Does anyone have a Penthrox SOP that you could share with me? Im trying to help my network work through nitrous oxide waste and this would be super helpful
I too would like a SOP for Penthrox for our sedation in Endoscopy but having complete lack of follow through from the companies rep when I have asked for names of hospitals that do use it outside of its product licence. To get a SOP!
"Penthrox is indicated for the emergency relief of moderate to severe pain in conscious adult patients with trauma and associated pain. Therefore use for procedural pain such as endoscopy would be outside the terms of the product license and would be at the discretion of the prescriber"
There are papers published re sedation for colonoscopies in other countries.
This is the Reps reply ....
"Regarding the request for evidence on use of methoxyflurane for painful procedures, we do not have papers on endoscopy but we do in colonoscopy. I have attached some relevant clinical papers, detailed these below. Also some posology information which may be relevant is that the dose is one bottle of 3 mL Penthrox as a single dose, administered using the device provided. A second dose should only be used where needed. The frequency at which Penthrox can be safely used has not been established. The following administration schedule is recommended: no more than 6 mL in a single day, administration on consecutive days is not recommended, and the total dose to a patient in a week should not exceed 15 mL. Continuous inhalation of a bottle containing 3 mL provides analgesic relief for up to 25-30 minutes. Intermittent inhalation may provide longer analgesic relief. Patients should be advised to use the lowest possible dose to achieve pain relief.
Clinical Papers
The Gaskell (2016) paper assessed the use of inhaled methoxyflurane in facilitating a variety of short, painful procedures. These procedures include colonoscopy.
The Jephcott (2018) paper is a review of the safety and efficacy of inhaled methoxyflurane as an analgesic for outpatient procedures and looked at colonoscopy also.
I have also attached three papers looking specifically at colonoscopy;
Nguyen (2013) evaluated the efficacy, safety and outcome of methoxyflurane for colonoscopy as compared to conventional sedation. The author makes reference to a shorter recovery time in patients given methoxyflurane.
Nguyen (2015) assessed the safety and feasibility of methoxyflurane for colonoscopy patients with morbid obesity and/or obstructive sleep apnea.
Nguyen (2016) looked at the psychomotor and cognitive effects of 15 minute inhalation of methoxyflurane and its implications for post-colonoscopy care.
Please also find attached Ruff (2018) which measures occupational exposure of methoxyflurane when used for short procedures."
Is GWP desflurane 2560, sevo 130, nitrous 265,methoxyflurane 4? I get confused between for one year and for 100 years when comparing. See BJA article above. So on the basis of these figures it is better than nitous?? Maybe someone can explain to me.
https://www.medicines.org.uk/emc/medicine/31391
https://www.medicines.org.uk/emc/files/pil.1939.pdf
I too would like a SOP for Penthrox for our sedation in Endoscopy but having complete lack of follow through from the companies rep when I have asked for names of hospitals that do use it outside of its product licence. To get a SOP!
"Penthrox is indicated for the emergency relief of moderate to severe pain in conscious adult patients with trauma and associated pain. Therefore use for procedural pain such as endoscopy would be outside the terms of the product license and would be at the discretion of the prescriber"
There are papers published re sedation for colonoscopies in other countries.
This is the Reps reply ....
"Regarding the request for evidence on use of methoxyflurane for painful procedures, we do not have papers on endoscopy but we do in colonoscopy. I have attached some relevant clinical papers, detailed these below. Also some posology information which may be relevant is that the dose is one bottle of 3 mL Penthrox as a single dose, administered using the device provided. A second dose should only be used where needed. The frequency at which Penthrox can be safely used has not been established. The following administration schedule is recommended: no more than 6 mL in a single day, administration on consecutive days is not recommended, and the total dose to a patient in a week should not exceed 15 mL. Continuous inhalation of a bottle containing 3 mL provides analgesic relief for up to 25-30 minutes. Intermittent inhalation may provide longer analgesic relief. Patients should be advised to use the lowest possible dose to achieve pain relief.
Clinical Papers
The Gaskell (2016) paper assessed the use of inhaled methoxyflurane in facilitating a variety of short, painful procedures. These procedures include colonoscopy.
The Jephcott (2018) paper is a review of the safety and efficacy of inhaled methoxyflurane as an analgesic for outpatient procedures and looked at colonoscopy also.
I have also attached three papers looking specifically at colonoscopy;
Nguyen (2013) evaluated the efficacy, safety and outcome of methoxyflurane for colonoscopy as compared to conventional sedation. The author makes reference to a shorter recovery time in patients given methoxyflurane.
Nguyen (2015) assessed the safety and feasibility of methoxyflurane for colonoscopy patients with morbid obesity and/or obstructive sleep apnea.
Nguyen (2016) looked at the psychomotor and cognitive effects of 15 minute inhalation of methoxyflurane and its implications for post-colonoscopy care.
Please also find attached Ruff (2018) which measures occupational exposure of methoxyflurane when used for short procedures."
Anyone in UK using it ourside of product license?
Thanks karina - I'll also ask in the green endoscopy group as they may have more users there
What is the carbon footprint for penthrox? Is it better than nitrous oxide I wonder?
https://doi.org/10.1016/j.bja.2020.06.055 Environmental sustainability in anaesthesia and critical care
Is GWP desflurane 2560, sevo 130, nitrous 265,methoxyflurane 4? I get confused between for one year and for 100 years when comparing. See BJA article above. So on the basis of these figures it is better than nitous?? Maybe someone can explain to me.
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