Toxic Nephropathy After Low-Dose Methoxyflurane Anesthesia

Churchill, David; Yacoub, Joseph M.; SIu, Kaganov; Symes, Abbey; Gault, M. H.

doi:10.1097/00132586-197610000-00033

Cited by 2 publications

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“…In contrast, the arterial blood concentration of methoxyflurane in anaesthesia has been reported to be about 6–13 mg/100mL. 16 –18…”

Section: Clinical Use Of Methoxyflurane As An Analgesic With the Penthrox® Inhalermentioning

confidence: 99%

Analgesic use of inhaled methoxyflurane

Dayan¹

2015

Hum Exp Toxicol

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Methoxyflurane is a volatile, halogenated analgesic, self-administered in a controlled low dose from the Penthrox® inhaler for short-term pain relief. It was formerly used in significantly higher doses to produce anaesthesia, when it caused a specific type of dose-related renal tubular damage. The pathogenesis of the renal damage and clinical use of methoxyflurane are discussed here with evidence that a low but effective analgesic dose is not associated with the risk of renal adverse effects. The maximum dose employed to produce analgesia is limited to methoxyflurane 6 mL/day and 15 mL/week, producing a minimum alveolar concentration (MAC) of 0.59 MAC-hours. Renal damage is due to the metabolism of methoxyflurane and release of fluoride ions. Exposure of humans to methoxyflurane ≤2.0 MAC-hours, resulting in serum fluoride ≤40 µmol/L, has not been associated with renal tubular toxicity. The safety margin of analgesic use of methoxyflurane in the Penthrox® inhaler is at least 2.7- to 8-fold, based on methoxyflurane MAC-hours or serum fluoride level, with clinical experience suggesting it is higher. It is concluded from clinical experience in emergency medicine, surgical procedures and various experimental and laboratory investigations that the analgesic use of methoxyflurane in subanaesthetic doses in the Penthrox inhaler does not carry a risk of nephrotoxicity.

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“…In contrast, the arterial blood concentration of methoxyflurane in anaesthesia has been reported to be about 6–13 mg/100mL. 16 –18…”

Section: Clinical Use Of Methoxyflurane As An Analgesic With the Penthrox® Inhalermentioning

confidence: 99%

Analgesic use of inhaled methoxyflurane

Dayan¹

2015

Hum Exp Toxicol

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“…We located only one study which measured both dose in MAC-hours and also serum fluoride for each patient (60). The anaesthesia regimen described by Churchill et al in 1976 (61) approximates mean 0.7 MAC-hours exposure with reported mean serum fluoride of 34 µmol/L. Patient dose from Yoshimura et al in 1976 (62) can be converted from grams to MAC-hours by using 3 mL methoxyflurane as equivalent to 0.34 MAC-hours (49).…”

Section: Nephrotoxicitymentioning

confidence: 99%

Exposure to Methoxyflurane: Low-Dose Analgesia and Occupational Exposure

Allison

Docherty

Pons

et al. 2020

Australasian Journal of Paramedicine

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IntroductionEvidence of nephrotoxicity led to abandonment of methoxyflurane anaesthesia. In lower doses via the Penthrox® inhaler, methoxyflurane is used for analgesia. We aim to review the literature to identify the relevance of methoxyflurane as an effective analgesic agent, identify whether there are any patient safety concerns in modern use, and determine occupational risk to healthcare personnel due to environmental methoxyflurane exposure.MethodsArticles were located via PubMed, ScienceDirect, Google Scholar, Anaesthesiology and the Cochrane Library.ResultsSingle low-dose exposure to methoxyflurane may elevate blood fluoride levels below the toxic range, and appears relatively safe for patients. There is limited literature of occupational methoxyflurane exposure within modern parameters. Risks could include nephrotoxicity or hepatotoxicity.ConclusionsThe safety of occupational methoxyflurane exposure is yet to be proved. Further independent studies quantifying occupational exposure and monitoring the health of personnel exposed to methoxyflurane need to be undertaken to ensure safety.

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Toxic Nephropathy After Low-Dose Methoxyflurane Anesthesia

Cited by 2 publications

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Analgesic use of inhaled methoxyflurane

Analgesic use of inhaled methoxyflurane

Exposure to Methoxyflurane: Low-Dose Analgesia and Occupational Exposure

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