TY - JOUR T1 - Methoxyflurane as an anaesthetic agent in aversive pleural procedures JF - European Respiratory Journal JO - Eur Respir J VL - 44 IS - Suppl 58 SP - P493 AU - Alice Cottee AU - Tajalli Saghaie AU - Philip Corke AU - Matthew Peters Y1 - 2014/09/01 UR - http://erj.ersjournals.com/content/44/Suppl_58/P493.abstract N2 - IntroductionRapid-onset, adequate analgesia in pleural procedures is important but commonly not achieved. Standard sedation as a supplement to local anesthesia(LA) carries the risk of respiratory depression. Methoxyflurane (Penthrox) is self-administered using a whistle-device and is used in Australia in trauma and before some procedures. Patients can self-titrate inhalation against pain during a procedure.AimTo assess the efficacy and tolerability of methoxyflurane during pleural procedures.MethodConsecutive consenting patients undergoing chest tube insertion or medical pleuroscopy were recruited. Subjects inhaled methoxyflurane prior to standard LA infiltration and during the procedure. Supplementary IV opiate analgesia was administered as needed. Patient and operator questionnaires regarding efficacy and tolerance of methoxyflurane were conducted after the procedure and the dose of opiate required recorded. Pain and anxiety were rated by subjects from 0(none)-10(worst imaginable). Operators rated pain in the same way.Results16 ICC insertions, 2 pleuroscopies and 4 tunneled pleural catheter procedures were studied. Mean age was 72(range 43-94). Mean(SEM) score was 2.9(0.5) for pain during and 1.7(0.5) for pain after procedure. Mean(SEM) anxiety was 4.5(0.6). Mean operator pain score was 2.3(0.2). No patient required opiate analgesia. Cough was seen in 35%. No patient became sedated. Renal function was unaffected. 77% of patients would use methoxyflurane in future procedures.ConclusionMethoxyflurane provided effective analgesia and was well tolerated. Its rapid onset provides adequate anaesthesia prior to LA infiltration. Further studies should compare this approach with current standard practice. ER -