Use Of Ethyl Chloride Research Articles

Ethyl chloride poisoning from inhalational misuse: clinical features and outcomes

Introduction Ethyl chloride misuse remains a prevailing concern due to its accessibility, but detailed descriptions of the features of toxicity are limited to sporadic reports, resulting in knowledge gaps in their clinical features and diagnosis. Objective To describe the clinical features, treatment, and outcomes of patients reported in the literature who developed toxicity from inhalational use of ethyl chloride. Methods We reviewed relevant literature over the past 50 years and analyzed the characteristics and outcomes of patients with toxicity from the inhalational use of ethyl chloride. Results A total of 21 studies from 1979 to 2024 were identified, making available 22 patients for analysis. Their median age was 40 years (range 16–62 years), and there were more than four times as many males as females. Ethyl chloride-containing cleaning solvents (8/22, 36%) were most commonly used. Regular inhalation of ethyl chloride was documented in approximately two-thirds of the patients (14/22, 66%), with a median duration of five months of misuse (range 2–360 months). A large proportion of patients (15/22, 68%) inhaled ethyl chloride again within a week from the onset of toxicity. Although features of cerebellar dysfunction were very common at presentation (13/16, 81%), abnormalities on neuroimaging studies were rare. Death occurred in more than a quarter of cases (6/22, 27%), with patients either already deceased or dying shortly after. Half (3/6) of these deaths were directly attributable to the development of lethal cardiac dysrhythmias. Conversely, most survivors either improved or fully recovered within a few days to weeks (14/16, 88%), independent of their presenting symptoms, clinical signs, and the treatments they received. Discussion Ethyl chloride users are likely young or middle-aged males, and clinical features of toxicity can range from transient neurological symptoms to cardiac dysrhythmias and death. The prominence of neurotoxicity may be attributed to the lipophilic nature of ethyl chloride and its tendency to accumulate in neural tissue, while cardiac dysrhythmias have been attributed to cardiac sensitization to catecholamines through ethyl chloride-induced inhibition of potassium, calcium, and sodium channels. Conclusions Toxicity from the inhalational misuse of ethyl chloride should be considered in young or middle-aged males presenting with acute cerebellar dysfunction. We recommend that suspected cases undergo telemetric monitoring for 24 h, especially when tachycardia and/or palpitations are present, as deaths from lethal cardiac dysrhythmias are not uncommon.

An investigation of the use of ethyl chloride and meloxicam to decrease the pain associated with a single or double incision method of castration in piglets.

Castration is a stressful and painful procedure that can impact swine welfare negatively. The objectives of this study were to (1) evaluate the effect of one incision compared to two incisions and the use of a topical vapocoolant (VAPO; ethyl chloride; a topical anesthetic) applied before castration and (2) evaluate the most effective combination in reducing pain in objective 1 and the use of Metacam®; meloxicam before castration on measures of performance, behavior, and physiology. Study 1 consisted of six treatment groups (N = 27 pigs per treatment) and included: nothing (NO); sham castrated (SH); one incision castration (C1); one incision castration plus VAPO (C1V); two incision castration (C2); two incision castration plus VAPO (C2V). Body weights and blood samples were taken at baseline and other time points after castration. Behavior measures were collected for 24 h after castration. Wound scores were collected daily for 10 days. The C1 pigs and C1V pigs were significantly heavier than the other castrated treatment groups but not different from NO and SH pigs. Vocalizations were louder for C1 and C1V pigs (P = 0.0015). Study 2 (N = 40 pigs per treatment) included: nothing (NO); one incision castration (C1); and one incision castration plus meloxicam administered 15 min before castration (C1M). The same measures (performance, behavior, and physiology) were collected as in Study 1. Performance measures and behavior did not differ among treatment groups. Physiological measures were only different for red blood cells (RBC; P = 0.0304). Pigs in C1 and C1M treatment groups had cortisol concentrations that were greater than the NO treatment group at 15 min post-castration (P < 0.05). The data collected give insight into the benefits of one-incision castration compared to 2-incision castration. However, the data only support a lower-level relief from acute pain associated with castration, as it is evident that pigs still experience stress at 15 min post-castration with or without the use of meloxicam. Further research could potentially identify the correct timing, route and dose for the administration of meloxicam.

Does The Use of Ethyl Chloride Improve Patient-Reported Pain Scores With Negative Pressure Wound Therapy Dressing Changes? A Prospective, Randomized Controlled Trial.

Negative pressure wound therapy (NPWT) is commonly used for surgical incisions and large wounds, particularly in the context of trauma. Research has shown that patients report that the most painful aspect of NPWT is related to foam dressing changes. This study aimed to determine whether topical use of the vapocoolant anesthetic ethyl chloride would impact patient-reported pain during these procedures. This study was a single-blinded, placebo-controlled randomized trial in patients who were undergoing NPWT foam dressing change following surgery performed by the orthopedic trauma team. A total of 100 patients were randomized to receive ethyl chloride topical anesthetic spray or placebo (tissue culture grade water) during dressing change. The outcome measure specified prior to enrollment was a mean decrease in patient-reported pain of 1.7 points using a numeric rating scale. Baseline and procedural characteristics were collected to investigate contributions to patient-reported pain. We hypothesized that the use of ethyl chloride would decrease patient reported pain scores. Significantly more females were randomized to the receive vapocoolant; remaining baseline and procedural characteristics were similar between groups. The median time for NPWT drape removal was 2.0 minutes in both groups (p = 0.66). The postprocedural pain reported by patients was significantly lower in the experimental group compared with placebo (median, 5.0 vs. 7.0; p = 0.03). Multivariate analysis adjusting for potential confounders showed treatment group to be the strongest predictor of postprocedure pain (p = 0.002). Additionally, a generalized linear model suggests that treatment group was the strongest predictor of change in pain score as reported by patients prior to and immediately following dressing change. Use of vapocoolant spray during NPWT dressing change for orthopedic trauma wounds and surgical incisions was feasible and resulted in significant reduction in patient-reported pain associated with the procedure. Therapeutic, Level I.

Prevenção da dor na punção venosa em crianças: estudo comparativo entre anestésicos tópicos

Background: The ideal topical anesthetic to prevent venipuncture pain should have high efficacy, a quick effect, a good safety profile, be easy to apply, low cost, and well accepted. Objective: To compare the effectiveness of 5 topical anesthetics in children who require venipuncture. Methodology: A randomized controlled study was conducted involving 350 children (6 - 17 years) who were randomly allocated to 5 groups. Pain was assessed using the Visual Analog Scale (0 to 10 cm). Between-group differences were analyzed using the Chi-square test and the Kruskal-Wallis test and within-group differences were analyzed using the Wilcoxon test. Results: All anesthetics were effective in preventing pain (mean pain intensity .1.1) and no between-group differences were found (p > 0.05). Ease of venous access, vein visibility and/or palpability, successful cannulation, and the childfs cooperation were good and similar between groups (p > 0.05). Conclusion: The differences between topical anesthetics were only significant in the procedures required for their application and the costs, for which reason the use of ethyl chloride should be reconsidered

Effects of ethyl chloride spray on early recovery after total knee arthroplasty: A prospective study.

Ethyl chloride spray as a common cooling modality has been widely used in acute sports injuries and joint injection procedures. Several clinical studies reported that use of ethyl chloride has positive effects on swelling, pain reduction and recovery from sports injuries. The main aim of present study was to analyze whether postoperative use of ethyl chloride spray benefits results after primary total knee arthroplasty (TKA). Between April 1, 2014 and October 21, 2015, 306 subjects undergoing primary TKA used ethyl chloride spray for improving recovery from the damage from surgery. After exclusion of 31 subjects due to adverse events including periprosthetic joint infection (PJI), deep venous thrombosis (DVT), acute myocardial infarction, finally 275 subjects' data regarding pain score, knee range of motion (ROM), knee girth, time of being able to reach 90° knee flexion and analgesic consumption were analyzed. Significant differences in pain score, knee ROM at each time point and knee girth at on 21st and 28th postoperatively were detected without increased incidence of adverse events. Besides, time of being able to reach 90° knee flexion and analgesic consumption in the treatment group were significantly decreased in comparison to the control group. Use of ethyl chloride spray can help patients recovery from the damage from TKA safely.

Reducing Immunization Discomfort in 4- to 6-Year-Old Children: A Randomized Clinical Trial

The goal was to test a multifaceted distraction method designed to reduce injection-associated pain in school-aged children. A clinical trial evaluated 41 children, 4 to 6 years of age, who were given 3 standard prekindergarten immunizations; 21 were assigned randomly to an office routine control group, whereas 20 received a multifaceted, discomfort-reducing intervention. The intervention added verbal suggestions of diminished sensation and a visual focusing activity to the use of ethyl chloride, an established pain-reducing measure. The distraction materials used for the intervention consisted of topical ethyl chloride spray, an improvised, plastic, multipronged arm gripper, and a vibrating instrument descending on the contralateral arm, which provided the focusing task and visual distraction. According to patient and parent Faces Pain Scale-Revised scores and nonblinded, video-taped observations scored according to the face-legs-activity-crying-consolability method, the intervention group showed highly significant reductions in pain and discomfort, compared with the control group (patient self-report, P < .0013; parent report, P < .0002; observation score, P < .0001). This multifaceted distraction intervention reduced significantly the pain and discomfort of childhood immunizations in children 4 to 6 years of age.

Misidentification of ethyl chloride in the routine GC-FID analysis for alcohol

GC-FID is the method of choice for alcohol screening and quantitative analysis in modern forensic medical practice. Although specific enough for routine use, some results could be misleading. In the current article we present a case of sexual asphyxia with drug and volatile substance abuse. Toxicological analysis revealed the presence of methamphetamine at a concentration of 1.3 μ g/mL in blood. An ethanol-like peak was detected during our routine GC-FID test for alcohol (methylethylketone IS). Subsequent GC–MS analysis identified the peak as ethyl chloride. Levels of 0.05 mg/mL in blood and 0.01 mg/mL in urine were measured. Two facts proved misleading in our case. First: very small difference of 0.027 between the ethyl chloride and ethanol peaks in relative retention times at the GC-FID chromatograms. Second: missing evidence for the use of ethyl chloride at the scene—neither cans of the substance were found, nor such information was available otherwise. Conclusion: there is a substantial risk for mistaking ethyl chloride for ethanol, when ethyl chloride abuse is unanticipated. In the case of slightest uncertainty a GC–MS analysis should be employed to reliably determine the actual substance.

Anaesthesia for arterial puncture in the emergency department: a randomized trial of subcutaneous lidocaine, ethyl chloride or nothing

To determine whether the use of ethyl chloride and subcutaneous lidocaine are associated with a reduction in pain during arterial blood sampling compared with using no local anaesthesia. Patients over the age of 16 years and who required arterial blood sampling as part of their on-going emergency department management were randomly allocated to one of three groups. Group A received routine skin preparation before arterial puncture (AP); group B received 0.5 ml of 2% lidocaine 2 min before AP; and group C received ethyl chloride immediately before AP. Pain was measured using 100-mm visual analogue scale. Two urban emergency departments. Fifty-four patients were recruited. Those receiving lidocaine before AP had lower pain scores [10.2 mm, 95% confidence interval (CI): 4.8-16.3 mm] compared with the use of ethyl chloride (23.9 mm, 95% CI: 12.4-35.5 mm) and nothing (23.4 mm, 95% CI: 11.7-35.0 mm). Lidocaine was more painful to administer (22.0 mm, 95% CI: 10.9-33.7 mm) compared with ethyl chloride (12.9 mm, 95% CI: 5.5-20.3 mm). Ethyl chloride is not an effective local anaesthetic agent for AP. When the pain of local anaesthetic administration is taken into account the benefit of subcutaneous lidocaine for single AP is limited.

Ethyl Chloride as a Cryoanalgesic in Pediatrics for Venipuncture

Ethyl chloride can be used as a cryoanalgesic, but with the availability of alternative and relatively safer topical analgesics, its use has decreased. However, it still has the advantage of being quicker to apply compared with other topical analgesics, making it ideal for use in the outpatient departments. We wanted to compare the effectiveness of ethyl chloride as an analgesic during venipuncture in children. Venipuncture was carried out using either no analgesia (NO), ethyl chloride spray (EC), or application of the topical anesthetic Ametop (TA) on children attending the phlebotomy outpatient service by experienced pediatric phlebotomists. A pain score was recorded using either the Faces scoring system or the Faces, Legs, Activity, Cry Consolability scoring system. A total of 55 patients were included in the study, 18 from group EC, 18 from group TA, and 19 from group NO. Thirteen patients from both groups EC and TA and 17 from group NO scored 2 or less on the pain scores. The use of ethyl chloride was as effective as topical anesthetics in preventing distress to children in venipuncture. However, in the appropriate situations, the use of NO could also be comfortable to the child if venipuncture was done by specialist pediatric phlebotomists.

Topical ethyl chloride fine spray. Does it have any antimicrobial activity?

The aim of this study was to assess whether ethyl chloride fine spray (Cryogesic) has antimicrobial activity. Blood agar plates supplemented with 5% horse blood were inoculated with five different organisms, coagulase-negative staphylococci (CNS), methicillin-sensitive Staphylococcus aureus (MSSA), methicillin-resistant S. aureus (MRSA), Streptococcus pyogenes and Enterococcus faecalis. The plates were assessed for growth inhibition at 24 and 48 h by the microbiologist and compared with the non-sprayed control plates. The model showed a highly significant (p<0.0001) reduction in bacterial count for the plates treated with fine ethyl chloride spray. The estimate of the percentage of bacteria remaining after spraying with ethyl chloride was 42.7%, with a 95% confidence interval of 35.9-50.9%. There was no evidence that the effect of ethyl chloride fine spray was different for the different organisms (p=0.49). The use of ethyl chloride shows bacterial count reduction but the clinical implication of this needs to be determined. The authors postulate that any statistically significant reduction can only be helpful in reducing the infection rates. This coupled with the already proven local anaesthetic effects of ethyl chloride will make it an important tool for procedures like arthrocentesis and venepunctures.

A new device for spraying commercially available freon 114 (dichlorotetrafluoroethane).

With the introduction of the refrigeration technique in abrasive surgery it became obvious that there were some disadvantages in the use of ethyl chloride. Although it was efficient and inexpensive, it required a blower to hasten its evaporation; it was inherently toxic, and could be, at least on a theoretic scale, dangerous because of its toxicity and because of its flammability. Therefore, as soon as the operation became more commonly employed, there was immediate interest in a substitute refrigerant which would erase these objections. Freon 114 (dichlorotetrafluoroethane) was then introduced * and made available in metal canisters which were equipped with spraying valves. Dichlorotetrafluoroethane is a gas of relatively low pressure and moderate boiling point which can, when sprayed on the skin, freeze it into the degree of hardness which is essential to this new method of abrasive surgery. In the form in which it is made available it

Use of ethyl chloride in minor dermatologic surgery.

Because of a lack of necessary equipment, Dr. Irving Schonberg 1 first used ethyl chloride in the removal of servicemen's verrucae. For the past year we have adopted a modification of his method and extended its use to the removal of verrucae, keratoses, fibromas, nevi to which it was applicable, skin tags and other benign growths. Ethyl chloride is sprayed on the affected surgical site until a frost appears. The site develops a boardlike hardness, and then quickly small sharp scissors are employed to remove the surface of the lesion. On completion of this procedure the site of the growth attains its normal texture. Then curettage is employed when indicated, and the base of the lesion is lightly touched with 50 per cent trichloroacetic acid. The entire procedure takes about 15 seconds and is especially adaptable for children. Caution should be taken not to employ electrosurgical methods when ethyl chloride

The use of ethyl chloride as a local anæsthetic

the aims of this survey were: (a) to evaluate the need of information after childbirth and what questions do ‘new’ mothers ask themselves; (b) to assess why and how women use the Internet to meet their need of information; (c) to describe how the respondents evaluate the reliability of the information found; (d) to understand how the information found on the Internet affects women's decision-making; and (e) to appreciate how health professionals react to the information found by the women.this study used a large web-based survey that was widely broadcasted on various websites and social networks.belgian women who had a child under 2 years old and who agreed to participate were included in the study.349 questionnaires were valid for analyses. After childbirth, 90.5% of women admitted to using the Internet to seek information about themselves or about their baby, regardless of socioeconomic status or age. There were various reasons for seeking information on the Internet, but the most frequent reason the women expressed was to find information ‘on their own’ (88.1%). The most searched for topic was breastfeeding. The women believed that the information was quite useful (82.7%) but they assigned an average score of 5.3 out of 10 for the quality of the information they found on the Internet. Approximately 80% of the women felt that the Internet helped them control a decision that they made ‘a little’, ‘often’ or ‘very often’. Professionals are not always willing to talk about information found on the Internet with mothers. Therefore, many women believed that health professionals should suggest reliable Internet websites for new mothers.the integration of the Internet and new technologies could be a useful tool during postpartum management.