Clinical Questions - Recent Threads

RE: Low flow anaesthesia - is it worth it?

Arlo Guthrie — Thu, 19 Feb 2026 13:51:49 GMT

DanB Thanks, that's very interesting.

[quote userid="50456" url="~/f/clinical-discussions/32641/low-flow-anaesthesia---is-it-worth-it/179229#179229"]There's a very easy, almost comforting cynicism to be found in the small scale of our own efforts: fewer than 100 companies produce over 70% of all global emissions, so why are we recycling at home, or cyling to work, or lowering the fresh gas flow rates used for patients under anaesthesia? It's more a question of perspective at that point, and I personally don't think being unable to stop entire nations burning coal completely frees us from any duty of care to the environment we all have to live in.[/quote]

I agree up to a point! I mean clearly something is not worth doing if it has little impact. But impact might be measured in other ways than JUST emission reduction. For example, the more people who adopt low carbon behaviour, the more that people in positions of power are likely to, too.

But it does seem to me that the emissions from veterinary anaesthesia are a very, very, very small part of the equation, so to my mind, the question of whether it is worth upgrading equipment on the grounds of sustainability comes down to cost. Vet profession is already under fire about the costs, and the increasing unaffordability of veterinary care, so then one has to weigh up the sustainability benefits vs animal welfare.

[quote userid="50456" url="~/f/clinical-discussions/32641/low-flow-anaesthesia---is-it-worth-it/179229#179229"]Another issue with greenhouse emissions specific to anaesthesia is they have a disproportionate effect on warming the environment relative to their actual emission level, because of how effectively they absorb infrared radiation (the worst example was desflurane, which fell out of use for this exact reason). A study in 2019 compared anaesthesia hours at MAC level to driving a car, and found using isoflurane at 1.3% at 1L/min of oxygen is equivalent to driving 12 miles, so 2L/min is 24 miles and so on...[/quote]

Yes ... the figures i used to compare veterinary anaesthesia emissions with coal-fired power stations was CO2e (equivalent) which takes that into account.

[quote userid="50456" url="~/f/clinical-discussions/32641/low-flow-anaesthesia---is-it-worth-it/179229#179229"]Re: patient benefit - is it worth it? Yes, but in some ways that likely aren't immediately apparent. There isn't data on improved recovery times specific to low flow as far as I know (although hypothermia from high rates of fresh gas delivery is an issue, and hypothermia is a proven contributor to perioperative mortality generally). Higher flow rates ultimately deliver more volatile agent, whether the patient needs it or not, and there you have all the usual implications for cardiovascular depression, hypotension and tissue injury. If the patient isn't metabolising the volatile then they exhale it, quite possibly in the recovery kennel into the face of the staff member monitoring them if there wasn't sufficient time between turning off the vapouriser and disconnecting the patient from the circuit, so there's a human health argument as well.[/quote]

To my mind, THIS is really the most important factor.

I think that the profession has, over the last 20-30 years, advanced at a phenomenal rate, driven largely by the fact that vets and nurses are driven PRIMARILY by the desire to do the very best for the patient in front of them, and less by money.

The problem is that 'the best' has now become very expensive, and some might argue out of proportion to the species being treated.

So I come at this very much from the perspective of challenging the cost/benefit equation.

To me, its not enough to say simply say that something is clinically better. I think there needs to be evidence. And the evidence needs to show a benefit that justifies the cost.

in simple terms, you might say that capnography is a "good thing", and I would say: "erm, yes, but how many patients dying before capnography, and how many after, and does the cost justfy the benefit".

I am not saying I know either way ... you know far more than me!

Just arguing that as the cost of veterinary care has increased, I think everyone needs to be less driven by the idea of offering the very best that science can offer, and more by whether it is affordable and proportionate.

Am I being unreasonable??!!

Low flow anaesthesia - is it worth it?

Arlo Guthrie — Tue, 10 Feb 2026 10:11:25 GMT

I have a plan. Once a week, I'm going to try and post a question which challenges the prevailing veterinary orthodoxy. Not to criticise or judge, just to raise the question.

This week’s question was prompted by IVC Evidensia’s £500,000 investment into low-flow anaesthesia, framed largely around sustainability, and I'd be fascinated to hear what vet nurses think about this subject:

https://www.vetnurse.co.uk/b/veterinary-nursing-news/posts/ivc-evidensia-invests-500-000-to-support-adoption-of-more-sustainable-low-flow-anaesthesia

The announcement very much led on sustainability. I dug a little deeper and discovered that UK veterinary anaesthesia emissions are estimated at under 100,000 tonnes of CO₂ equivalent per year. A single medium-sized coal-fired power station emits several million tonnes annually. One plant. Millions.

Even allowing for hundreds of such plants globally, veterinary anaesthesia is — in planetary terms — a very small contributor.

Which brings me to the question: is low-flow worth it?

People talk about smoother recoveries, reduced hypothermia, better airway humidity, lower volatile use. But is there hard data showing meaningful patient benefit? I can’t see evidence of improved survival rates, and mortality under modern anaesthesia is already low.

So the practical questions are:

How much more does low-flow cost once you factor in monitoring, consumables and training?

Does it actually shorten recovery in a way that changes discharge timing or cost to the owner?

Is there a clear per-case cost-benefit analysis?

I’m not taking a position. I’m simply asking whether the numbers stack up — clinically and economically — not just environmentally, and I'm really interested to hear what veterinary nurses' take on it is.

RE: Low flow anaesthesia - is it worth it?

DanB — Thu, 12 Feb 2026 17:19:49 GMT

I think these are really 2 different questions, possibly 3 if you include the effort to reduce overhead costs. Coming from a referral anaesthesia background and having taught low-flow techniques to various levels of practice, it's not completely cut and dry.

Re: sustainability - is it worth it? Yes, in the sense that where we have some ability to minimise our impact on the environment we have an ethical responsibility to exercise it, and not being in charge of the operation of coal-fired power stations, we can find other ways to reduce our contribution to climate change.

There's a very easy, almost comforting cynicism to be found in the small scale of our own efforts: fewer than 100 companies produce over 70% of all global emissions, so why are we recycling at home, or cyling to work, or lowering the fresh gas flow rates used for patients under anaesthesia? It's more a question of perspective at that point, and I personally don't think being unable to stop entire nations burning coal completely frees us from any duty of care to the environment we all have to live in.

Another issue with greenhouse emissions specific to anaesthesia is they have a disproportionate effect on warming the environment relative to their actual emission level, because of how effectively they absorb infrared radiation (the worst example was desflurane, which fell out of use for this exact reason). A study in 2019 compared anaesthesia hours at MAC level to driving a car, and found using isoflurane at 1.3% at 1L/min of oxygen is equivalent to driving 12 miles, so 2L/min is 24 miles and so on...

Re: costs to practice - is it worth it? Maybe, in that volatile agents and oxygen are expensive. Isoflurane at 2% using 2L/min of oxygen costs about 25p/hr, but sevoflurane at 2% and 2L/min costs over £4/hr (human hospitals get sevo far cheaper, but that's a separate issue!) so multiply to some of the standardised O2 rates used in practice, with the old excessive circuit factors, especially for non-rebreathing circuits, and it soon adds up. Does it offset the cost in training or purchasing equipment like capnography? It's possible it doesn't when things are all added up.

Re: patient benefit - is it worth it? Yes, but in some ways that likely aren't immediately apparent. There isn't data on improved recovery times specific to low flow as far as I know (although hypothermia from high rates of fresh gas delivery is an issue, and hypothermia is a proven contributor to perioperative mortality generally). Higher flow rates ultimately deliver more volatile agent, whether the patient needs it or not, and there you have all the usual implications for cardiovascular depression, hypotension and tissue injury. If the patient isn't metabolising the volatile then they exhale it, quite possibly in the recovery kennel into the face of the staff member monitoring them if there wasn't sufficient time between turning off the vapouriser and disconnecting the patient from the circuit, so there's a human health argument as well.

I'd also argue there's an indirect patient benefit in that low flow can't (safely) be done without capnography, and if it takes a corporate sustainability campaign to get capnography into practices that didn't have it before, then anaesthesia safety overall will only improve.

So it might depend on how you look at it. I think there are more benefits than drawbacks, whether it ultimately saves the planet or not.

RE: Low flow anaesthesia - is it worth it?

Arlo Guthrie — Wed, 11 Feb 2026 19:51:17 GMT

Selena Carnell - interesting. I presume you've done a fair amount of monitoring in your time, interested to know what opportunity you've had to compare. Also, for a layman idiot like me, what does this mean:

[quote userid="2368" url="~/f/clinical-discussions/32641/low-flow-anaesthesia---is-it-worth-it/179227#179227"]but most of the nurses i work with tend to whack up the oxygen.[/quote]

I know you mean that they turn up the 02, but why and what is the consequence of that?

RE: Low flow anaesthesia - is it worth it?

Selena Carnell — Tue, 10 Feb 2026 21:28:31 GMT

Personally i haven't seen any benefit in low flow towards quicker recovery times.

It does reduce the amount of Isoflurane used, but most of the nurses i work with tend to whack up the oxygen.

RE: Happy Christmas everyone

Arlo Guthrie — Tue, 30 Dec 2025 12:17:29 GMT

Selena Carnell, Margaret Fry and Bantambec, thank you and a very happy new year to you all!

Happy Christmas everyone

Arlo Guthrie — Tue, 23 Dec 2025 13:53:37 GMT

And a happy new year!

RE: Happy Christmas everyone

Bantambec — Mon, 29 Dec 2025 19:29:54 GMT

Hope you had a good christmas everbody! Happy new year when it gets here!

RE: Happy Christmas everyone

Margaret Fry — Mon, 29 Dec 2025 16:35:26 GMT

Happy belated Christmas ..wishing you a Happy New year!

RE: Happy Christmas everyone

Selena Carnell — Sun, 28 Dec 2025 12:37:25 GMT

happy Christmas and new year to you and your family.

Are you worried about IV complications? Which tape to use? How to bandage? Here's a chance to discuss....

Georgie Hollis — Tue, 18 Nov 2025 20:55:41 GMT

The next bandaging angels clinical club is up tomorrow 19th of November at 12:30. It's live and free and if you have burning questions and controversies in practice please make the time to join us live. We will explore the common problems and the science of bandaging to see if you're achieving the best results. This will be a session led by you. You need to be in it to win it!

If you're not already registered to watch the Bandaging Angels Clinical Club you can do so here: https://form.jotform.com/Georgieiwc/bandaging-angels-clinical-club-regi

Would you like to learn about the applications of negative pressure wound therapy in practice?

Georgie Hollis — Sun, 02 Nov 2025 20:38:51 GMT

Free webinar, the first of a series on the practical applications of NPWT in the referral and hospital setting.

This is an incredibly helpful tool to aid wound bed preparation and actively improve rates of healing while reducing interventions required to get to a surgically viable closure.

This series is provided by Aluco Health - a company committed to innovations for animal health and welfare first solutions for better care.

Visit www.alucohealth.com for more information on NPWT and the philosophy behind it.

Vetasept Chlorhex Spray alternative??

Calli D — Wed, 30 Jul 2025 09:50:57 GMT

Hello all - after some advice and/or what you use in practice for skin prep for sampling/Iv's etc.

Up until now we have been using Vetasept Chlorhex Spray as final application skin prep for sampling, iv's and surgical procedures but now it is no longer available. Searches for an alternative are proving fruitless and NVS say there is nothing and won't be.

What are people using?

Thank you

RE: Vetasept Chlorhex Spray alternative??

Alice Weaver — Wed, 22 Oct 2025 15:53:01 GMT

Hi Georgie- I haven’t been able to find a non-scrub chx product anywhere for a while. Do you know of any brands that I could search? I probably won’t be able to order it in due to restrictions by my employer, but I can try! Thanks

RE: Help with disinfectant

Sasha Irwin — Tue, 16 Sep 2025 16:00:35 GMT

We use Anigene High Level Disinfectant in a spray bottle diluted 10ml in 490ml water and have no issues with our mats on table tops.

Help with disinfectant

PJ Zurawel — Tue, 02 Sep 2025 14:54:41 GMT

We are finding that our disinfectant that we are using is very abrasive especially on the rubber mats that we have on the tables. We have triple checked the dilution rates but this has not made any difference.

Can anyone recommend a disinfectant that is a bit kinder to the rubber surfaces??

RE: Help with disinfectant

zoe north — Wed, 03 Sep 2025 15:35:11 GMT

What brand are you currently using?

RE: Can you recommend a company that gives in house CPR training?

Heather Newton — Tue, 05 Aug 2025 10:56:10 GMT

I could recommend ‘the vintage RVN’ enough if she is able to come to you- I have personally worked with Kath and she is a fantastic nurse and teacher. She is a RECOVER rescue teacher and I am now RECOVER rescue certified in basic and advanced life support from completing CPD that she delivered. I couldn’t recommend the course enough and Kath to deliver it, I am now completely confident in CPR.

Can you recommend a company that gives in house CPR training?

lskm 23 — Fri, 25 Jul 2025 07:08:37 GMT

We are looking for in house training for CPR and wondered if you lovely people could recommend a company? I have contacted Vet Med CPR and also Synergy CPD but my boss would like to see dhat rlse is available.

Thank you in advance

RE: Vetasept Chlorhex Spray alternative??

Waterfalls — Mon, 04 Aug 2025 17:37:48 GMT

I spoke to pioneer today. They said it is manufacturing problem and will be back. No date atm though.

RE: Vetasept Chlorhex Spray alternative??

Georgie Hollis — Sun, 03 Aug 2025 20:10:27 GMT

Probably should have said that the NON-scrub version at 5% is mixed with 70% isopropyl alcohol at 1:10 dilution is the recipe to create your own skin prep solution. I believe!!!

RE: Vetasept Chlorhex Spray alternative??

Kirsty Clark — Wed, 30 Jul 2025 12:13:01 GMT

We use chloraprep - they come in different sizes so are very useful from IV prep up to large ones for surgical prep.

RE: Vetasept Chlorhex Spray alternative??

Carolyn Edwards — Wed, 30 Jul 2025 11:07:01 GMT

We just use alcohol wipes for IVs amd blood sampling (https://www.imseuro.co.uk/alcohol-swabs). I prefer to wipe with chlorhex then wipe with an alcohol swab for IVs, or if the patient is particularly dirty. For surgical sites, we use ChloraPrep as our final prep. We get them from Invicta (http://www.invictavet.com/chloraprep.html), who will provide free on-site CPD.

RE: Vetasept Chlorhex Spray alternative??

Calli D — Wed, 30 Jul 2025 10:39:36 GMT

Thank you, we shall look into that

RE: Vetasept Chlorhex Spray alternative??

Georgie Hollis — Wed, 30 Jul 2025 10:08:25 GMT

This is a really challenging area as these products are hard to market legally for vet use due to biocide regulations. Which is why they tend to get discontinued or disappear.... it's complicated!! BUT.... there are some around....

Try Duggans! .....https://dvs-group.paperturn-view.com/hygiene-brochure-2024?pid=ODg8848117&v=5

Iodosept might be a good alternative if you can't find CHX version?