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I was uncertain in which forum this thread should be placed or indeed if it has been covered before.
My question is, do any of us use entonox for sedation?
From the material I have read online (my lovely Google) there seems to be no reason why we do not utilise this gas mixture to alleviate pain & anxiety in certain situations eg. nail surgery & painful injections.
It has been noted in the following article that it is recommended that individuals do not drive for 12 hours post use but even if that is the case then children or needle phobic patients would be ideal clients if given the choice.
It is identified as very safe (barring certain exclusions eg. head injury or risk of pneumothorax, air embolism etc.).
I am interested to hear anyones views either for or against.
Attached following article:
Quote:
Patient-administered inhalation of nitrous oxide and oxygen gas for procedural pain relief
Author(s)
Ramon Pediani
PhD, BSc(Hons), RN
Honorary Postdoctoral Research Fellow
University College of St Martin
Lancaster UK
Email: pain.pediani@btinternet.com
Contents
Historical background
Indications for use
Administration
Use in children
Compatibility
Contraindications to the use of Entonox
Protocol for administration
Health and safety precautions
Cross infection
Training and operational protocols
Conclusion
References
Published: Oct 2003
Last updated: Oct 2003
Revision: 1.0
Keywords: Entonox; gas and air; procedural pain relief; nitrous oxide and oxygen; inhaled analgesia; wound dressing changes.
Key Points
Nitrous oxide and oxygen gas mixture (also known as 'gas and air' or Entonox) has been available for many years and is an excellent method of providing short-term pain relief and relaxation during a number of painful procedures.
Entonox is safe and simple to use, provided certain cautions are observed.
Nurses can become involved in developing training and operational protocols for use, and should actively drive the development of these protocols to meet the need of patients in their care.
Abstract
There are a number of procedures that patients undergo without appropriate analgesia, even though the means to provide adequate pain relief has been available for many years by the administration of a mixture of nitrous oxide and oxygen. For some patients, even apparently trivial procedures such as having an intravenous cannula sited, or sutures removed can cause a great deal of distress and discomfort. However, the profession has been slow at taking the lead in developing the organisational structure to support the more widespread use of 'gas and air'.
Historical background
Nitrous oxide (N2O) gas has been known to have analgesic and sedative properties for over two hundred years. The gas was discovered by a Yorkshire chemist named Joseph Priestly and in 1799 the scientist Humphry Davy inhaled the gas and found it gave him rapid pain relief from an infected tooth; on one occasion he reported momentarily losing consciousness, waking up laughing about the pleasurable feelings he had experienced [1]: hence the term 'laughing gas'. As a medicinal gas, it is available as a mixture containing equal parts of N2O and oxygen (O2). In many countries this is commercially available as Entonox, although it is also available as Kalinox in France or Medimix in Sweden. In the UK it is often known to patients and staff as 'gas and air' and since the 1960s has most frequently been associated with childbirth and use by ambulance crews.
Indications for use
Entonox is ideal in situations where pain is predictable and of a short duration [2]. It can provide relief of pain during minor procedures such as wound dressing changes, debridement, the removal of drains or sutures and even turning a patient with a fracture or a pressure ulcer. In some circumstances the use of Entonox may aid the patient's ability to comply with lengthy or uncomfortable procedures, such as flexible sigmoidoscopy examination [3]. All are situations where the nurse can instigate and supervise the use of this rapid action analgesic gas mixture.
Administration
The gas is administered using a face mask or mouthpiece; gas flow is controlled by a sensitive demand-valve activated by the patient's inspired breath. This allows pressurised gas from the cylinder to flow through a pressure regulator into the lungs at a steady rate. Longer and deeper breaths allow greater volumes of gas to be taken into the lungs if necessary.
The gas is rapidly absorbed on inhalation, providing analgesia within minutes. It is excreted, largely unchanged, by the lungs and its rapid elimination from the body on cessation of inhalation makes it ideal for controlling pain during short procedures. The patient safely controls the dosage and, under normal conditions, there is no risk of overdose as the patient's level of consciousness governs his/her ability to maintain the flow of gas [4].
With mobile equipment, Entonox can be used anywhere. This may be by a hospital bed or treatment room, or in the patient's own home. In each case the patient must be made comfortable, be assured of privacy, and be guaranteed a short period of rest following the procedure.
Use in children
Entonox is safe for any age group as long as the patient is able to comprehend the activity and be physically capable of operating the system. The same cautions and care in use must therefore apply for all ages.
Entonox is an excellent analgesic for children, providing pain relief, distraction and relaxation but preparation and training may need to be more sensitive and involve parents or carers. However, while parents or carers may support the child during the procedure they must not take over the positioning of the face mask. Younger children who are either unable to understand or handle the equipment may require assisted administration, but this is outside of the scope of the current paper and is generally carried out by specially trained paediatric nurses.
Compatibility
There are no major incompatibilities with other drugs and its use with other analgesics is appropriate when given in a controlled manner. For example, oral analgesia can be given at least an hour prior to a procedure so that this has started to take effect by the time the Entonox gas has worn off. Any additional sedative action by other analgesics, such as oral morphine elixir, will be safely accommodated as the patient's active participation is needed to operate the Entonox system.
Contraindications to the use of Entonox
Entonox will cause an enclosed air-pocket in the body to expand rapidly in volume as the gas mixture is absorbed from the blood into the space, resulting in a build up of pressure [5]. It must therefore never be used if the patient has any conditions where air is trapped in the body and expansion would be dangerous [4]; for example, it will exacerbate the onset and development of a pneumothorax (air inside the chest cavity but outside of the lung) and can increase the pressure of intracranial air following head trauma. Entonox can also be drawn into other cavities, such as the sinuses, middle ear and gut, causing expansion and pain. In such cases the patient should stop using the gas.
It is recommended that Entonox gas should not be used in the following situations:
Following a head injury where consciousness is impaired. However, for patients who require sutures to a head wound, the use of Entonox may be appropriate providing the patient is alert and able to follow simple commands [6]. Such judgements regarding Entonox use should only be made by an experienced practitioner
Where there is artificial, spontaneous or traumatic pneumothorax
If there is an air embolism
In cases of decompression sickness
Where there is abdominal distension or suspected bowel obstruction
In maxillofacial injuries.
Repeated exposure to Entonox may result in megaloblastic anaemia owing to interference with the action of vitamin B12. If a procedure is to be carried out more frequently than every four days, the patient should be monitored and a routine blood cell count carried out [4]. As the gas mixture is designed for short-term use only it should not be used in place of general continuing analgesia; for example in the case of burns or fractures, where an appropriate analgesic assessment is necessary for long-term management. It has been suggested that using Entonox for a short-duration but with repeated daily exposure in burns patients may increase the risk of developing megaloblastic anaemia and leukopenia in a group that invariably have blood abnormalities as a result of the tissue trauma and serus fluid loss following the burn damage [7].
Protocol for administration
Entonox should be administered according to a locally agreed protocol following a period of instruction or training. The protocol should cover a number of key areas as follows:
Assessment: Consider the need for Entonox during the planned procedure and whether other analgesics may be required. It is important to remember that oral analgesics can take some time to work and should be given in advance if they are to have any benefit in the immediate post-procedure phase when the gas has worn off. Entonox is not as effective as intravenous sedation and analgesia [8], for example midazolam plus an opioid such as fentanyl, but it is simpler to administer, wears off more quickly and is potentially safer. Entonox should not be used as a substitute for general anaesthesia or more profound supervised sedation where this is in the patient's best interests. Expert advice should be sought where there is any doubt before commencing what could be a major procedure.
Patient involvement: For patients who have not previously used Entonox, explain what the gas is for and what is required of them. Give them an opportunity to practice a few breaths to check their technique prior to commencing the procedure. Time spent at this stage will ensure the patient is relaxed and gains full benefit from the system. Select a mask or mouthpiece that is appropriate for the patient and instruct him/her on how to hold the mask over the nose and mouth, or in the case of the mouthpiece, between the teeth sealing around it with the lips, and to then breath normally.
Documentation: Consent is not normally required as the patient is self-administering the gas, but nursing documentation should confirm that proper patient instruction took place, and record the time period in which the gas was used. Generally, record keeping should also document an assessment of the pain experienced during and after the procedure and what steps have been taken to provide on-going comfort.
Practical considerations: Check the amount of gas in the cylinder prior to commencing therapy as it is important not to run out part way through a painful procedure. Check that the cylinder valve is turned on fully (at least two full turns) and use the demand valve test-button to demonstrate to the patient that the gas is flowing and familiarise him/her with the noise made on inspiration.
Procedure for administration: Encourage the patient to breathe the gas for around two minutes before commencing the procedure. Never hold the mask on the patient's face, as his/her active involvement is crucial to the safety of the Entonox system. Continually assess the patient's progress during the procedure. At all times the patient should be able to obey commands, but if a momentary loss of consciousness does occur, the seal around the mask or mouthpiece will be lost as it falls away and the demand valve will fail to operate causing the flow of gas to stop. On breathing normal air these effects will quickly wear off, at which point the patient may choose to continue using the gas. During dressing changes or debridement, the amount of pain will vary throughout the procedure. Sometimes painful events happen intermittently throughout the procedure and the patient must be given adequate warning to top-up as required in advance. If only the clinician is involved in treatment, it is important to be especially vigilant and maintain frequent verbal contact. Elderly patients may require a higher level of support and can experience difficulties maintaining a seal where dentures have been removed. If an assistant is helping they should support and supervise the patient, but it is the responsibility of the clinician to ensure that the assistant is aware not to hold the mask onto the patient's face. Patients using Entonox for the first time will require observation after treatment until they have fully regained their normal level of alertness and balance.
Health and safety precautions
In the UK, Entonox is supplied in blue cylinders with a white and blue band around the top. A unique pin-index valve port on the cylinder prevents the wrong type of gas cylinder from being connected to the Entonox regulator valve and tubing. Local policies should cover access to medical gas cylinders and ensure staff training in assembling the necessary components. Where necessary, this should also cover transportation of the systems by nurses in their cars. It is advisable to keep the cylinder stored in the boot, away from the driver area, in case of a leak. The tubing should be disconnected and the cylinder turned off prior to starting a journey. It may also be worth checking with an employer about whether any additional insurance cover is required to carry Entonox.
The gas is stored in cylinders at a pressure of 137 bar, where it remains gaseous at temperatures above 6oC. If the gas has been stored in the boot of a car, or outdoors in cold weather, it is important to check that the cylinder has no ice on it. It should be allowed to return to room temperature (above 10oC for at least 2 hours or placed in water at body-temperature for 5 minutes) and the cylinder inverted three times to ensure an even mixture [4].
Occasional patient supervision by staff should not subject them to any undue risks of prolonged exposure to Entonox, but frequent use in a treatment room should prompt management to provide a gas scavenging system or increased ventilation.
Although Entonox is rapidly eliminated from the body, the British Oxygen Company (BOC) advises that patients should not drive or operate machinery for at least 12 hours [4]. For patients having repeated procedures, where there has been time for individual assessment as to the duration of effect, a less strict regime may be appropriate. Experienced clinicians may also develop confidence with the safety of the system through seeing its predictable effects on a number of patients undergoing similar procedures. For example, Martin et al [9] conducted a controlled study in patients undergoing flexible sigmoidoscopy as a day-case procedure. A total of 40 men and 40 women were enrolled in the study group, and matched controls who were not given Entonox were sourced from the same procedure list. A computerised 'tracking test' was employed to measure the subjects' complex motor skills before and after the procedure. The study found no difference between the group receiving Entonox and the control group. The authors concluded that their study supported the view that Entonox does not impair driving ability, and in the context of flexible sigmoidoscopy, its use is expected to lead to an increase in compliance with the procedure. The assessment of individuals is most important, and local policy should allow for an element of professional judgement, lest the benefits be denied unnecessarily.
NOTE: Peate and Lancaster [10] have discussed the practical tips on the safe use of medical gases in the clinical setting in more detail. For further Health and Safety information consult the manufacturers' data sheet [4].
Cross infection
One perhaps overlooked aspect of delivering Entonox gas is the need to ensure patient safety from infectious agents contaminating the apparatus. The Blood Borne Viruses Advisory Panel of the Association of Anaesthetists of Great Britain (AAGBI) produced an advisory report in 1996 [11] that included consideration of the possible transmission of infections via anaesthetic breathing systems. Following cases of cross infection with hepatitis C (HCV) its recommendations highlighted the need for an appropriate filter to be placed between the breathing system and the patient, and for the filter to be changed between patients. Although Entonox was not specifically mentioned in this document, the same risks of cross infection can be assumed to apply [12]. Patients should therefore be protected from possible contamination, not simply by providing a clean mask or new mouthpiece, but also by providing a physical barrier between the Entonox equipment and the patient; the mouthpiece or facemask, tubing and control valves would otherwise have to be discarded after each use [12].
Some researchers have examined practices relating to infection control around the UK and found an almost complete lack of consistent guidance for staff. Chapman and Clarke [13], in 1999, contacted all training managers in the UK ambulance service and obtained a 90% response rate (n=36) to a factual questionnaire. This study found that simple soap and water was the most common method of cleaning equipment after use, and that none of the ambulance services used filters. The authors cite staff education as the cornerstone of any infection control programme, adding that relying on the use of disposable equipment and sterilising agents alone to counteract poor general hygiene is "both inadequate and unsafe."
Two studies of Entonox looking at cross infection in obstetric units have been published recently. The first [12] surveyed the use of anti-infective filters being used in Entonox systems following the guidance from the Association of Anaesthetists. Of 100 delivery-suite units in the UK that provided information, only seven used filters. One quarter of respondents washed the mouthpieces after each case, but this, it was suggested, would probably be ineffective in preventing viral transmission. The second study [14] was conducted in obstetric units within the Anglia and Oxford regions of the UK. It too found that there was no consensus on the cleaning of Entonox equipment after use, or the use of filters with the apparatus. Interestingly, 75% of respondents (15/20) reported that cleaning procedures were taken more seriously in known 'high risk' cases, but, as the authors pointed out, all patients should be treated as potentially infected, and all patients should be protected from potential cross infection. In the majority of units (18/20) the expiratory valve was not cleaned between patients. Both studies confirm the need for proper decontamination guidelines, including methods of initial cleaning and sterilisation, and the use of a microbiological filter between the mouthpiece or facemask and the control valves and tubing of the system.
Training and operational protocols
Nitrous oxide and oxygen (Entonox) is an excellent method of providing short-term pain relief and relaxation during a number of painful procedures. There are, however, a number of reasons why such a valuable asset has not been made more readily available to nurses and their patients. These may include a lack of awareness and confidence on the part of the nurse about the pharmacological effects of Entonox, misconceptions about the 'extended role' system for nursing task authorisation, and local policy regarding its prescription by a doctor [15], [16]. In the UK, Entonox is not classed as a Prescription Only Medicine (POM) but is designated as a Pharmacy (P) product. This means that it does not require a doctor's prescription, but must be issued by a pharmacist, who may be unwilling to do so without confirmation from a doctor. Local policies should, therefore, be designed to meet patient needs and provide a pathway for trained staff to have appropriate access to both the gas cylinders and the demand-valve breathing apparatus. This can be developed around training and operational protocols involving medical, pharmacy and nursing staff and other professionals such as physiotherapists who encounter many situations in which the gas would be of benefit.
Conclusion
Entonox gas is an established and safe short-term analgesic. It is ideal for patients undergoing wound dressing procedures where an element of both analgesia and distraction may be of benefit. Its historic use by midwives and paramedics and use in investigative procedures does not preclude its adoption by wound care nurses. The motivation to develop Entonox services must come from the nurses themselves, as it has, perhaps, rarely been seen as a priority by the healthcare management. This lack of access, coupled with a lack of organised training to support its development, has resulted in the under-utilisation of this valuable resource. There need be no great mystique about Entonox but it must be introduced alongside clear department policies regarding its use and training requirements of staff. Box 1 summarises the key elements of a typical operational protocol for a wound dressing change.
Box 1: Factors to consider when preparing and supporting a patient for a dressing change using Entonox
Assess pain using a validated pain scale and administer appropriate oral analgesics in advance of the procedure.
Check the amount of gas in the cylinder prior to commencing therapy and verify air flow using the demand valve-test button.
Prepare the patient with instruction, demonstration of equipment and an opportunity to practice prior to commencing the procedure.
Never hold the mask on the patient's face, as his/her active involvement is crucial to the safety of the Entonox system.
Continually assess the patient's progress during the procedure. At all times the patient should be able to obey commands.
The removal of existing dressings, the cleansing of the wound and the re-dressing of the wound are distinct phases during which the pain may be increased. Give the patient adequate warning to top-up in advance.
The patient may wish to retain control of the demand valve for a short time at the end of the procedure as oral analgesia may not yet be fully effective. However, continuous or prolonged use of Entonox is not appropriate.
A short period of rest should be encouraged to allow the sedative effects of the gas to wear off completely.
References
1. Fairley P. The Conquest of Pain. London: Michael Joseph, 1978 (Chapter 7).
2. Spencer EM. Inhaled sedative agents. Current Opinion in Critical Care 1999; 5(4): 257-62.
3. Harding TA, Gibson JA. The use of inhaled nitrous oxide for flexible sigmoidoscopy: a placebo controlled trial. Endoscopy 2000; 32(6): 457-60.
4. British Oxygen Company. Data Sheet April 1992 (Revision 2). Manchester, UK: BOC Gases, 1992.
5. Eger EI, Saidman LJ. Hazards of nitrous oxide anesthesia in bowel obstruction and pneumothorax. Anesthesiology 1965; 26(1): 61-66.
6. British Oxygen Company. Entonox Protocol Template Available from: BOC Customer Service Centre, Manchester, UK, .
7. Pal SK, Cortiella J, Herndon D. Adjunctive methods of pain control in burns. Burns 1997; 23(5): 404-12.
8. Forbes GM, Collins BJ, Foster N. Nitrous oxide for colonoscopy: a randomised controlled study. J Gastroenterol Hepatol 1998; 13(Supplement A178).
9. Martin JP, Sexton BF, Saunders BP, Atkin WS. Inhaled patient-administered nitrous oxide/oxygen mixture doesnot impair driving ability when used as analgesia during screening flexible sigmoidoscopy. Gastronintestinal Endoscopy 2000; 51(6): 701-03.
10. Peate I, Lancaster J. Safe use of medical gases in the clinical setting: practical tips. Br J Nursing 2000; 9(4): 231-36.
11. Association of Anaesthetists of Great Britain and Ireland. . A report received by council of the Association of Anaesthetists on Blood Bourne Viruses and Anaesthesia. 1996 http://www.aagbi.org/pdf/20.doc.pdf.
12. Bajekal RR, Turner R, Yentis SM. Anti-infective measures and Entonox equipment. A survey. Anaesthesia 2000; 55(2): 153-54.
13. Chapman G, Clarke TNS. Infection control of breathing circuitry in pre-hospital care. Pre-hospital Immediate Care 1999; 3: 84-88.
14. Chilvers RJ, Weisz M. Entonox equipment as a potential source of cross infection. Anaesthesia 2000; 55(2): 176-79.
15. Sealey L. Nurse administration of Entonox to manage pain in ward settings. Nursing Times 2002; 98(46): 28-29.
16. Lawler K. Entonox: too useful to be limited to childbirth? Professional Care of Mother and Child 1995; 5(1): 19-21.
Nitrous Oxide Gas ask your local car hoon and watch his face light up . This is used in Dragsters to supplement fuel to get outrageous power.
It is highly flammable.
Now add Oxygen which is an oxidising agent and you have an even more flammable gas.
I used nitrous oxide gas years ago as a freezing agent for the tt of VP.
Not many people in the building realised the risks of using such a gas and used to ask why we hada pipe to vent the spent gas to the outside of the building. Worying as it meant many had no idea that myself and the dental clinic used such a flammable gas.
So please make sure you understand the fire risks associated with this gas mixture.
I appreciate that risk factors should always be given consideration but if the appropriate protocols were in place would you consider the use of entonox as a sedative?
Regards,
__________________
:)
twirly
Mandy Brooks
Brooks Podiatry
S64 0DE
Suffering a fondness for odd things.
“ Though the mills of God grind slowly;
Yet they grind exceeding small;
Though with patience he stands waiting,
With exactness grinds he all. ”
Entonox is a very effective drug, simple to use and vrtually no persistent side effects or contraindications (at least not in the podiatric office seting). It has been used widely in medical and dental practice for decades. The explosive dangers are no more than those that apply to having an oxygen cylinder in your practice. However there should be a scavenging system in place wherever etonox is used to prevent exposure to the gas by others in the room.
Would be fanastic option for brief painful procedures, and especially for those podiatrists who manage acute injuries such as fractures that may need closed reduction & casting it would be an excellent drug to have available. Not really sure what the legalities are regarding its use by podiatrists in Australia but I do know that it has / still is used widely in Australian ambulance services and I understand that even some first aid organisations / occupational health first aiders / surf lifesavers are using it.
I cannot understand why this drug (given the benefits) is not more widely used in Podiatric practice.
I understand Dave is concerned RE: explosive/flammable potential but as posalafin identified, if oxygen is available in a clinic environment then surely health & safety issues including appropiate storage & disposal would already be in place.
Still my question is, are any pods actually using entonox?
If yes, is there access to appropriate training in its use?
I'm sure I have mentioned previously that my daughter is needle phobic. Not shy, scared or a little worried. The sort of see a needle on a syringe, passing out & throwing up kinda scared witless.
She required a very minor op. (partial nail avulsion) Would not permit me, colleagues or lord God almighty to inject L/A into her toe.
She was booked privately into local hospital for general anaesthetic.
Problem 1) G/A requires siting of needle usually into dorsum of hand to administer.
Problem 2) Screaming 16 year old in hysterics while pod. surgery team & aneathetist look on.
Solution 1) Aneasthetist in a moment of inspiration offers gas & air to calm her. Two whiffs of mask & tada..... shunt in place & child asleep.
In truth I feel the g/a was unecessary as a l/a could easily be administered once she was calmed by the gas mix.
Surely we all see patients who become so distressed at the thought of a relatively routine procedure that could be made so much less of a trial given the choice of such a simple solution.
Any thoughts?
__________________
:)
twirly
Mandy Brooks
Brooks Podiatry
S64 0DE
Suffering a fondness for odd things.
“ Though the mills of God grind slowly;
Yet they grind exceeding small;
Though with patience he stands waiting,
With exactness grinds he all. ”
I know this thread hasn't been active for a while, but entonox use in Podiatry is a topic i have recently become very interested in.
I'm a 3rd year student, and when i was on placement the NHS Pod department i was working in had a training day for their Podiatrists on the use of entonox in nail surgery.
It was really interesting to see how easy entonox was to use and the positive effect it had on the patients, who as a result of the gas felt very little discomfort from the LA injections. There was one very nervous patient in particular who i am sure would not have gone through with the proceedure if he hadn't had entonox
I have been researching entonox a bit and cant see that it is being used in Podiatry very much. As part of my 3rd year i have to produce a research proposal, and i was wondering about about seeing how useful/viable entonox is as pain releif for LA administration during nail surgery. if anyone has any thoughts or opinions or has used entonox in their practise i would be really interested to hear from you!
I work in a pod surg unit and we frequently give entonox to nervous patients before LA is given. DAVOHORN, watch that 15 blade, one slip your finger could be gone! seriously don't be so over protective!
The Following User Says Thank You to G Flanagan For This Useful Post:
Thank you for your post RE: Entonox use in Podiatry.
I understand from your post that your team use entonox for procedures.
If possible could you post your protocols for its use.
I am very interested in the use of entonox in certain situations & appreciate its potential value in otherwise anxiety producing situations for patients.
Kind regards,
Mandy Brooks
PS. Sez, I would also be very interested in your findings.
Thank you.
Mandy Brooks
__________________
:)
twirly
Mandy Brooks
Brooks Podiatry
S64 0DE
Suffering a fondness for odd things.
“ Though the mills of God grind slowly;
Yet they grind exceeding small;
Though with patience he stands waiting,
With exactness grinds he all. ”
Entonox was quite widely used in the early days of the Podiatry Association in the U.K. The reasons that most podiatric surgeons stopped using it were i) improved technique with L.A. and ii) patients requiring sedation were transferred to hospitals and sedated by Anaesthetists who tend to prefer G.A. or i/v sedation. I certainly did not hear of any adverse reactions from podiatric use of Entonox at the time , nor since.
All the best
Bill
The Following User Says Thank You to W J Liggins For This Useful Post:
Methoxyflurane (C3H4Cl2F2O) is an inhalational anaesthetic used in the 1960s and early 1970s, but withdrawn because of detrimental effects on the kidneys. This was due to fluoride ions being produced by its metabolism in the kidney.
Are you aware if Australian medical teams have access? As the article also mentioned:
Quote:
Methoxyflurane is used extensively in Australian ambulance services, and in St John Ambulance as an emergency analgesic.
The links provided by Wikipedia would have been helpful but each one shows as 'Not available.'
It happens that I don't use it because my practice does not require it. However, given that there are no known adverse reactions recorded (that I have been able to find), that the patient effectively self administers, that it is avantageous to the (nervous) patient, then why not?
My comment pre-supposes that all consents are appropriate and signed, that insurance is checked and that Health and Safety measures are as required.
All the best
Bill
The Following User Says Thank You to W J Liggins For This Useful Post:
Methoxyflurane is used extensively by all ambulance services in Australa for inhalational pain relief. It has been demonstrated in this setting to be an effective & safe analgesic.
It was withdrawn from anaesthetic practice due to it nephrotoxic effects and the introduction of better inhalational anaesthetics such as sevoflurane. The kidney toxicity isn't such an issue in the short term use of methoxyflurane as the doses and duration of use are typically much less than in the anaesthetic setting.
In having said that it is contraindicated in patients with established renal disease and in patients currently taking tetracycline antibiotics.
Methoxyflurane is used extensively by all ambulance services in Australa for inhalational pain relief. It has been demonstrated in this setting to be an effective & safe analgesic.
...as well as surf lifesavers, ski patrollers and mine operators in certain jurisdictions.
If it is safe enough for non-health professionals to use - then there should be little argument from drug regulators for us to use it.
If you're not in WA, write to your local Board.
LL
__________________
***************************************** Remember, it's just a foot.
Big disadvantage, the equipment is abut £500, so how often in PP would I use it?
I appreciate that the costs are high (also including abiding by COSH standards & regulations for carrying potentially explosive gas etc) although if a clinic also kept O2 then safety & a supplier should already be in place to negotiate a reasonable fee.
The cost (I imagine, I have not enquired as yet) should be 100% tax deductable.
Regards,
Mandy.
__________________
:)
twirly
Mandy Brooks
Brooks Podiatry
S64 0DE
Suffering a fondness for odd things.
“ Though the mills of God grind slowly;
Yet they grind exceeding small;
Though with patience he stands waiting,
With exactness grinds he all. ”
Slightly off the subject but Mandy raised the issue of Tax.
IMO this is often misunderstood by 'business' people.
True you can set the cost of equipment against expenses therefore such costs will reduce your tax bill at the end of the year.
However how much you 'benefit' by this depends on what level you pay tax at, basic or higher rate.
But you still bear a large proportion of the cost of the equipment which should in a well run business show a return on investment over a reasonable period of time.
!00% tax relief does not mean you get all your money back from the Tax man.
I'm sure you all understand this, but just for those that may be confused?
I practice in Perth WA and we had a short day course in the use of Methoxyflurane approxiamtely 18 months ago. I have since used it a few times on patients who are needle phobic.... mainly children and big burly men!!
It has been very successful and easy to use. We buy it in a single use disposable pack which includes a vial of the drug and the inhaler. The whole thing cost approx $30, which is passed on as an extra fee, to the patient.
The Following User Says Thank You to Steve Jackson For This Useful Post:
You pay for the demand valve and pipe. You pay BOC a rental for whichever size cylinder of Entonox you need (from memory you can have quite a small cylinder). The Entonox istelf is not expensive.
Check with BOC (Medical) for info.
Regards,
Davidh
The Following User Says Thank You to davidh For This Useful Post:
It does however not mention the 'fire hazard' referred to by another poster!
I'm not convinced there is one.
Anyone have evidence to the contrary?
As far as 'course' go I when I did my degree I was trained in the use of Entonox so see no reason why I should not use it.
Equally as the Wiki bit says it is actually 'self administered'.
Google Entanox and there is loads of info.
Still reckon you are looking at an initial investment of about £500 and yes David the 'little' cylinder a 'D' cylinder is what in general is now used, all the equipment is very similar to emergency Oxygen. which of course does need specialist training to administer!
The fire hazard of entonox is no more so than the fire hazard of an oxygen cylinder. Same precautions apply avoid getting oil/grease near outlet and avoid naked flame when using it. You also need to have a warning plate indicating there is oxidising gas in place for fire services (at least in australia).
Safety is alwas important but I think the poster who brought up the fire risk of entonox was overstating it just a little.
Well done on finding this course Mandy, and very well done on resurrecting the South Yorkshire branch of the SCP, and becoming it's Chair.
Just a couple of questions.
Is this course just for ST Johns Ambulance members or is it open to the 'general public'?
If you undertook this course, which does not state any 'qualification' would the Society recognise it for insurance purposes if you were using Entonox in your day to day practise?
My fear is that those recently trained FHPs may see this course and think that once done they could join the St Johns Ambulance Brigade then merrily go around treating IGTN under Entonox.
Hi just want to throw in a little diversion clubbers and festival goes use this on a regular basis I have seen the empty canisters thrown on the floor and people filling up balloons from the back of their cars from larger bottles. Not sure what the effects of long term users on there lungs will be.
Must say did not like it myself when I gave birth made me feel sick and then there was a the rubber mask uhhh
Jude
Last edited by betafeet : 24th September 2008 at 01:47 PM.
Reason: spelling
I have been told anecdotally (by the entonox trainer and the Pods who were undertaking the training) that as Podiatrists are registered with the Health Professions Council we are permitted to use Entonox as long as local PCT policy permits and practitioners have undergone appropriate training.
I have contacted the HPC to try and veryfy this bit of information, but as there are pods training and using entonox i am guessing it is correct!
Entonox (nitrous oxide)
there seems to be no reason why we do not utilise this gas mixture to alleviate pain & anxiety in certain situations eg. nail surgery & painful injections. 
Re: Entonox
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