Methoxyflurane for Procedural Analgesia at 4470 m Altitude

Wilkes, Matt; Heath, Eleanor C.; Mason, Nicholas

doi:10.1016/j.wem.2018.02.011

Cited by 7 publications

(5 citation statements)

References 22 publications

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“…Future studies on the prehospital administration of methoxyflurane could also focus on other non-medical mountain patrols, other non-medical first responders, or participants in remote high-altitude expeditions ( 4 , 22 , 23 ). Randomized controlled trials in the pre-hospital setting to compare methoxyflurane to other well-known substances such as IV morphine or IN fentanyl will also help to inform decision-making for pain therapy strategies in austere environments.…”

Section: Discussionmentioning

confidence: 99%

Pain Management with Inhalation of Methoxyflurane Administrated by Non-Medical Ski Patrol: A Quality Assessment Study

Rydlöv,

Fjose,

Heyerdahl

2023

Pain Ther

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Introduction Pain management can be challenging, especially in remote locations where first responders are not certified health care personnel. In these settings, traditional intravenous administration of analgesics is not feasible. In this study, we explore the feasibility of using methoxyflurane as a first-line analgesic in ski-related traumas, administered by the ski patrol, acting as the municipality physician’s aiding personnel. Methods This is a quality assessment of a project aimed at improving pain management in trauma patients at the largest ski resort in Norway. Members of the ski patrol were trained and delegated administration of methoxyflurane on behalf of the municipality physician. Patients > 18 years with ski-related trauma and pain Numeric Rating Scale (NRS) of 6 or more were included. The patients received inhalational methoxyflurane on site, with continued administration during transport. Data were collected by the ski patrol and entered into a quality register. Results In total, 53 patients (18 to 76 years, 32 (60%) males) accepted to be registered. The injuries were fractures in 35 (66%), joint luxation in seven (13%), combination of fracture and luxation in seven (13%), and blunt soft tissue damage in four (8%) cases. Median NRS before administration of methoxyflurane was 8 decreasing to median NRS 5 after 5–10 min. The median NRS reduction of 3 (25–75% percentiles 2–5) was significant, p < 0.001. Patients rated the perceived effect as good in 40 (80%) moderate in nine (18%) and no effect in 1 (2%). Side effects were mild: Six patients (11%) experienced dizziness, one patient (2%) was considered drowsy. Conclusions Methoxyflurane is feasible as a first-line analgesic administered by a non-medical ski patrol in a responsibly organized system. Early pain management with inhalation of methoxyflurane provides good perceived effect with mild adverse events and can be of great value in settings where few alternatives for pain management are available.

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Section: Discussionmentioning

confidence: 99%

Pain Management with Inhalation of Methoxyflurane Administrated by Non-Medical Ski Patrol: A Quality Assessment Study

Rydlöv,

Fjose,

Heyerdahl

2023

Pain Ther

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“…Efficacy for analgosedation at high altitude (4470 m) appears to be preserved in one case study. 199 Methoxyflurane has been shown to have more rapid onset and comparable or better initial analgesia compared to IV opiates or APAP. 200,201,202,203 In addition, its portability, stability, and ease of administration make it highly suitable for use in austere settings.…”

Section: Methoxyfluranementioning

confidence: 99%

“…Efficacy for analgo-sedation at high altitude (4470 m) appears to be preserved in one case study. 199…”

Section: Inhalational Analgesicsmentioning

confidence: 99%

Wilderness Medical Society Clinical Practice Guidelines for the Treatment of Acute Pain in Austere Environments: 2024 Update

Fink,

Wheeler,

Smith

et al. 2024

Wilderness & Environmental Medicine

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The Wilderness Medical Society (WMS) convened an expert panel to develop evidence-based guidelines for the management of pain in austere environments. Recommendations are graded based on the quality of supporting evidence as defined by criteria put forth by the American College of Chest Physicians. This is an update of the 2014 version of the “WMS Practice Guidelines for the Treatment of Acute Pain in Remote Environments” published in Wilderness & Environmental Medicine 2014; 25:41–49.

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“…19 This is borne out by a case report of procedural analgesia undertaken at 4 470 m in the Himalaya, in which methoxyflurane was highly effective. 20 Methoxyflurane as a drug cannot be examined in isolation without consideration of the delivery method. Modern vaporisers are sophisticated and compensate for many variables, but Windsor et al notes that the simplicity of the inhaler may make it susceptible to cold.…”

Section: Editorialmentioning

confidence: 99%

Methoxyflurane : inspiration of the old to breathe life into the new

Hofmeyr

2020

Southern African Journal of Anaesthesia and Analgesia

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The history of modern anaesthesia – from “...no humbug!” to HFNO – has a remarkably short span for the degree of scientific advancement and technological complexity we currently enjoy. Indeed, the data-saturated clinical and research environments within the speciality may lead us to presume that development of new therapies is continuously accelerating. Remove the electronics, however, and examination of the therapeutics at our disposal reveals a different story. Using inhaled agents as an example: Scientific descriptions of the use of ether and diethyl ether in the 1500s are available. Priestley’s ‘airs’ of oxygen and nitrous oxide date from the late 1700s, although it was a century later by the time anyone suggested that administering the nitrous oxide with oxygen was perhaps a safer plan. Morton’s 1846 Etherdome demonstration of effective operative anaesthesia in humans precipitated a gust of inhalational invention that also saw chloroform becoming commonplace, but it was only in the 1920s that volatile anaesthesia using ethylene and cyclopropane began to resemble anything like modern delivery methods. The explosive potential of early agents holds an ironic twist for the discovery/development of the halogenated/fluorinated volatiles, which stemmed from the field of chemistry advanced to support the Manhattan Project. Steadily, the names of agents familiar to those practising anaesthesia today emerged: halothane (in clinical use from 1956), methoxyflurane (1960), enflurane (1966), isoflurane (1972), and then a two-decade hiatus before the introduction of desflurane (1992) and sevoflurane (1994). While the latter may feel recent, it is sobering to consider that we are now reaching the point at which our “newest” inhalational agents were introduced before our registrars were born. (Xenon has been excluded from this discussion, as it is still not, nor is it likely to be, in regular clinical use).

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Methoxyflurane for Procedural Analgesia at 4470 m Altitude

Cited by 7 publications

References 22 publications

Pain Management with Inhalation of Methoxyflurane Administrated by Non-Medical Ski Patrol: A Quality Assessment Study

Pain Management with Inhalation of Methoxyflurane Administrated by Non-Medical Ski Patrol: A Quality Assessment Study

Wilderness Medical Society Clinical Practice Guidelines for the Treatment of Acute Pain in Austere Environments: 2024 Update

Methoxyflurane : inspiration of the old to breathe life into the new

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