Alfaxan

Re: Alfaxan

Martin Atkinson — Fri, 26 Sep 2014 08:54:57 GMT

I use it routinely in dogs especially large ones if nothing else it reduces the volume of stuff to give. I find little difference in anaesthetic management to be honest. Regards the cost thing I assume you've found you can get away with half recommended induction dose in dogs and a quarter in cats which makes a big difference!

Re: Alfaxan

Anonymous — Thu, 25 Sep 2014 23:25:23 GMT

I know this post is old but a cardiologist told me that they Have used it safely to scan aggressive dogs and cats in heart failure, without getting falsely dilated chambers. On top of that, you can give it s.c. (Off license of course) with a bit of butorphanol or buprenorphine. I have used it this way too - and really like using it in cats!

Re: Alfaxan

Tim Charlesworth — Thu, 19 Dec 2013 22:13:34 GMT

[quote user="John Flynn"]

[quote user="Tim Charlesworth"]A very nice trick (and I digress) if you have any really sick patients (e.g. GDV) is to use diazepam (0.5mg/kg) and ketamine (5mg/kg) as the induction agent. Draw up both and give incrementally and you normally can intubate on 1/3 the above dose (bit off-putting as they still seem awake but no jaw tone etc).[/quote]

Why diazepam in preference to midazolam for the sickies?

[/quote]

No reason other than I have lacked the imagination to try midazolam as an alternative!

Re: Alfaxan

John Flynn — Wed, 18 Dec 2013 17:29:36 GMT

Why diazepam in preference to midazolam for the sickies?

Re: Alfaxan

Mark Holmes — Wed, 18 Dec 2013 00:00:47 GMT

Yes I love diazepam/ketamine recently did some extractions on a dog with cardiac failure. Sailed through. They can be a but drooly on it but great for critical cases

Re: Alfaxan

Tim Charlesworth — Tue, 17 Dec 2013 22:47:11 GMT

Sorry that should have been "give it IM" not give it "I'm"....spellchecker on autocorrect grr..

Re: Alfaxan

Tim Charlesworth — Tue, 17 Dec 2013 22:46:02 GMT

NB I am not an anaesthetist but we started using Alfaxan a couple of years ago in the really ill cases (much as when we started to use propofol instead of thio) and we get along with it very well. Most of the nurses prefer it to propofol. It is a very smooth induction agent and is nice to work with. As far as I understand, Alfaxan has much less suppressive effect on cardiac function (and you can see a compensatory tachycardia on induction as the patient compensates for a dip in blood pressure so don't be alarmed by this). Volumes needed are less than that of propofol, it's non-lipid based and so better for pancreatitis cases etc. Constant rate infusions are much nicer than propofol CRI's as they tend to keep breathing nicely and you don't see the apnoea that can be seen with propofol. Another advantage of alfaxan is that you can give it I'm if you have a particularly feisty patient (though I have never done this). It is a little more expensive but we almost exclusively use it on the referrals side. Our first opinion side probably uses 50/50 alfaxan/propofol and will probably move to using it more as time goes on. I have seen a couple of violent recoveries from very short Alfaxan inductions so wouldn't use it on cat castrates etc

A very nice trick (and I digress) if you have any really sick patients (e.g. GDV) is to use diazepam (0.5mg/kg) and ketamine (5mg/kg) as the induction agent. Draw up both and give incrementally and you normally can intubate on 1/3 the above dose (bit off-putting as they still seem awake but no jaw tone etc).

Re: Alfaxan

Martin Atkinson — Mon, 16 Dec 2013 10:00:36 GMT

We switched to Alfaxan for dogs a couple of years ago but have recently reverted to Propofol. Even at 1/2 recommended dose which is just enough to anesthetise to intubate it is a lot more expensive than propofol and as I'm having to compete with cut price vets all around me I can't afford to give it away or charge more. The exception is with very large breeds where I would need more than 20ml propofol because it keeps it to one syringe.

In all honesty I found little or no difference in ease of administration, maintenance or recovery except I found apnoea an occasional issue although barely a problem, more so than with Propofol.

Re: Alfaxan

Braden Collins — Mon, 16 Dec 2013 05:35:23 GMT

I find it very useful for aggressive cats or when I am on my own after hours and need to GA a cat. A dose IM is very easy and safe for me and the cat. I also love it for caesareans. The puppies are so quick to breathe and move on their own when this is used for induction I wouldn't use anything else.

For healthy animals, I'm still quite happy with diaz/ket induction as I can't justify the extra price of alfaxan when this combination is perfectly safe.

Re: Alfaxan

Dalya Livy — Sun, 15 Dec 2013 21:26:52 GMT

Alfaxan is supposed to maintain HR, RR and respiratory effort better, and also allow for better blood pressure during gas anaesthesia. There are some very nice published papers supporting that.

However, in my hands, hypotension is an issue in approx 75% of patients induced with Alfaxan and maintained on iso, independent of premed given, and also independent of whether I give them a full dose of Alfaxan or a bit less. The vaporiser settings do not differ much between the two induction agents - if anything, they are generally lower with Alfaxan. These are routine ops by the way - spays/neuters/young to middle aged mass removals/wounds etc. I very rarely see hypotension with propofol in these situations, and we do measure BP in every patient.

Where I do like it is for short ops - cat castrates, radiographs - where they get a premed + Alfaxan + ET tube + oxygen with no iso required. No hypotension in these cases.

This is just personal experience, and I may be a jinx because some weird stuff does happen in my hands (you don't want to know what happens when I give a cat ACP, but it sure is not sedation).

Re: Alfaxan

Emily Rainbow — Sun, 15 Dec 2013 19:13:23 GMT

I raised this question with the anaesthetists at Uni during my rotation as i've seen both used in practice. They say it may have fewer/less cardiovascular effects but in general they see it as being no different to propofol (given slowly), or they have yet to see any concrete evidence saying there's a major advantage to using it. They tend to use Etomidate in the more critical patients.

From limited personal experience I found it more unpredictable during anaesthesia, with dogs showing signs of becoming light very quickly, and often having to be topped up rather than managing them with Iso/Sevo. Many cases I used it in also required re-sedation on recovery as they come round too quickly, although I appreciate that may have been due to other factors too e.g. pre-med/analgesia.

Re: Alfaxan

Rob Loxley — Sun, 15 Dec 2013 18:24:06 GMT

[quote user="Hannah Wynne Richards"]Try it, and I'm sure you'll be a convert[/quote]

Tried it a while back and it worked fine just not convinced to change from using propofol. IME your choice of premed agent and dose and analgesia has as much influence on your anaesthetic; YMMV.

[quote user="Hannah Wynne Richards"]This is the cost of doing things properly[/quote]

Not sure that using propofol is not doing things properly??

Re: Alfaxan

Hanna Bennett — Sun, 15 Dec 2013 14:57:45 GMT

we use alfaxan for everything, just keep propofol for status dogs now. It is a nice smooth induction, and if you give it slowly (over 2 minutes or so) you can get cats larynx's sprayed and wait for the intubeaze to work so nice to intubate. works very slowly so quite easy to get them too deep if given at the same speed as propofol, just takes a bit of getting used to. we have dose charts based on 3/4 dose for acp premeds, and 1/3 dose for domitor premeds - never give it all so cost wise it really isn't as bad as you think - propofol may be cheaper but I remember drawing up more than the recommended dose every time so not sure that was true economy. You don't get the apnoea that you sometimes saw with propofol (again I think a factor of giving it too quickly), and it is not as cardiorespiratory depressant so better for critical cases but then I think if you are going to use something in critical patients you should be familiar with it in normal patients - still remember the saying 'the safest anaesthetic is the one you are familiar with'. We make the pricing work - but then I'm with t'other Hannah on this - use what you think is best, charge for it, clients will make their own mind up - if you believe it is worth it and tell them so they will pay for it, if you waver then they will too.

Re: Alfaxan

Sammy82 — Sun, 15 Dec 2013 00:55:01 GMT

As far as I am aware it is supposed to have a greater safety margin. I find that it lasts longer than propofol in cats, usually induction dose lasts for the spay. In dogs it seems to be quite the opposite, only used it once and constantly had to top up, a lot more often than datasheet was suggesting.

Re: Alfaxan

Michael Woodhouse — Sat, 14 Dec 2013 23:43:16 GMT

Those that think it's the bee's knee's - what exactly are the advantages over propofol?

Re: Alfaxan

Evelyn Barbour-Hill — Sat, 14 Dec 2013 15:53:01 GMT

Got some in when a shortage of propofol threatened, tried it, works fine but I couldn't see any advantage for general purposes over propofol. I have no respiration or recovery problems with propofol.

Re: Alfaxan

Kate Richardson — Sat, 14 Dec 2013 12:43:33 GMT

Love love love alfaxan, soooo much better than propofol

Re: Alfaxan

Neil Wheadon — Sat, 14 Dec 2013 12:24:01 GMT

[quote user="Hannah Wynne Richards"]As far as cost is concerned - why on earth are we as a profession so reluctant to tell clients " This is the cost of doing things properly - end of. "[/quote]

Because as I saw this morning.

Client had second puppy vaccination at the practice I am in, as had Vanguard 7 at the first vaccination. His original practice wouldn't vaccinate with a single as use Nobivac (not vanguard 7), so were technically doing the right thing. (Wanted to re-start) Result Lost a client

Neil

Re: Alfaxan

Hannah Wynne Richards — Sat, 14 Dec 2013 09:57:17 GMT

I changed entirely to alfaxan a long time ago - and won't even consider going back. They do so well on it brilliant recoveries. Anyway, my RVN wouldn't let me go back to propofol - and she's got her Nurses Cert in anaesthesia and critical care. Try it, and I'm sure you'll be a convert. As far as cost is concerned - why on earth are we as a profession so reluctant to tell clients " This is the cost of doing things properly - end of. "

Wynne

Re: Alfaxan

Utlendigur — Fri, 13 Dec 2013 21:28:44 GMT

I've used it once so far, in a very geriatric cat that had had propofol a couple of days previously, so I didn't want to use propofol again so soon. It worked really well, nice and smooth induction with good resps and good recovery. I qualified at a time of thio and saffan, and always liked saffan for cats - alfaxan is better. I've got a small stash for similar cases but propofol is less expensive for general use.

Re: Alfaxan

John Flynn — Fri, 13 Dec 2013 19:59:26 GMT

Have used it and thought it fine.

Use propofol routinely and not sure I'd think the extra money worthwhile, though if were priced equally, I'd choose the alfaxan.

I think it might result in less hypotension post-induction and I would see that as a small plus perhaps in ill cases, such as a GDV? But then etomidate is much cheaper and possibly just as good in sickies?

Re: Alfaxan

Clive Ansell — Fri, 13 Dec 2013 19:33:06 GMT

One of my regular practices uses it as their routine induction agent, although they do have propofol on the shelf too if prefered. I quite like it; smooth inductions and recoveries and gives more time on induction than propofol. One colleague speys cats with it without intubation and has enough time without topping up. I personally prefer them intubated and on sevo or iso/02 but each to their own and all that.

I have had one terrible and violent recovery with it, almost to the point of convulsions, in a fractious highly strung GSD. With hindsight I could have probably used more or a different premed, or better still dom/torb/ket'd the b****y thing. Wouldn't rule it out on n=1 bad experience though.

Re: Alfaxan

Michael Woodhouse — Fri, 13 Dec 2013 19:32:54 GMT

We tried it. It works fine. Don't appreciate any great apena with propofol. Wasn't 'worth' the extra money so we no longer use it.

Re: Alfaxan

Marie Kubiak — Fri, 13 Dec 2013 19:17:19 GMT

I use it for reptiles and occasionally in rabbits and like it - less respiratory depression than propofol and faster recovery.

More usefully for cats and dogs, our small animal staff use it for the critical patients, pancreatitis cases and for caesarians and prefer it but it isn't in regular use due to slightly higher cost than propofol (though volume used is less so it isn't as poorly economical as it first appears).

Marie