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Methoxyflurane Toxicity

Edwin J. Goldman, MD
JAMA. 1970;214(12):2195. doi:10.1001/jama.1970.03180120067022.
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To the Editor.—  In addition to "Toxicity Following Methoxyflurane Anesthesia" (214:86, 1970), several articles in the past months noted renal failure following methoxyflurane anesthesia.1,2 All suffer from a common information gap. The anesthetic administration and management is dismissed in a few words eg, "under methoxyflurane anesthesia..." "The surgery lasted six hours, and there was no hypoxia or hypotension." While it is reassuring to note the absence of hypoxia and hypotension, your anesthesiologist reader wishes to know a great deal more.What per cent of anesthetic was administered? Was it in a closed system, or a semiclosed system, or nonrebreathing? Was nitrous oxide used as well and in what concentration? What was the total flow of gas? Were muscle relaxants used or was the anesthetic pushed to deep levels to provide relaxation? How long was each setting used? The answers to these questions would allow us to guess at


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