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Endosc Int Open 2016; 04(11): E1171-E1177
DOI: 10.1055/s-0042-115409
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Psychomotor and cognitive effects of 15-minute inhalation of methoxyflurane in healthy volunteers: implication for post-colonoscopy care

Nam Q. Nguyen
1   Department of Gastroenterology and Hepatology. University of Adelaide, Adelaide, South Australia
2   Discipline of Medicine, University of Adelaide, Adelaide, South Australia
,
Jenna Burgess
1   Department of Gastroenterology and Hepatology. University of Adelaide, Adelaide, South Australia
,
Tamara L. Debreceni
1   Department of Gastroenterology and Hepatology. University of Adelaide, Adelaide, South Australia
,
Leanne Toscano
1   Department of Gastroenterology and Hepatology. University of Adelaide, Adelaide, South Australia
› Author Affiliations
Further Information

Publication History

submitted08 February 2016

accepted after revision29 July 2016

Publication Date:
08 November 2016 (online)

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Background and study aims: Colonoscopy with portal inhaled methoxyflurane (Penthrox) is highly feasible with low sedation risk and allows earlier discharge. It is unclear if subjects can return to highly skilled psychomotor skill task shortly after Penthrox assisted colonoscopy. We evaluated the psychomotor and cognitive effects of 15-minute inhalation of Penthrox in adults.

Patients and methods: Sixty healthy volunteers (18 to 80 years) were studied on 2 occasions with either Penthrox or placebo in a randomized, double-blind fashion. On each occasion, the subject’s psychomotor function was examined before, immediately, 30, 60, 120, 180 and 240 min after a 15-minute inhalation of studied drug, using validated psychomotor tests (Digit Symbol Substitution Test (DSST), auditory reaction time (ART), eye-hand coordination (EHC) test, trail making test (TMT) and logical reasoning test (LRT).

Results: Compared to placebo, a 15-minute Penthrox inhalation led to an immediate but small impairment of DSST (P < 0.001), ART (P < 0.001), EHC (P < 0.01), TMT (P = 0.02) and LRT (P = 0.04). In all subjects, the performance of all 5 tests normalized by 30 minutes after inhalation, and was comparable to that with placebo. Although increasing age was associated with a small deterioration in psychomotor testing performance, the magnitude of Penthrox effects remained comparable among all age groups.

Conclusions: In all age groups, a 15-minute Penthrox inhalation induces acute but short-lasting impairment of psychomotor and cognitive performance, which returns to normal within 30 minutes , indicating that subjects who have colonoscopy with Penthrox can return to highly skilled psychomotor skills tasks such as driving and daily work the same day.

 

  • References

  • 1 Grindlay J, Babl FE. Efficacy and safety of methoxyflurane analgesia in the emergency department and prehospital setting. Emerg Med Australas 2009; 21: 4-11
    CrossrefPubMedGoogle Scholar
  • 2 Nguyen NQ, Toscano L, Matthew L et al. Patient-controlled analgesia with inhaled methoxyflurane versus conventional endoscopist-provided sedation for colonoscopy: a randomized multi-center trial. Gastrointest Endosc 2013; 78: 892-901
    CrossrefPubMedGoogle Scholar
  • 3 Nguyen NQ, Toscano L, Matthew L et al. Portable inhaled methoxyflurane for colonoscopy in patients with morbid obesity and/or obstructive sleep apnoea: a feasibility study. Endoscopy International 2015; 3: E487-493
    PubMedGoogle Scholar
  • 4 Coffey F, Wright J, Hartshorn S et al. STOP!: a randomised, double-blind, placebo-controlled study of the efficacy and safety of methoxyflurane for the treatment of acute pain. Emerg Med J 2014; 31: 613-618
    CrossrefPubMedGoogle Scholar
  • 5 Johnston S, Wilkes GJ, Thompson JA et al. Inhaled methoxyflurane and intranasal fentanyl for prehospital management of visceral pain in an Australian ambulance service. Emerg Med J 2011; 28: 57-63
    CrossrefPubMedGoogle Scholar
  • 6 Middleton PM, Simpson PM, Sinclair G et al. Effectiveness of morphine, fentanyl, and methoxyflurane in the prehospital setting. Prehosp Emerg Care 2010; 14: 439-447
    CrossrefPubMedGoogle Scholar
  • 7 Wasiak J, Mahar PD, Paul E et al. Inhaled methoxyflurane for pain and anxiety relief during burn wound care procedures: an Australian case series. Int Wound J 2014; 11: 74-78
    CrossrefPubMedGoogle Scholar
  • 8 Spruyt O, Westerman D, Milner A et al. A randomised, double-blind, placebo-controlled study to assess the safety and efficacy of methoxyflurane for procedural pain of a bone marrow biopsy. BMJ Support Palliat Care 2014; 4: 342-348
    CrossrefPubMedGoogle Scholar
  • 9 Huang S, Pepdjonovic L, Konstantatos A et al. Penthrox alone versus Penthrox plus periprostatic infiltration of local analgesia for analgesia in transrectal ultrasound-guided prostate biopsy. ANZ J Surg 2016; 86: 139-142
    CrossrefPubMedGoogle Scholar
  • 10 Moss A, Parrish FJ, Naidoo P et al. Self-administered, inhaled methoxyflurane improves patient comfort during nasoduodenal intubation for computed tomography enteroclysis for suspected small bowel disease: a randomized, double-blind, placebo-controlled trial. Clin Radiol 2011; 66: 125-131
    CrossrefPubMedGoogle Scholar
  • 11 Australian Government, Department of Health, Therapeutic Goods Administration. Medicines Safety Update, Volume 5, Number 2, April 2014. Available from: https://www.tga.gov.au/publication-issue/medicines-safety-update-volume-5-number-2-april-2014 Accessed May 14, 2015
    PubMedGoogle Scholar
  • 12 Zacny J, Paice J, Coalson D. Characterising the subjective and psychomotor effects of carisoprodol in healthy volunteers. Pharmacol Biochem Behav 2011; 100: 138-143
    CrossrefPubMedGoogle Scholar
  • 13 Galinkin J, Janiszewski D, Young C et al. Subjective, psychomotor, cognitive and analgesic effects of subanesthetic concentrations of sevoflurance and nitrous oxide. Anesthesiology 1997; 87: 1002-1008
    CrossrefPubMedGoogle Scholar
  • 14 Janiszewski D, Galinkin J, Klock A et al. The effects of subanesthetic concentrations of sevoflurane and nitrous oxide, alone and in combination, on analgesia, mood, and psychomotor performance in healthy volunteers. Anesth Analg 1999; 88: 1149-1154
    CrossrefPubMedGoogle Scholar
  • 15 Wetherell A. Performance tests. Environ Health Perspect 1996; 104 (Suppl. 02) 247-273
    CrossrefPubMedGoogle Scholar
  • 16 van Hoof JJ, Jogems-Kosterman BJ, Sabbe BG et al. Differentiation of cognitive and motor slowing in the Digit Symbol Test (DST): differences between depression and schizophrenia. J Psychiatr Res 1998; 32: 99-103
    CrossrefPubMedGoogle Scholar
  • 17 Baddeley AD. Prior recall of newly learned items and the recency effect in free recall. Can J Psychol 1968; 22: 157-163
    CrossrefPubMedGoogle Scholar
  • 18 Nuotto EJ, Korttila KT. Evaluation of a new computerized psychomotor test battery: effects of alcohol. Pharmacol Toxicol 1991; 68: 360-365
    CrossrefPubMedGoogle Scholar
  • 19 Reitan RM. The relation of the trail making test to organic brain damage. J Consult Psychol 1955; 19: 393-394
    CrossrefPubMedGoogle Scholar
  • 20 Australian and New Zealand College of Anaesthetists. Endoscopy of the Airways. Review PS17. 1997
    PubMedGoogle Scholar
  • 21 Mitchell MC. Alcohol-Induced Impairment of Central Nervous System Function: Behavioral Skills Involved in Driving. Journal of Studies on Alcohol 1985; Suppl. 10: 109-116
    PubMedGoogle Scholar
  • 22 Tucker PF and Chilvers CR. Fitness to drive after intravenous sedation and general anaesthesia: a literature review. Australian Anaesthesia 2003; 27-40
    PubMedGoogle Scholar
  • 23 Hindmarch I, Subhan Z. The Effects of Midazolam in Conjunction with Alcohol on Sleep, Psychomotor Performance and Car Driving Ability. Internat J Clin Pharmacol Res 1983; 3: 323-329
    PubMedGoogle Scholar
  • 24 Nuotto EJ, Korttila KT, Lichtor JL et al. Sedation and Recovery of Psychomotor Function After Intravenous Administration of Various Doses of Midazolam and Diazepam. Anesthesia Analgesia 1992; 74: 265-271
    CrossrefPubMedGoogle Scholar
  • 25 Gudgeon AC, Hindmarch I. Midazolam: Effects on Psychomotor Performance and Subjective Aspects of Sleep and Sedation in Normal Volunteers. Br J Clin Pharmacol 1983; 16 (Suppl. 01) 121S-126S
    CrossrefPubMedGoogle Scholar
  • 26 Ghoneim MM, Mewaldt SP, Thatcher JW. The Effect of Diazepam and Fentanyl on Mental, Psychomotor and Electroencephalographic Functions and Their Rate of Recovery. Psychopharmacologia (Berl.) 1975; 44: 61-66
    CrossrefPubMedGoogle Scholar
  • 27 Manner T, Kanto J, Salonen M. Simple devices in differentiating the effects of buprenorphine and fentanyl in healthy volunteers. Europ J Clin Pharmacol 1987; 31: 673-676
    CrossrefPubMedGoogle Scholar
  • 28 Larson LE, Gupta A, Ledin T et al. Psychomotor recovery following propofol or isoflurane anaesthesia for day-care surgery. Acta Anaesthesiol Scand 1992; 36: 276-282
    CrossrefPubMedGoogle Scholar
  • 29 Milligan KR, O’Toole DP, Howe JP et al. Recovery from Outpatient Anaesthesia: A Comparison of Incremental Propofol and Propofol-Isoflurane. Br J Anaesthesia 1987; 59: 1111-1114
    CrossrefPubMedGoogle Scholar
  • 30 Kestin IG, Harvey PB, Nixon C. Psychomotor Recovery after Three Methods of Sedation during Spinal Anaesthesia. Br J Anaesthesia 1990; 64: 675-681
    CrossrefPubMedGoogle Scholar
  • 31 Horiuchi A, Nakayama Y, Kajiyama M et al. Safety and effectiveness of propofol sedation during and after outpatient colonoscopy. World J Gastroenterol 2012; 18: 3420-3425
    CrossrefPubMedGoogle Scholar
  • 32 Dong MH, Kalmaz D, Savides TJ. Missed work related to mid-week screening colonoscopy. Dig Dis Sci 2011; 56: 2114-2119
    CrossrefPubMedGoogle Scholar
  • 33 Leung FW, Aljebreen AM, Brocchi E et al. Sedation-risk-free colonoscopy for minimizing the burden of colorectal cancer screening. World J Gastrointest Endosc 2010; 2: 81-89
    CrossrefPubMedGoogle Scholar
  • 34 Leung FW. Is there a place for sedationless colonoscopy?. J Interv Gastroenterol 2011; 1: 19-22
    CrossrefPubMedGoogle Scholar
  • 35 Paggi S, Radaelli F, Amato A et al. Unsedated colonoscopy: an option for some but not for all. Gastrointest Endosc 2012; 75: 392-398
    CrossrefPubMedGoogle Scholar