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doi: 10.1016/j.neulet.2010.09.076

Based on these studies, elevated C2, C3-DC, C4, or C5 imply impaired metabolism of BCAAs and/or metabolic inflexibility, therefore, supporting their use as potential early biomarkers of the onset of PRIS that could be incorporating into a therapeutic monitoring strategy for propofol [97,98,99,131]

Considerations: Proper spray technique (appropriate angle, avoiding the septum) Alternating nostrils per dose Using a saline rinse periodically to support nasal mucosal health Discontinuation and route change if persistent irritation develops Patients with allergic rhinitis, chronic sinusitis, or significant septal deviation may be poor candidates for nasal delivery and should be considered for injection or oral spray instead