Propofol...

Re: Propofol...

Laura Harvey — Wed, 03 Jun 2009 19:13:29 GMT

Hi, When working in NZ, we used Alfaxan all the time for cats...find it gives much smoother induction and recovery than propofol. We would keep using a bottle until it was all finished...sometimes for up to a week, and never had any problems...just need to be sterile with your technique when you broach the bottle.

Re: Propofol...

Gillian Mostyn — Wed, 20 May 2009 13:24:21 GMT

Everything? Why?

Re: Propofol...

Mrs Dot Dot — Wed, 20 May 2009 09:47:50 GMT

[quote user="SaskiaVN"]

I am with Nick on this one too. What is the point in leaving it to the owners to decide? Thats why vets are vets and nurses are nurses!! oh, and clients will always be clients

[/quote]

At the end of the day, alot comes down to cost to the client, regardless of how we feel about it, and how much we want to provide the best service etc etc, and IVFT add extra cost to a bill........ and that is why we offer it to the clients, to give them the choice.

All our clients get a pre-op form sent out to them with some information about intra-op IVFT and also info and a leaflet about the pre-anaesthetic blood screen a few days before their op, so that the choice is not 'dumped' on them while admitting their animal... and if they have any questions then they can speak to someone about it before.

We also say at time of admit that we will give IVFT if needed, but if the Owners opt not to have them then routinely we won't give them. In the perfect world, in my eyes, everything would have IVFT and pre-g/a bld tests but......................................

Re: Propofol...

Saskia Quinn — Tue, 19 May 2009 23:38:18 GMT

I am with Nick on this one too. What is the point in leaving it to the owners to decide? Thats why vets are vets and nurses are nurses!! oh, and clients will always be clients

Re: Propofol...

Juliet Drummond DAVN (med) RVN D32/33 — Tue, 19 May 2009 22:36:42 GMT

i agree completely with nick,

i had written a lengthy response, but my pc had a wobbly

the discussion you have with the client on admittance of their animal, should be tailored to the individual patient requirements.

Re: Propofol...

Nick Shackleton — Tue, 19 May 2009 21:31:21 GMT

Forgive me, but I remember being told that every anaesthetic and it should be tailored to each patients needs. I feel IV fluids should not be up to owneres as well as bloods. If a vet deems them necessary they should be given/done and not left down to the owners.

Re: Propofol...

Cat Woman — Tue, 19 May 2009 21:05:24 GMT

[quote user="Nick Shackleton"]At the end of the day its a drug and it should be the vets choice [/quote]

I agree. Surely the "best" anaesthetic for the animal would be one which the vet feels confident & competant about using & not just to use something new cos they have been told it is "better".

Re: Propofol...

Nick Shackleton — Tue, 19 May 2009 19:36:31 GMT

At the end of the day its a drug and it should be the vets choice as to when it is used and not down to the owners to make the decission!

Re: Propofol...

Jack — Tue, 19 May 2009 19:08:49 GMT

I have to agree with Juliet.

My boss insists that we use rapinovet and Isoba rather than any other, it is more expensive at list price, but the discounts/deal he gets from the supplier means it actually works out cheaper than Abbotts price.

Re: Propofol...

Juliet Drummond DAVN (med) RVN D32/33 — Fri, 15 May 2009 07:27:45 GMT

hi all, though i'd add my 2p worth,

having worked with experience anaesthetists in the past, the principle's i maintain with regards to anaesthetic drug choice is,

there is no such thing as a 'routine' anaesthetic.

there are no 'safer' drugs, the safest option is to use what you are familiar with, many problems can occur when you use a new drug, that you are unfamiliar with.

i'm not suggesting that you should not try new drugs, but you need to consider the risks, and research the drug, not just use it because the drug rep says it is the 'gold standard'.

if you decide you use a new drug (one that you have not used before- i mean). select your patient carefully, preferabily young (not neonates or peadiatrics), healthy patients for short procedures.

if you are conderned re costs v's usage, then you need to calculate the average cost of the drugs you use, for some that use lots of propofol the cost per patient will be minimal, but if you have you open a 20ml bottle of propofol, and use only 6mls between 2 cats, then obviously your costs are higher (though still only about £1.75 per cat). not a problem if the anaesthetic is charged separately from the procedure, but is a big factor in your pricing for the competative neutering market.

also have a look at how much your triple combination is actually costing, you may be surprised.

juliet

Re: Propofol...

Freckle — Fri, 15 May 2009 00:02:38 GMT

i used to work at a practice, which had iso as standard, but on the consent form, we had to ask the client if they would prefer sevo for an extra £5! we were made to do this on every consent form for a GA (including cats) which made me uncomfortable, as I am sure that sevo is contraindicated in some GA's, ie caesars?

don't get me wrong, i think sevo is fab, but i also think that some vets people just see it as 'safe for everything' when it isn't!

Re: Propofol...

Gillian Mostyn — Thu, 14 May 2009 22:00:09 GMT

I'm not denying it sounds like an excellent product, but as we know drugs aren't always the same when being used in people as in animals. And in these days of litigation, going off-license is unfortunately a brave step. Would love to see it in use one day - never seen it used yet.

Re: Propofol...

Fiona Leathers — Thu, 14 May 2009 21:53:55 GMT

Well I would go with what I would be happy to use in my own cat and I would rather use Sevo than anything else. If its good enough to use on human babies........

Re: Propofol...

Gillian Mostyn — Thu, 14 May 2009 21:50:59 GMT

[quote user="Bouncyfi"] go with a anaesthetic agent which is obviously better for the patient[/quote]

Sorry to be a pedant but if it isn't licensed, that isn't yet proven.......

Re: Propofol...

Fiona Leathers — Thu, 14 May 2009 21:26:35 GMT

I think the optimum word is "yet". Abbott certainly tell you when you take sevo on thats its not licensed so its down to the vet to decide to follow the cascade or go with a anaesthetic agent which is obviously better for the patient, but not yet licensed.

Re: Propofol...

Claire Cameron — Thu, 14 May 2009 21:15:59 GMT

[quote user="Kimbo1985"]

We have both iso and sevo at our practice and the vets had a meeting with a rep the other day and got told that sevo isn't actually licensed in cats!

[/quote]

Yeah I heard that, only licensed in dogs. Not sure how that works with the cascade?

Re: Propofol...

Kim Buckley — Thu, 14 May 2009 19:30:04 GMT

We have both iso and sevo at our practice and the vets had a meeting with a rep the other day and got told that sevo isn't actually licensed in cats!

Re: Propofol...

Claire Cameron — Wed, 13 May 2009 21:19:57 GMT

[quote user="Gillian Mostyn"]

With Dunlops the cheapest seems to be propoflo - £17.50 for 5 x 20ml bottles, so £3.50 each. However, if you want to keep stock to a minimum (relevant if the op list is small at the moment) you can buy single bottles of vetofol for £3.61.

It is always worth approaching the companies and reps with a new business to get good deals - they want the long-term loyalty so may give you cheaper deals when you start. Some examples that we secured were:

Dunlops gave us 6 months without a bill, interest free. Although we then received a fairly large bill, our income had improved dramatically by then - it is the first few months when turnover is very low so cash flow is difficult. It also allows you to stock the place properly without worrying - some things you just HAVE to have 'just in case' but won't necessarily use (sell) for quite some time.

Intervet gave us free vaccines for 6 months.

Norbrook gave us a lot of their drugs FOC - a bottle of everything they did etc.

Even companies like Rogz (collars and leads) will often give you a few collars and leads to have on display.

Hope the new practice is going well - I still remember the rigid fear! I remember we had one day when I made the grand total of £3.58 - I sold a worming tablet! Cashing up wasn't fun that night. But things build really quickly - now I pray for quiet days to get some paperwork done! Good luck.

[/quote]

Thanks Gillian. New practice is great thanks. Clients are coming slowly but surely! We're kept busy with all sorts of admin, marketing etc to do so keeping me outta mischief

Thanks again everyone x

Re: Propofol...

Fiona Leathers — Wed, 13 May 2009 14:59:59 GMT

No we use ACP & buprenorphine pre-med & then o2 & sevo - they are maintained on 2-2.5% depending on the case obviously - we've also just got a pulse ox & I think this is making it easier to monitor the anaesthesia, more or less see whats going on all the time instead of just every 5 minutes or so.

But we are only a small practice so maybe you're using so much more cos you're doing more ops??? Definitely using less sevo than iso though!

Re: Propofol...

Gillian Mostyn — Wed, 13 May 2009 12:27:43 GMT

Intervet gave us free vaccines for 6 months.

Norbrook gave us a lot of their drugs FOC - a bottle of everything they did etc.

Even companies like Rogz (collars and leads) will often give you a few collars and leads to have on display.

Re: Propofol...

Sandra Taylor RVN, MBVNA — Wed, 13 May 2009 12:24:21 GMT

Hi fi, you are running it on a lower%... dont you mean a higher %........ mind you I suppose it depends what you are using for pre meds as that should keep your % down to a minimum.

Re: Propofol...

S-J — Wed, 13 May 2009 10:53:37 GMT

a bottle a week blimey, we are on 2 a day, is there any particular reason u use so little, do u give something else that keeps them anaethatised, just curious

Re: Propofol...

Fiona Leathers — Wed, 13 May 2009 09:10:43 GMT

Yes it is expensive but we've had it 3 weeks & its great, seem to be using less of it as well, because its running on lower %, still on our first bottle, whereas with iso we use about a bottle a week. Animals seem to be much more settled on it and the difference when you turn them up is almost instant! God I'm starting to sound like a rep!! And if we get cheaper propofol then we'll be saving that way too. We charge it to the client as a per minute use & we've not noticed the price being drastically different.

Re: Propofol...

Katy — Wed, 13 May 2009 09:09:32 GMT

We use Vetofol too. And we tend to use the triple on cats or dom/ket depending on the vet.

If it's a longer op and the cat has had a premed, then we would use propofol.

I think that Alfaxan sounds quite interesting. Have you had any problems with it?

Re: Propofol...

Nicki Fern — Wed, 13 May 2009 09:02:33 GMT

Hey yes we have the exact same problem too! We have just started to use Alfaxan. Although it is considerably more expensive per bottle and it does not have a license in this country to be stored it does havea license in Australia to be stored when broached for up to 7 days in the fridge! (Exact same product) They have been using it in Australia for many years so I was happy to hear that thay have tested it out for us! The Vetoquinol reps are hapy to come and talk about it and let you trial it! Hope that helps.