Résumé
Resumen: El metoxiflurano es un anestésico halogenado que se utilizó hace varias décadas para anestesia general balanceada y que actualmente está indicado para otorgar sedación controlada por el paciente. Este medicamento se encuentra actualmente a la venta en la República Mexicana, por lo que recordar las características que lo hacen diferente a otros halogenados, su farmacocinética y su utilidad para distintos escenarios proporciona el conocimiento adecuado para su uso en la práctica clínica.
Abstract: Methoxyflurane is a halogenated anesthetic that was used decades ago for a balanced general anesthesia and is currently indicated for patient-controlled sedation. This drug is currently on sale in the Mexican Republic, so remembering the characteristics that make it different from other halogenated drugs, its pharmacokinetics and its usefulness for different scenarios provides knowledge for use in clinical practice.
Résumé
As a fluorinated hydrocarbon anesthetic, methoxyflurane may cause serious adverse reactions such as renal damage under anesthetic doses, but its analgesic effect at sub-anaesthetic doses is safe, high tolerability, and short-term acute Good choice for analgesia. This article describes the pharmacokinetics, clinical validity, adverse reactions and clinical application of methoxyflurane, and explores the feasibility of methoxyflurane as an analgesic in clinical application. Methoxyflurane is convenient to use as an inhaled analgesic. It can provide patients with emergency analgesia without intravenous administration. It is a good choice for emergency analgesia in pre-hospital and emergency settings.
Résumé
INTRODUCTION@#Treatment of pain is an important component of prehospital care. Inhalational analgesia agents have attractive strengths, but there is a paucity of studies comparing these with more conventional agents. We aimed to compare inhalational methoxyflurane and intramuscular (IM) tramadol as first-contact analgesia in the Singapore national ambulance service.@*METHODS@#Ambulances were randomised to carry either methoxyflurane or IM tramadol for the first six months and crossed over to the other arm after six months. Patients aged ≥ 16 years, with acute pain arising from musculoskeletal trauma with Numerical Rating Scale (NRS) score ≥ 3 were enrolled. Variables included NRS reduction, time variables, adverse effects, Ramsay Sedation Scores, and patient and paramedic satisfaction scores on a Likert scale.@*RESULTS@#A total of 369 patients were enrolled into this study, but 26 patients were excluded due to missing data. The methoxyflurane arm had a shorter median time taken from arrival at the scene to drug administration (9.0 [interquartile range 6.0-14.0] minutes vs. 11.0 [interquartile range 8.0-15.0] minutes). For patients who achieved reduction in NRS ≥ 3 within 20 minutes, those in the methoxyflurane arm took a shorter time. However, the methoxyflurane (46.7%) arm experienced lower proportion of patients not achieving NRS reduction ≥ 3 when compared to the tramadol (71.6%) arm after over 20 minutes. The methoxyflurane arm had significantly higher paramedic and patient satisfaction scores.@*CONCLUSION@#For the doses of medication used in this implementation study, methoxyflurane was superior in efficacy, speed of onset and administration, but had more minor adverse effects when compared to IM tramadol.
Résumé
Ginseng has been believed to be a powerful tonic by oriental people for a long time and is one of the most popular folk medicine in oriental countries. Intraperitoneal injection of ginseng into rats and mice has been reported to Increase the rates of hepatic RNA and protein synthesis, increase proliforation of rough RES of liver, and enhance alcohol metabolism. We have carried out a study to see the effects of red ginseng powder and extract on in vivo and in vitro metabolism of enflurane and methoxyflurane in male Fisher 344 rats. Red ginseng powder was dissolved in deionized water and dosed for two weeks ad libitum in rats. Hepatic microsomes were prepared and oxidative defluorination of enflurane and methoxyflurane were measured in vitro. Using red ginseng extract, studies were done of both acute and chronic treatment in rats. In chronic experiments, they were dosed with several dosages three times a day for three days; on the fourth day enflurane was administered i.p. and one hour later fluoride levels were mesured in plasma and hepatic microsomes were prepared for in vitro studies as above. In the acute experiment enflurane was administered intraperitoneally eighteen hours after single oral dosage of ginseng and plasma defluorination was measured. There were no statistically significant differences in hepatic microsomal cytochrome P-450 content or defluorination of enflurane and methoxyflurane between control and experimental groups using either red ginseng extract or powder. The results showed that ginseng ingestion did not affect the metabolism of enflurane and methoxyflurane.