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Inhaled methoxyflurane as a prehospital analgesic in children
Franz E Babl1, Sarah R Jamison, Maureen Spicer
1Emergency Department, Royal Children's Hospital, Parkville, Vic. 3055, Australia. franz.babl@rch.org.au
Insights
Methoxyflurane is an effective prehospital pain reliever for children, showing significant pain reduction with few serious side effects. However, it can cause deep sedation in very young children.
Area of Science:
- Emergency Medicine
- Pediatric Anesthesiology
- Prehospital Care
Background:
- Methoxyflurane is widely used as an inhaled analgesic by Australian ambulance services.
- Published data on its use pattern, efficacy, and safety in prehospital pediatric settings are lacking.
Purpose of the Study:
- To characterize the use pattern, efficacy, and safety of methoxyflurane in children in the prehospital setting.
Main Methods:
- An 8-month observational case series enrolled 105 children transported to a tertiary children's hospital.
- Data collected included indications for use, pain scores, adverse events, and sedation depth via surveys and record review.
Main Results:
- Methoxyflurane was primarily used for extremity injuries (82%).
- Paramedic-reported pain scores significantly decreased post-administration.
- No serious adverse events were reported; mild adverse events occurred in 36.2% of patients.
Conclusions:
- Methoxyflurane appears to be an effective analgesic in the prehospital pediatric setting with a low adverse event profile.
- Deep sedation can occur in young children, requiring careful monitoring.
Objective:
Despite widespread use of methoxyflurane as an inhaled analgesic by ambulance services in Australia there are no published data as to its use pattern, efficacy and safety in the prehospital setting. We set out to characterize methoxyflurane use in children in the prehospital setting.
Methods:
An observational case series was conducted over an 8 month period. Children who received methoxyflurane while being transported to a tertiary children's hospital by ambulance were enrolled. We analysed indications for use, verbal numerical pain scores, adverse events and depth of sedation based on paramedic, patient, parent and ED staff surveys and review of ambulance care records.
Results:
During the study period 105 patients were enrolled with an age range of 15 months to 17 years (median age 11 years). Methoxyflurane was mainly used for extremity injuries (82%). Paramedic pain scores dropped from a mean of 7.9 (95% confidence interval [CI] 7.5-8.3) prior to methoxyflurane use to 4.5 (95% CI 3.9-5.0) at 2-5 min and to 3.2 (95% CI 2.8-3.7) at 10 min. There were no serious adverse events (one-sided 97.5% CI 0-3%). Mild adverse events occurred in 38 patients (36.2%; 95% CI 27.0-46.1%). Five of 15 (33.3%) patients under 5 years of age were deeply sedated.
Conclusion:
In the present paediatric case series methoxyflurane appears to be an efficacious analgesic with a low adverse events profile. In young children in particular it can briefly lead to deep sedation.
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