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Statement on Entonox and Fitness to Drive

Tuesday, 06 July 2010 09:01

The BSGE has recently received an enquiry into the use of Entonox and fitness to drive. Entonox (50% nitrous oxide, 50% oxygen, manufactured by BOC) is mainly used in obstetric units and by the ambulance service, but its analgesic and sedative properties with rapid onset and offset make it a potentially attractive agent in patients having colonoscopy and it is already in use in many units. A number of publications in the 1990s showed that it is safe and effective, with reduced discomfort and nausea compared to IV agents and allows earlier discharge from the recovery unit. It is perhaps surprising that it is not more widely used.

As for the question of fitness to drive: the recently revised product licence states that patients are fit to drive a vehicle (or operate machinery) after only 30 minutes. Used in combination with a rapidly acting bowel cleansing agent, this could mean that for patients whose colonoscopy is to be done mid-week, only half a day away from work is required – a major advantage for the self-employed. A pdf file, "Entonox: Information for the User" is available from BOC (and on the BSG website)

Alistair McNair, Secretary BSG Endoscopy

Reducing risk of overdose with midazolam injection in adults

Sunday, 15 March 2009 00:47

National Patient Safety Agency Rapid Response Report Issued: Reducing risk of overdose with midazolam injection in adults

Some adult patients are being overdosed with midazolam injection when used for conscious sedation. The presentation of high strength midazolam as 5mg/ml (2ml and 10ml ampoules) or 2mg/ml (5ml ampoule) exceeds the dose required for most patients. There is a risk that the entire contents of high strength ampoules are administered to the patient when only a fraction of this dose is required. Doses often exceed that required, are not titrated to the patient’s individual needs, do not take into account concurrent medication (e.g. opioids) and may involve high risk groups for example, the frail or the elderly. There is frequent reliance on injectable flumazenil (antagonist/reversing agent) for reversal of sedation in patients that have been over sedated.

Attachments:
Download this file (midazolam_rrr_08.pdf)Reducing risk of overdose[Reducing risk of overdose with midazolam injection in adults ]44 Kb

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