions and with the devices as provided with this product.
Danish: For at minimere den potentielle risiko for, at Beriplast P anvendes med en trykregulator, der ikke anbefales til dette produkt, anbefalede CHMP, at produktinformationen for Beriplast ændres, så det fremhæves, at Beriplast kun må rekonstitueres og administreres i overensstemmelse med den medfølgende vejledning og ved hjælp af de medfølgende anordninger.
English: Grounds for the variation to the terms of the marketing authorisation of Beriplast P
Danish: Begrundelse for ændringen af betingelserne for markedsføringstilladelsen for Beriplast P
English: The anticipated benefit of mandating CO2 use in open surgery may not outweigh the risks linked to inappropriate use of Tisseel/ Tissucol and Artiss.
Danish: De forventede fordele ved et påbud om anvendelse af CO2 ved åbne kirurgiske indgreb opvejer muligvis ikke risiciene ved uhensigtsmæssig brug af Tisseel/Tissucol og Artiss.
English: However the CHMP noted that to date, only one non-fatal case of air embolism has been reported for these products as compared to the 8 cases of air embolism (including 3 cases with fatal outcome) reported with Quixil and Evicel.
Danish: CHMP bemærkede imidlertid, at der hidtil kun er indberettet ét ikke-dødeligt tilfælde af luftemboli for disse produkter, sammenholdt med de 8 indberettede tilfælde af luftemboli (herunder 3 med dødelig udgang) med Quixil og Evicel.
English: Risk of air embolism associated with the spray application of fibrin sealants
Danish: Risiko for luftemboli ved spraypåføring af fibrinklæbere
English: Considering the limited evidence of risk of air embolism with those specific products (Tisseel/Tissucol and Artiss), CHMP concluded that beyond the above mentioned risk minimisation measures no further actions were deemed justified.
Danish: I betragtning af den begrænsede risiko for luftemboli med de pågældende produkter (Tisseel/Tissucol og Artiss) konkluderede CHMP, at der ikke er behov for yderligere tiltag ud over de nævnte risikominimeringsforanstaltninger.
English: The CHMP reviewed all cases of gas embolism reported with the use of sprayable fibrin sealants (including the cases reported with Quixil and Evicel).
Danish: CHMP gennemgik alle indberettede tilfælde af gasemboli ved spraypåføring af fibrinklæbere (herunder de indberettede tilfælde med Quixil og Evicel).
English: Grounds for the variation to the terms of the marketing authorisation of Tisseel/Tissucol and Artiss (and associated names)
Danish: Begrundelse for ændring af betingelserne for markedsføringstilladelsen for Tisseel/Tissucol og Artiss (og relaterede navne)
English: The experts agreed that sprayable fibrin sealants are recommended when there is a large surface area of surgical bleeding, generally oozing, and that not using sprayable fibrin sealants in these cases would lead to an increased use of other blood products, which would lead to a higher risk of complications.
Danish: Eksperterne fandt, at spraypåføring af fibrinklæbere må anbefales ved blødende operationssår med stor overflade og generel væskeudsivning, og at undladelse af brug af fibrinklæbere i sådanne tilfælde vil føre til øget brug af andre blodprodukter med deraf følgende øget komplikationsrisiko.
English: During the Article 31 procedure, the CHMP also noted a new case of gas embolism reported with the use of Evicel during laser prostatectomy.
Danish: Under artikel 31-proceduren konstaterede CHMP desuden et nyindberettet tilfælde af gasemboli, hvor Evicel blev anvendt ved laserprostatektomi.
English: In addition, ARTISS is indicated as an adjunct to haemostasis on subcutaneous tissue surfaces.
Danish: Derudover er ARTISS indiceret som supplement til hæmostase på subkutane vævsoverflader.
English: • The Committee has considered that as no gas-assisted spray device is available for Beriplast and that an attachment of air feeding lines or other device components to the manual spray tips is not possible, the risk of air embolism with Beriplast is negligible;
Danish: • udvalget har taget i betragtning, at der ikke findes nogen gasassisteret sprayanordning til Beriplast, og at der ikke kan tilsluttes trykluftslanger eller andre komponenter til de manuelle sprøjtespidser, hvorfor risikoen for luftemboli med Beriplast er ubetydelig,
English: From 2008 until May 2012, a total of eight cases of life-threatening air embolism were associated with the spray application of the fibrin sealants Quixil or Evicel (of which three had a fatal outcome, in one case no product was administered).
Danish: Fra 2008 til maj 2012 blev i alt 8 tilfælde af livstruende luftemboli sat i forbindelse med spraypåføring af fibrinklæberne Quixil og Evicel (tre af tilfældene fik dødelig udgang, i det ene tilfælde blev der ikke administreret noget produkt).
English: Artiss is indicated as a tissue glue to adhere/seal subcutaneous tissue in plastic, reconstructive and burn surgery, as a replacement or an adjunct to sutures or staples.
Danish: Artiss er indiceret som vævsklæber til at fremme sammenføjning af subkutant væv ved plastik-, rekonstruktions- eller brandsårskirurgi som erstatning for eller supplement til suturer eller hæftninger.
English: The CHMP pointed out that surgeons and surgical staff should be advised on the appropriate means of achieving a tissue surface that is as dry as possible (e.g. intermittent application of compresses, swabs, use of suction devices).
Danish: CHMP påpegede, at kirurger og kirurgisk personale bør instrueres i passende metoder til opnåelse af så tør en vævsoverflade som muligt (f.eks. intermitterende påføring af kompresser eller renseservietter og brug af sug).
English: Fibrin sealants can be applied either by drip or spray method, the choice of method is left to the surgeon depending on the degree and surface area of bleeding expected or encountered and the remoteness of the location of the bleeding surface.
Danish: Valget af påføringsmetode overlades til kirurgen, alt efter omfanget eller udstrækningen af den forventede eller opståede blødning og beliggenheden af den blødende overflade.
English: In particular, the MAH was requested to ensure that all users of the spray application are provided with adequate educational material on the correct use of the product and are offered an educational program which teaches the content of the mentioned educational material.
Danish: Herunder blev indehaveren af markedsføringstilladelsen anmodet om at sikre, at alle brugere af spraypåføring får udleveret passende uddannelsesmateriale om korrekt brug af produktet og tilbydes et uddannelsesprogram, hvor de instrueres i indholdet af dette materiale.
English: In one of the Quixil cases, the air embolism was caused by using pressurised air to dry the wound area, with a fatal outcome, although no product was administered.
Danish: I et af tilfældene med Quixil blev luftembolien forårsaget ved, at der blev påført trykluft for at tørre såroverfladen, hvilket fik dødelig udgang, skønt der ikke blev påført noget produkt.
English: With regards to safety, the CHMP noted that the main risk with sprayable fibrin sealants is the risk of air embolism, due air entering the vasculature.
Danish: Vedrørende sikkerheden bemærkede CHMP, at hovedrisikoen ved spraypåføring af fibrinklæbere er risikoen for luftemboli gennem luftindtrængen i karrene.
English: Use on open vessels or within a highly vascular cavity e.g. bone marrow.
Danish: Anvendelse på åbne kar eller i stærkt vaskulariserede hulrum, f.eks. knoglemarv.
English: Therefore the CHMP agreed that the use of carbon dioxide should not be mandatory for the spray application using a pressure regulator of those products.
Danish: CHMP fastslog derfor, at der ikke skal være påbud om anvendelse af kuldioxid ved spraypåføring af disse produkter med trykregulator.
English: The risk of air embolism with this product was therefore considered negligible by the CHMP.
Danish: CHMP anså derfor risikoen for luftemboli med dette produkt for ubetydelig.
English: Appropriate means of achieving a tissue surface that is as dry as possible should be used and changes in blood pressure, pulse, oxygen saturation and end tidal CO2 should be monitored during application of those products by spray because of the possibility of occurrence of air or gas embolism.
Danish: Der bør anvendes passende metoder til at opnå så tør en vævsoverflade som muligt, og når produkterne påføres som spray, skal ændringer i blodtryk, puls, iltmætning og slutekspiratorisk CO2 overvåges på grund af faren for luft- eller gasemboli.
English: When applied by spraying and in order to achieve a sufficiently fine and uniform spray, the syringe containing the fibrin and thrombin components is usually connected to a supply of gas through a pressure regulator.
Danish: For at opnå tilstrækkeligt fin og ensartet påføring med spray bliver sprøjten med fibrin- og trombinkomponenten sædvanligvis tilsluttet en gastilførsel gennem en trykregulator.
English: The CHMP however recommended the inclusion in the Product information of the warning that the risk of gas embolism appears to be higher when fibrin sealants are sprayed using air, as compared to CO2 and cannot be excluded with Tisseel/Tissucol and Artiss when sprayed in open wound surgery.
Danish: CHMP anbefalede dog, at der i produktinformationen indsættes en advarsel om, at risikoen for gasemboli ved spraypåføring af fibrinklæbere tilsyneladende er større med trykluft end med CO2, og at det ikke kan udelukkes, at der er risiko for gasemboli ved spraypåføring af Tisseel/Tissucol og Artiss ved åben kirurgi.
English: For Tisseel and Tissucol, which are also recommended for use in laparoscopic procedures, a label for the pressure regulator with a symbol that informs about the correct pressure and distance laparoscopic procedures should also be provided.
Danish: For Tisseel og Tissucol, som desuden anbefales til laparoskopiske procedurer, skal der derudover udleveres en etiket til trykregulatoren med et symbol, der informerer om det korrekte tryk og den korrekte sprøjteafstand ved laparoskopiske procedurer.
English: Tisseel/Tissucol use different pressure regulators for open surgery (pressurized air) and minimally invasive/laparoscopic procedures (pressurized CO2), respectively.
Danish: For Tisseel/Tissucol anvendes forskellige trykregulatorer til henholdsvis åbne kirurgiske indgreb (trykluft) og minimalt invasive/laparoskopiske procedurer (CO2).
English: Furthermore, the device design should have a specific gas pressure governor to be used with the spray applicator and with a limit not above the maximal optimal pressure recommended.
Danish: Desuden bør anordningen forsynes med en særlig gastrykregulator, der anvendes sammen med sprayapplikatoren og begrænser trykket til en værdi, der ikke overstiger det anbefalede maksimale optimale tryk.
English: The patient underwent a surgical procedure for an unknown reason and Tisseel was reported to have been sprayed using the Easyspray pressure regulator to a ‘closure port' leading to an air embolism.
Danish: Patienten blev opereret af ukendt årsag, og Tisseel blev angivet at være blevet spraypåført med Easyspray trykregulatoren tilsluttet en afspærringsport, hvorved der opstod luftemboli.
English: CHMP considered restricting spray application of these products to CO2 gas only.
Danish: CHMP overvejede at påbyde anvendelse af CO2-gas ved spraypåføring af disse produkter.
English: The authorised indications for Tisseel/Tissucol and Beriplast P are the “supportive treatment where standard surgical techniques are insufficient for improvement of haemostasis” and “to promote adhesion/sealing or as suture support”.
Danish: De godkendte indikationer for Tisseel/Tissucol og Beriplast P er “støttende behandling, hvor sædvanlige kirurgiske teknikker er utilstrækkelige til at forbedre hæmostasen” og “fremme af sammenføjning eller støtte ved sammensyninger”.
English: In addition, in line with the changes requested for the other fibrin sealants used by spray, the PI was amended to reflect that appropriate means of achieving a tissue surface that is as dry as possible should be used (see Annex III).
Danish: Ligesom for andre fibrinklæbere, der spraypåføres, blev produktinformationen desuden ændret med en angivelse af, at der bør anvendes egnede metoder til at opnå så tør en vævsoverflade som muligt (jf. bilag III).
English: In addition, the MAH should ensure that all users of the spray application of those products are provided with labels for the pressure regulator with a symbol that informs about the correct pressure and distance in open surgery.
Danish: Derudover skal indehaveren af markedsføringstilladelsen sørge for, at alle, der bruger disse produkter ved spraypåføring, får udleveret etiketter til trykregulatoren med et symbol, der informerer om det korrekte tryk og den korrekte afstand ved åbne kirurgiske indgreb.
English: • The Committee agreed on a number of risk minimisation measures, including changes to the product information regarding the use of the product as well as educational materials and training to be provided to users of the product, which adequately addressed the identified risk of air embolism;
Danish: • udvalget vedtog en række risikominimeringsforanstaltninger, som tilstrækkeligt imødegik den konstaterede risiko for luftemboli, herunder ændring af produktinformationen med hensyn til produktets anvendelse samt uddannelsesmateriale og oplæring til brugerne af produktet,
English: An attachment of air feeding lines or other device components to the manual spray tips physically is not possible.
Danish: Det er ikke fysisk muligt at tilslutte trykluftslanger eller andre anordninger til de manuelle sprøjtespidser.
English: The MAHs provided responses to a request from the CHMP to discuss the merits and feasibility of any risk minimisation measures which could be introduced in order to improve the benefit/risk of Tisseel, Tissucol and Artiss spray application.
Danish: Indehaverne af markedsføringstilladelsen besvarede en anmodning fra CHMP om at gennemgå fordelene ved og den praktiske gennemførlighed af alle risikominimeringsforanstaltninger, der kan tænkes indført til forbedring af benefit/risk-forholdet for spraypåføring af Tisseel, Tissucol og Artiss.
English: Regarding the clinical use of the products, the CHMP was of the opinion, based on the last case of air embolism reported during an endoscopy procedure with Evicel, where the surgeon had limited visibility of the tissue surface, that the use of fibrin sealants with compressed gas should only be considered if it is possible to accurately judge the spraying distance.
Danish: På baggrund af det seneste indberettede tilfælde af luftemboli ved en endoskopisk procedure med Evicel, hvor kirurgens overblik over vævsoverfladen var begrænset, var det CHMP's opfattelse, at klinisk anvendelse af fibrinklæbere ved spraypåføring med komprimeret gas kun bør overvejes, hvis sprayafstanden kan bedømmes nøjagtigt.
English: The Committee agreed that the benefit-risk balance of Evicel was positive under normal conditions of use, subject to similar risk minimisation measures (including changes to the Product Information) as for Quixil.
Danish: Udvalget afgjorde, at benefit/risk-forholdet for Evicel var positivt under normale anvendelsesbetingelser, forudsat at der gennemføres tilsvarende risikominimeringsforanstaltninger (herunder ændringer af produktinformationen) som for Quixil.
English: • The Committee reviewed all the data provided by the MAH in writing and in the oral explanation and the outcome of the ad-hoc expert advisory group meeting;
Danish: • udvalget gennemgik alle de oplysninger, der var forelagt af indehaveren af markedsføringstilladelsen, dels skriftligt, dels ved den mundtlige fremlæggelse, og resultatet af mødet i den rådgivende ad hoc-ekspertgruppe,
English: • The Committee considered all the cases of air embolism associated with the use of fibrinogensealants by spray application that have been reported and concluded that the reported cases had only occurred when the instructions for use were not followed;
Danish: • udvalget tog hensyn til alle indberettede tilfælde af luftemboli relateret til anvendelse af fibrinklæbere ved spraypåføring og konkluderede, at de indberettede tilfælde kun var indtruffet, når brugsanvisningen ikke var blevet fulgt,
English: • The Committee, as a consequence, concluded that the benefit-risk balance of the spray application of Beriplast P is positive under normal conditions of use, subject to changes to the product information.
Danish: • udvalget konkluderede derfor, at benefit/risk-forholdet for spraypåføring af Beriplast P er positivt under normale anvendelsesbetingelser, forudsat at produktinformationen ændres,
English: • The Committee reviewed all the data provided by the MAH in writing and the outcome of the adhoc expert advisory group meeting;
Danish: • udvalget gennemgik alle de skriftlige oplysninger fra indehaveren af markedsføringstilladelsen og resultatet af mødet i den rådgivende ad hoc-ekspertgruppe,
English: Therefore the CHMP recommended the variation to the terms of the Marketing Authorisations for the Tisseel/Tissucol and Artiss medicinal products (and associated names) referred to in Annex I, in accordance to the amendments to the Summary of Product Characteristics and Package Leaflet set out in Annex III and subject to the conditions set out in Annex IV.
Danish: anbefalede CHMP ændring af betingelserne for markedsføringstilladelserne for lægemidlerne Tisseel/Tissucol og Artiss (og relaterede navne), der er anført i bilag I, i overensstemmelse med de ændringer af produktresuméet og indlægssedlen, der fremgår af bilag III, og på de betingelser, der er angivet i bilag IV.