title: Self-administered methoxyflurane for procedural analgesia: experience in a tertiary Australasian centre.
abstract: Methoxyflurane, an agent formerly used as a volatile anaesthetic but that has strong analgesic properties, will soon become available again in the UK and Europe in the form of a small hand-held inhaler. We describe our experience in the use of inhaled methoxyflurane for procedural analgesia within a large tertiary hospital. In a small pilot crossover study of patients undergoing burns-dressing procedures, self-administered methoxyflurane inhalation was preferred to ketamine-midazolam patient-controlled analgesia by five of eight patients. Patient and proceduralist outcomes and satisfaction were recorded from a subsequent case series of 173 minor surgical and radiological procedures in 123 patients performed using inhaled methoxyflurane. The procedures included change of dressing, minor debridement, colonoscopy and incision-and-drainage of abscess. There was a 97% success rate of methoxyflurane analgesia to facilitate these procedures. Limitations of methoxyflurane include maximal daily and weekly doses, and uncertainty regarding its safety in patients with pre-existing renal disease.
authors.affiliation: Department of Anaesthesia, Waikato Hospital, Hamilton, New Zealand.
authors.forename: A L
authors.initials: AL
authors.lastname: Gaskell
authors.affiliation: Department of Anaesthesia, Waikato Hospital, Hamilton, New Zealand.
authors.forename: C G
authors.initials: CG
authors.lastname: Jephcott
authors.affiliation: Department of Anaesthesia, Waikato Hospital, Hamilton, New Zealand.
authors.forename: J R
authors.initials: JR
authors.lastname: Smithells
authors.affiliation: Department of Anaesthesia, Waikato Hospital, Hamilton, New Zealand.|University of Auckland, Auckland, New Zealand.
authors.forename: J W
authors.initials: JW
authors.lastname: Sleigh
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D018685:Anesthetics, Inhalation / Q000008:administration & dosage*; D044362:Australasia; D002056:Burns / Q000150:complications; D018592:Cross-Over Studies; D003646:Debridement; D005260:Female; D006801:Humans; D008297:Male; D008733:Methoxyflurane / Q000008:administration & dosage*; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy*; D010865:Pilot Projects; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D018685:Anesthetics, Inhalation; D008733:Methoxyflurane