I better explain myself about MIMS.

Checkout this post by Squezzy at Girl in Green

I'm bad because they do mention it but under a name I've not heard before, Toxaemia of Pregnancy. Further to that there is some misdirection or poor direction on the MIMS Online reference that I wish to go into.

Now in the MIMS Abbreviated Prescribing Information, the style we're normally looking at from the MIMS book we got from the GP. Contraindications does include toxaemia of pregnancy.

However if you follow through to the much more twisty and detailed Full Prescribing Information it has disappeared from the contraindications.

It is now only a precaution!!!

Allow me to cut and paste,

Use in pregnancy.All general anaesthetics cross the placenta and carry the potential to produce central nervous system and respiratory depression in the newborn infant. In routine practice this dose does not appear to be a problem; however in a compromised foetus, careful consideration should be given to this potential depression, and to the selection of anaesthetic drugs, doses and techniques.

Toxaemia of pregnancy. It is advisable not to administer methoxyflurane due to the possibility of existing renal impairment.

Now this sounds like a contraindication but it's not.

Reading a bit further about Toxaemia of pregnancy. It is pregnancy induced hypertension but it does not seem to be pre-ecclampsia until more severe or untreated lets look at some signs and symptoms.

Tox of Preg - elevated BP, protein in the urine, hyper-reflexia, bloating and oedema.

Pre-ecclampsia - severe elevated BP, headaches, gastric pain, even seizures.

Continued and untreated Toxaemia can lead to Liver and Kidney damage and that's where the hiccup is.

Our use is very short term analgesia at very small concentrations, do our Clinical Managers need to re-evaluate this pharmacology or change it to a guideline with further information?

I'm very confused the more I read, here are some possible adverse reactions.

Other reported events: cardiac arrest, respiratory depression, laryngospasm, bronchospasm, hypotension, bradycardia, renal failure, increased serum urea, increased serum creatinine, increased urinary oxalate excretion, increased serum inorganic fluoride, pallor, muscle relaxation.

Shit this stuff sound dangerous maybe we shouldn't use it!!!!!

Can't knowledge be empowering.

I've ranted enough I'm off.



Be careful out there and I'll see you at the Big One.

Taz