Sevoflurane in Cats

Re: Sevoflurane in Cats

Michael Woodhouse — Sat, 29 Sep 2012 13:47:53 GMT

And it costs more than 8 times as much and you need a higher setting on the vaporiser.

At less than £20/250ml the cost of iso in an operation is insignificant, not so with sevo.

Re: Sevoflurane in Cats

Clive Ansell — Sat, 29 Sep 2012 07:03:25 GMT

[quote user="Mark Hedberg"]

I see your point, Clive - on the other hand, is it doing any harm? (ok, maybe that's not a supremely scientific question.)

[/quote]

Probably not, but is there a good evidence based clinical argument for using Sevoflurane off label in cats when a safe and effective licensed alternative exists.

Re: Sevoflurane in Cats

Ian Mostyn — Fri, 28 Sep 2012 15:42:53 GMT

[quote user="robloxley"]Maybe because Abbott would effectively swap your iso vaporiser for a sevo one, so once you've moved you're pretty tied in, unless you bought a separate sevo vaporiser yourself (or equally had a spare iso one)?

[/quote]

We had some old vapourizers that were no longer needed so I have both iso and sevo vapourizers. We decided to have all sevo at one site as it was going to cause complications / damage by swapping over. Our other site doesn't do much exotics work so is just iso. We did think about being half-and-half but didn't want to risk dropping a vapourizer or swapping over mid-op by mistake when we go from prep room to op room.

Ian

Re: Sevoflurane in Cats

Mark Hedberg — Fri, 28 Sep 2012 08:47:17 GMT

I see your point, Clive - on the other hand, is it doing any harm? (ok, maybe that's not a supremely scientific question.)

Re: Sevoflurane in Cats

Clive Ansell — Thu, 27 Sep 2012 16:30:47 GMT

Why not have both? most of the practices I work in, even some of the one man shows, have more than one anaesthetic machine. Therefore using both Sevo and Iso is possible.

I am still not convinced there is a valid case for using Sevo off label in healthy, or even in unhealthy, cats? I can see I am in a minority as 80% of those polled either do use it or would do if they had it.

Does anyone have both Iso and Sevo?

Re: Sevoflurane in Cats

Rob Loxley — Thu, 27 Sep 2012 16:03:07 GMT

[quote user="Clive Ansell"]I am surprised so many use it off licence when a perfectly effective and safe licenced alternative exists[/quote]

Maybe because Abbott would effectively swap your iso vaporiser for a sevo one, so once you've moved you're pretty tied in, unless you bought a separate sevo vaporiser yourself (or equally had a spare iso one)?

Re: Sevoflurane in Cats

Mike Martin — Thu, 27 Sep 2012 09:22:40 GMT

So of those of you using sevo (off label) in cats.....do you get the owner to sign a a form highlighting the fact that the anaesthetic is off label?

Just curious.

Re: Sevoflurane in Cats

Elizabeth Tuley — Wed, 26 Sep 2012 14:14:48 GMT

We used to have sevo, but due to cost we now just have iso. Haven't noticed any differences in cats/dogs, but I think the bunnies have a smoother GA and better recovery with sevo.

Re: Sevoflurane in Cats

Clive Ansell — Wed, 26 Sep 2012 12:18:02 GMT

[quote user="James Laidlaw"]

[quote user="Clive Ansell"]

I've used it and can't say I've noticed a great difference from Isofluorane in cats and dogs.

It is not licenced for use in cats, so why would anyone choose to use it instead of Iso. Unless a good evidence supported clinical argument can be put forward, its use is not legal and blatantly flouts cascade regs. I'm amazed that 40% of those who have voted use it in cats.

[/quote]

Sorry, might just be having a brain meltdown, but you say you have used it and then that you're amazed people have used it in cats? Did you use it for a specific case, or just surprised so many have gone off cascade?

[/quote]

I use Isofluorane in one of my regular practices, it is all they have so have to use it. I can't say I notice a huge difference from Isofluorane, other than slightly faster recoveries which is not always an advantage anyway. It certain seems quicker for gassing down small furries though with faster recoveries I have to admit.

I am surprised so many use it off licence when a perfectly effective and safe licenced alternative exists. Is it significantly better and safer that Isofluorane ?

Almost all of my routine cat neuters get dom/ket/vetergesic, speys are intubated, and most only need o2 with no inhalation agent at all. One of my practices uses Alfaxan, and again many just need o2, with just a few needing iso/sevo towards the end of the procedure.

Re: Sevoflurane in Cats

Noweia — Tue, 25 Sep 2012 21:16:55 GMT

We just have sevo, no iso, and have never had any problems!

Re: Sevoflurane in Cats

Rajat — Tue, 25 Sep 2012 18:48:55 GMT

[quote user="Michael Woodhouse"]occasionally used it on old, sick cats for quick procedures [/quote]

this really isn't an indication for Sevo IMHO. It will give you the same issues as Iso and a good vet-nurse team will titrate the GA so the patient is awake within a minute of the vet finishing if that is the aim. There is no major safety advantage to a patient being awake a minute sooner- IMHO the real problems are going to persist in many cases after the patient has woken up(hypoventilation hypotension hypoxemia etc etc)

Re: Sevoflurane in Cats

Michael Woodhouse — Tue, 25 Sep 2012 17:51:16 GMT

[quote user="Clive Ansell"]It is not licenced for use in cats, so why would anyone choose to use it instead of Iso. Unless a good evidence supported clinical argument can be put forward, its use is not legal and blatantly flouts cascade regs. I'm amazed that 40% of those who have voted use it in cats.[/quote]

Another poll limitation - if a practice had both Iso and Sevo and occasionally used it on old, sick cats for quick procedures then they would have to tick the top box, even if they used Iso as a routine.

I can see you may be on dodgy ground getting your VMD inspection and not having a licensed inhalational agent or suitable vaporiser for cats, but I am totally supportive of its use in specific cases. I can't see any advantage in the vast majority of cases and with a higher MAC and much higher cost I can't see any justification for changing.

Re: Sevoflurane in Cats

Rob Loxley — Tue, 25 Sep 2012 17:22:06 GMT

I'm not convinced for our caseload (cats and dogs, occasional rabbit) that the cost is justified clinically. If you want the VDS perspective, John Hird is your man, and from the talk he gave, he seemed to feel you could make a clinical argument.

Anywho, it seems the demand is there and people are prepared to pay the extra cost, so it's high time Abbott got it licensed

Re: Sevoflurane in Cats

James Laidlaw — Tue, 25 Sep 2012 16:44:47 GMT

[quote user="Clive Ansell"]

I've used it and can't say I've noticed a great difference from Isofluorane in cats and dogs.

[/quote]

Re: Sevoflurane in Cats

Rajat — Tue, 25 Sep 2012 15:19:54 GMT

[quote user="Clive Ansell"]Had it been very different and she wanted to pursue a claim for negligence would I have been able to justify using an unlicensed product when a perfectly safe licensed one exists. Would colleagues, the courts, the VDS and the RCVS have backed me?[/quote]

Yes- you can justify it- there is safety data out there, and enough literature to support you that it has been proven to be safe.I am sure your colleagues peers and specialist anaesthetists would back you.

The courts VDS and RCVS? Who the hell knows. Given the licensing laws it would not be surprising if at least one of those didn't!

Re: Sevoflurane in Cats

Hannah Wynne Richards — Tue, 25 Sep 2012 15:16:34 GMT

This is again 1 of the very few occasions when I think I'm clinically justified in going against the cascade -2 in short succession now I like the fact that they wake up quicker and as my RVN is (metaphorically ) chained to the patient whilst it's under, the increased sensitivity is an advantage Not a drug to use unless you 100% trust your anaesthetist though Anyway I'm a coward and my nurse would kill me if I went back to iso The rep lent us a vapouriser to try-and at the end of the trial my nurse said "You're buying it or it will be over YOUR dead body"-or words to that effect

Only thing I would say is that you need a very heavy pre-med with ferrets-or it becomes a bit too responsive

Wynne

Re: Sevoflurane in Cats

Mark Hedberg — Tue, 25 Sep 2012 14:55:44 GMT

Clinical judgement, I expect. To clarify my answer, I generally reserved sevo for high-risk patients who I wanted under for as short a time as possible.

Re: Sevoflurane in Cats

Clive Ansell — Tue, 25 Sep 2012 14:23:11 GMT

I've used it and can't say I've noticed a great difference from Isofluorane in cats and dogs.

The only anaesthetic related death I have had in a young outwardly healthy cat was being maintained on sevo/02 (cause unknown and may or maynot be related to sevo use). Fortunately the lady owner was a decent, understanding and sensible client who accepted that it was a one off unexplainable event and no one was at fault. Had it been very different and she wanted to pursue a claim for negligence would I have been able to justify using an unlicensed product when a perfectly safe licensed one exists. Would colleagues, the courts, the VDS and the RCVS have backed me?

Re: Sevoflurane in Cats

Martin Atkinson — Tue, 25 Sep 2012 12:55:35 GMT

[quote user="Rajat"]I saw a bunny die while under it- not sevo's fault but they were trialling Sevo in the practice, the rabbit was light, the nurse turned it up to 4% for 'a bit' and lo and behold the bunny died within a minute or two.[/quote] I think that may have just answered my previous question!

Re: Sevoflurane in Cats

Rajat — Tue, 25 Sep 2012 12:49:12 GMT

Hi All

I can certainly see the advantages in birds and small furries. I was speaking primarily about cats and dogs as 90% at least if not more of our caseload is cats and dogs. In them, there is really no advantage to Sevo as far as I know other than quicker GA depth changes in response to changes of the dial.

I have been a bit put off Sevo- not because of its inherent aroperties but because as a student I saw a bunny die while under it- not sevo's fault but they were trialling Sevo in the practice, the rabbit was light, the nurse turned it up to 4% for 'a bit' and lo and behold the bunny died within a minute or two. In large busy practiuces used to Iso- like ours- I think one gas is safest unless only certain trained people are allowed to use it- in smaller practices or those where lots of small furry work is being done ( ) I think Sevo would be my first choice.

Re: Sevoflurane in Cats

Martin Atkinson — Tue, 25 Sep 2012 12:37:27 GMT

[quote user="Mark Rowland"]IMO its the small furries and sick birds that benefit the most. [/quote] I castrated a bunny this morning which was bit up and down on the Iso, Normally I have induced a nice plane of anaesthesia with sedation with triple combo before I intubate so the Iso just maintains the plane but this one was up and down on the vapouriser setting. Sevo supposedly has the advantage of being able to change the plane more rapidly than Iso but is there also a risk of them going more rapidly apnoeic if you're not careful?

Re: Sevoflurane in Cats

David Mills — Tue, 25 Sep 2012 12:12:04 GMT

[quote user="Rajat"]

Personally I cannot see the advantage of Sevo over Iso given the price difference- if the price was the same I may use it, but given our familiarity with Iso I am tempted to stick to it.

At vet school (RVC) they used everything! they had halothane iso sevo and desflurane.Used whichever was felt to be appropriate. I think they had halothane so we could get used to it because t was still being used although infrequently in private practice.

[/quote]

Same position as this. Sevo does have the distinct advantage of rapid change of depth of anaesthesia (ie 10-15s) as opposed to 90-120s for iso but a well-managed GA shouldn't need such a quick change in most cases, and shouldn't rest on how quickly you can change depth of GA. The Abbot (?) graphs about tailoring the depth of GA every few seconds to ensure optimal depth without overdosing is a pipe dream in most busy general practice. It's been used in cats extensively in the places where I've worked

As an aside, those 2-3 minutes at the end of an op are useful for cleaning off the blood. Additionally, it is doubtful that we want animals to wake up quickly and suddenly - a gradual waking up is often more desribale

Re: Sevoflurane in Cats

Lorna McHardy — Tue, 25 Sep 2012 11:53:56 GMT

[quote user="Mark Rowland"]

IMO its the small furries and sick birds that benefit the most.

[/quote]

Note to self: read all posts before responding :0)

Re: Sevoflurane in Cats

Lorna McHardy — Tue, 25 Sep 2012 11:52:41 GMT

[quote user="Rajat"]

Personally I cannot see the advantage of Sevo over Iso given the price difference- if the price was the same I may use it, but given our familiarity with Iso I am tempted to stick to it.

[/quote]

I gather it's a lot better in small furries and birds in particular; can't say I notice much of a difference myself but then, I don't GA that many of them. Sevo does take some getting used to. It's a bit like the difference between an electric cooker and a gas one... both equally effective but you do need to adjust how you twiddle the controls! Being now used to both, I can't see much to choose in one over the other in purely practical terms.

[quote user="Rajat"]

At vet school (RVC) they used everything! they had halothane iso sevo and desflurane.Used whichever was felt to be appropriate. I think they had halothane so we could get used to it because it was still being used although infrequently in private practice.

[/quote]

That makes sense :0) I suppose what I meant was, do they use sevo in cats, and if so, why, given that they do have a choice. Most practices decide on one or the other and therefore don't have a case by case choice of gaseous options.

Re: Sevoflurane in Cats

Ian Mostyn — Tue, 25 Sep 2012 11:48:40 GMT

We have used sevo for a couple of years now. Makes a huge difference for rabbits and rodents - they seem to breathe much better. Birds seems to be similar to iso but they again tend to breathe better which makes me much happier. I don't notice any difference to iso for cats and dogs but we do use it in cats. Saying that, a lot of our cat ops are on medetomidine / ketamine / butorphanol anyway and get none or very little sevo. Can't wait for the price to come down as I have 4 sevo vapourisers!

Ian