Kelty Erin A, Murray Kevin, Sanfilippo Frank M, Preen David B
School of Population and Global Health, The University of Western Australia, Crawley, Western Australia.
Prehosp Emerg Care. 2025;29(6):768-775. doi: 10.1080/10903127.2024.2397519. Epub 2024 Sep 17.
The use of methoxyflurane is becoming increasingly popular in the treatment of pain in an emergency setting, in part due to its ease of administration. However, little is known about the risk of serious adverse events in children and adolescents. The aim of this study was to examine the safety of methoxyflurane in a pediatric population.
The study was a retrospective cohort study of pediatric prehospital events using probabilistic linked health data. All ambulance transfers in Western Australia between 1990 and 2016 involving children and adolescent patients were identified. Patients were categorized based on administered analgesia: methoxyflurane, an opioid analgesic, both methoxyflurane and an opioid analgesic, or no analgesic. Hospital and mortality data were linked to transferred patients to identify deaths, adverse drug reactions, liver and kidney toxicity, and re-admissions to hospital following ambulance transfer. Generalized linear models, adjusting for sociodemographic and ambulance transfer characteristics, were used to compare outcomes between children exposed to methoxyflurane and the other three groups.
The study cohort consisted of 37,211 children, including 9,472 patients (25.5%) treated with methoxyflurane alone, 2,764 (7.4%) treated with an opioid analgesic, 1,235 (3.3%) treated with both methoxyflurane and an opioid analgesic, and 23,740 (63.8%) treated with no analgesic. Death in children and adolescents was uncommon, with less than five deaths (<0.1%) observed in the 12 months following treatment with methoxyflurane and no deaths in those treated with both methoxyflurane and an opioid analgesic. Adverse drug reaction was rare (<0.1%) in patients treated with methoxyflurane, as was liver and kidney toxicity with no case observed. At 90-days follow-up, there was no significant difference in hospitalization in patients treated with methoxyflurane and those treated with methoxyflurane and an opioid analgesic (adjusted OR:1.01, 95%CI:0.85-1.21). Compared with methoxyflurane treated patients, patients treated with an opioid analgesic were more likely to be hospitalized (aOR:1.23, 95%CI:1.09-1.39), while patients treated with no analgesic were less likely to be hospitalized (aOR:0.85, 95%CI:0.79-0.92).
In children and adolescents transported by ambulance, the use of methoxyflurane was not associated with an increased risk of hospitalization, death, serious adverse drug reactions or liver and kidney toxicity.
甲氧氟烷在紧急情况下治疗疼痛中的应用越来越普遍，部分原因是其易于给药。然而，对于儿童和青少年发生严重不良事件的风险知之甚少。本研究的目的是探讨甲氧氟烷在儿科人群中的安全性。
本研究是一项回顾性队列研究，利用概率关联健康数据对儿科院前事件进行研究。确定了1990年至2016年西澳大利亚州所有涉及儿童和青少年患者的救护车转运情况。根据给予的镇痛药物对患者进行分类：甲氧氟烷、阿片类镇痛药、甲氧氟烷和阿片类镇痛药两者或未给予镇痛药物。将医院和死亡率数据与转运患者相关联，以确定死亡、药物不良反应、肝肾毒性以及救护车转运后再次入院情况。使用广义线性模型，并对社会人口统计学和救护车转运特征进行调整，以比较暴露于甲氧氟烷的儿童与其他三组儿童的结局。
研究队列包括37211名儿童，其中9472例（25.5%）仅接受甲氧氟烷治疗，2764例（7.4%）接受阿片类镇痛药治疗，1235例（3.3%）同时接受甲氧氟烷和阿片类镇痛药治疗，23740例（63.8%）未接受镇痛药物治疗。儿童和青少年死亡情况并不常见，在接受甲氧氟烷治疗后的12个月内观察到不到5例死亡（<0.1%），同时接受甲氧氟烷和阿片类镇痛药治疗的患者无死亡病例。接受甲氧氟烷治疗的患者药物不良反应罕见（<0.1%），肝肾毒性也未观察到病例。在90天随访时，接受甲氧氟烷治疗的患者与接受甲氧氟烷和阿片类镇痛药治疗的患者在住院方面无显著差异（调整后的比值比：1.01，95%置信区间：0.85-1.21）。与接受甲氧氟烷治疗的患者相比，接受阿片类镇痛药治疗的患者更有可能住院（校正后的比值比：1.23，95%置信区间：1.09-1.39），而未接受镇痛药物治疗的患者住院可能性较小（校正后的比值比：0.85，95%置信区间：0.79-0.92）。
在通过救护车转运的儿童和青少年中，使用甲氧氟烷与住院、死亡、严重药物不良反应或肝肾毒性风险增加无关。
