"What is he smoking?"
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@Mik said in "What is he smoking?":
Good? Bad? I could not quite tell.
Gonna get geeky here...
Penthrane (the trade name for methoxyflurane) is an inhalation anesthetic that was in pretty wide use in the mid 1970s. Two big drawbacks:
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For general anesthesia, it is slow as FUCK. If you're giving enough to keep someone anesthetized, you gotta shut the stuff off at least 20 minutes before the end of the case and hope that the patient will be awake enough to transport. If you're too conservative, and wait, you're gonna sit in the OR for a while as everyone stands, stares at you thinking, "Why didn't you plan ahead." OTOH, if you turn it off too soon, you got someone who's going to be wiggling around as the final stitches go in. I only used it a handful of times. Hated the stuff.
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It releases free fluoride ions, which are nephtrotoxic - they kill your kidneys, or at least hurt them. The amount of fluoride is related to the dose of Penthrane (as a % of inhaled gas) and the time of exposure.
All that said, it's been used for analgesia in Great Britain and I believe Canada during labo(u)r. My understanding is that it's pretty effective, but, if mom uses it a LOT, she can lose consciousness - not a good thing in a laboring woman. I don't recall the amount of maternal-fetal transmission that occurs.
So, it's not without some risk, but I wonder if it's safe enough to use in the field. I also wonder how quickly it works, and whether it can become dangerous if used too much.
Just my geeky anesthesiologist post of the week.
ETA: Slow...
When I was a student, I asked my attending if I could do a gas induction with Penthrane. A gas induction is when you hold the mask on the patient's face and have him breathe anesthetic gases until he loses consciouness sufficient for surgery. With today's anesthetics, (Sevoflurane), you can do it in about 4-5 minutes - it's great for kids who you can't start an IV. With Pethrane, it took about 20 minutes. It was quite the adventure, LOL.
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