From the Research
Methoxyflurane is not supported by the provided evidence for procedural sedation in children, as none of the studies directly address its use in this context. However, based on the available evidence, methoxyflurane has been used as an analgesic in various settings, including trauma pain and minor surgical procedures, with a favorable safety profile and minimal side effects 1, 2, 3, 4. The most recent and highest quality study provided is from 2021, which compares the efficacy and adverse events of intranasal fentanyl and nitrous oxide to intravenous ketamine and midazolam for painful orthopedic procedures in a pediatric emergency department, but does not mention methoxyflurane 5. Key points to consider when using methoxyflurane in a clinical setting include:
- It is typically administered via a handheld inhaler device at doses of 3mL for children over 5 years (maximum 6mL per day, not to exceed 15mL per week) 1, 2, 3, 4
- The child self-administers by inhaling through the device, with onset of analgesia occurring within 6-10 breaths and lasting approximately 20-30 minutes 1, 2, 3, 4
- Advantages include rapid onset, short duration of action, minimal preparation requirements, and no need for IV access 1, 2, 3, 4
- Methoxyflurane provides both analgesic and mild sedative effects while maintaining the child's ability to follow commands 1, 2, 3, 4
- Side effects are generally mild and include dizziness, headache, and nausea, but it should be used cautiously in patients with renal impairment due to potential nephrotoxicity at higher doses, and is contraindicated in patients with history of malignant hyperthermia or significant cardiovascular disease 1, 2, 3, 4.