Cardiac arrhythmias. II
BMJ (Clinical Research Edition)
511 out and he remained worried for about seven minutes after the gas was withdrawn. He then made a rapid and complete recovery, and though he said that he had felt no pain he did not wish to have the gas again. Two patients hyperventilated during inhalation and developed generalized muscle rigidity which, however, did not progress into a tetanic state. They made an uneventful recovery after the administration had finished. It was thought that this was a psychological effect of being asked to
... hale from a mask. Only 13 (60o) patients did not use the apparatus properly. This was due to the fact either that they did not hold the mask tightly enough to their face to obtain an airtight fit (six patients) or that they did not breathe deeply enough to trip the tilting demand valve (seven patients), which requires a negative pressure of -1 cm/H2O. The latter group were all afraid to breathe deeply because of pain, and might have benefited from Entonox delivered from a continuous flow device in the manner described by Keane.20 Entonox administered in this way must be supervised by a competent doctor, because the inherent safe principles of self-administration with the demand apparatus are then lost. A few patients complained of the smell of the black antistatic mask which is provided as standard equipment with the apparatus. They found the optional Perspex mask with the latex rubber cuff much more acceptable. Conclusion The results of the trial have convinced us that Entonox is safe in the hands of some non-medical personnel such as Stateregistered nurses and chartered physiotherapists, provided that they are carefully trained and the principle of selfadministration is rigidly adhered to. Obviously the gas is not the panacea for all pains, in all people, at all times, but a large proportion of patients gets substantial relief with almost complete freedom from undesirable side effects in circumstances where hitherto often no analgesia was attempted. In recent years there has been a great deal of attention paid to patient safety-and rightly so. It is, however, also vital that we should look to our resources in providing patient comfort and, within rigid and stringent safety limits, utilize these resources to the full. The patient's feelings regarding his stay in hospital are often highly coloured by painful incidents, many of which can be simply ameliorated. We would like to thank our medical, nursing, and physiotherapy colleagues at the Royal Infirmary and Frenchay Hospital, Bristol, for their kind and helpful co-operation during this trial. Thanks are also due to Miss Judy Pile for help in producing the manuscript.