methoxyflurane

[Medic 1]

Hi group
Do any of you use methoxyflurane as an analgesia, we are trying to get it banned for health reasons and would appreciate any papers/ examples of other services discontinuing its use.

Jerry

[Jamie Davis, the Podmedic]

Jerry,

I'd be interested in more information on what you are currently seeing in your area or service that is causing the push to ban the use of Methoxyflourane in your service. I don't currently use it and my investigation via a few searches for pre-hospital pain management cites that it is used in less than 1% of the services surveyed. The most common drug is Morphine in the majority of cases, followed by Fentanyl and then Demerol.

Here is the abstract of one pain management study that briefly mentions the scarce use of Methoxyflourane.
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[Medic 1]

Hi Jamie
Thanks for the article. We have a mad Medical Director! How's this; We can't use long boards, 12 leads, anti-emetics or 5% Dexrose but can give IM/ IV Ketamine [best analgesic ever for trauma] and MAST suits.
Our Union has instructed that all Methoxyflurane is returned to HQ and not to be used until further tests have been conducted [our ex medical director owns part of the company]. Used within a closed environment of the Ambulance usually results in headaches and it's close relationship with Halothane [and hence Halothane Hepatitis] needs to be researched. There are far better analgesics out there for mild/ moderate pain. We also have I/N Fentanyl that is used with limited effect.

Jerry

[Jamie Davis, the Podmedic]

Thanks for the info, Jerry. That is an interesting mix of protocol meds. We can't give anti-emetics or D5W either but have 12 leads and long boards. The strongest analgesic is Morphine in our ALS bags, no Ketamine or Fentanyl. Keep in touch!
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[Tim - The Burns Nurse]

Jerry how is methoxyflurane administered by your dept?

All Australian ambulance services, there is one service per state/territory, use Methoxyflurane in the PenthroxTM Inhaler. There have been over 2,000,000 administrations of Methoxyflurane for analgesia since 1975 in Australia, with NO reported directly attributable adverse reactions. The Australian Defence Force (ADF) also use the Penthrox inhaler. Many hospitals, professional sporting teams, mines rescue, volunteer first aiders, lifesavers/lifeguards etc also use the Penthrox inhaler.

If you're worried about using it in a closed environment, the Penthrox inhaler can have a charcoal filter attached to it.

I have plenty of information on this product in PDF form. LMK if you or anyone else is interested in it. We're about to introduce it into our Burns Unit and Burns Outpatients Dept. I'll post our protocol when it is in effect.

Cheers,

Tim

[Medic 1]

Hi Tim
Methoxyflurane is very closely related to the volatile Anaesthetic Agent Halothane, and Hepo-toxic. There have been numerous reports of Methoxy induced headache in the crews using this drug. Yes there is now a charcoal filter that cuts down most of the vapour smell but in the confined space of the back of a vehicle is is still noxious, horrible stuff.
Yes is is effective, with a probable effective life of 15-20 mins if taken properly, but 2 doses within a 24 hr period should get a few alarm bells ringing eh?
In conclusion, Methoxy might be a drug of choice for First Aiders but it is not the professional option, the half life is poor, there are concerns over user safety and basically there is better alternatives out there.

thanks

Jerry

[Sharon]

Jerry have you thought about presenting a research paper to ACAP about this?
Continuing education credits and a way to be heard by other paras in government based services. To be recognised as professionals we need more research done at the "sharp end" and you sound passionate enough to change protocols!!
I personally prefer Entonox and I wasn't aware of the "Glide plane pilot's" involvment in the company.

[Medic 1]

Hi Shaz
If I ever have time yes, maybe I could use my Anaesthetic Knowledge to write for ACAP, did you see my MH article I wrote last year?

Jerry

[Sharon]

Yes just recieved my copy of the Response and there's your grinning dial!!!
But it is an article re tourniquets.

[Dean Harris]

Was this med used alot in themiddle of the 20th century? My dad mentions that he was caring for burn victims (about 85%) and that they were giving them an inhaled analgeisc.

I forwarded him the wiki, and he said he is pretty sure that what it was.

Any ideas?

[Tim - The Burns Nurse]

Methoxyflurane has been around since the 1960s. It's been used here in Australia for over 30 years. You dad could've been using Nitrous Oxide as well. It was first synthesized in the 1770s and was in regular use in the 1860s.

[Sharon]

Try being a vollie with only methoxy and having to transport for two hours with a pt in 9/10 pain, but also being an IP and normally having access to much, much more on a mine site. It makes you feel barbaric.
On the one hand on the mine site you can with a phone call use morphine, pethadine etc but because you are wearing green all of your brains disapear and you go back to basic!!!

[Medic 1]

Hi Shaz
Well in my opinion we are luck to have Ketamine to use, good stuff in trauma.......we just need something for cardiac pain!

Jerry