Human licensed propofols

RE: Human licensed propofols

Charlotte Marshall — Sat, 29 Aug 2015 18:41:52 GMT

Yeah, heard about the rabbit vaccine. Now there is also a shortage of purevax cat vaccines. In fact we have a list of about eight or nine products on back order!

RE: Human licensed propofols

Martin Atkinson — Fri, 28 Aug 2015 10:03:42 GMT

[quote user="Iain Richards"]Why loathe to use alfaxan? It's excellent. Jurox do decent in-house training, the only down side is relative cost, so use good pre-meds and pass the cost on.[/quote]This is fine expect when you are doing charity neutering and competing on cost with the cheapskate practices that surround you.

RE: Human licensed propofols

Iain Richards — Thu, 27 Aug 2015 22:54:46 GMT

Why loathe to use alfaxan? It's excellent. Jurox do decent in-house training, the only down side is relative cost, so use good pre-meds and pass the cost on.

I'm not aware of diprivan vs propofol issues, I've used diprivan in the days when you could get it at a fraction of the price.

Iain

RE: Human licensed propofols

karen jones — Thu, 27 Aug 2015 22:36:36 GMT

Jurex who sell alfaxan will come in and give good cpd on using alfaxan.we have been using it for couple of weeks and it has to been injected differently than propofol. great for caesarians otherwise much the same once you get used to different way of induction[quote user="Rachael Winder"]

We're now at the point where we can't obtain any form of veterinary licensed propofol from our suppliers and are being offered Diprivan as an alternative. We're a little loathe to suddenly start using Alfaxan. I am aware that there were some issues with some formulations of propofol in the past, is anyone aware of any particular risks with Diprivan or any of the other human formulations?

Thanks,

Rachael.

[/quote]

RE: Human licensed propofols

Martin Atkinson — Thu, 27 Aug 2015 10:47:26 GMT

[quote user="Charlotte Marshall"]Despite phoning NVS last week to check and being told there was no problem with availability of propofol this week thereis none. [/quote]I ordereds some as soon as I heard there was going to be a shortage and it arrived. And no I haven;t stockpiled thereby using up their entire stock!

The next shortage is apparently going to be Nobivac Myxo-RHD so I've just ordered in some that. I do wonder if when pharma companies sent out warnings of impending shortage whether they shoot themselves in the foot.

RE: Human licensed propofols

Charlotte Marshall — Wed, 26 Aug 2015 21:22:38 GMT

Despite phoning NVS last week to check and being told there was no problem with availability of propofol this week thereis none. Apparently it is going to be another couple of weeks before it is back in stock. So we have ordered some alfaxan. Not used it before any tips? I understand that you are supposed to give it very slowly for induction.

RE: Human licensed propofols

Martin Atkinson — Wed, 19 Aug 2015 16:44:22 GMT

[quote user="Bob Russell"]

Do people use propofol rather than Alfaxan based on price?

They are both perfectly good induction agents that do their jobs well.

[/quote] There's another thread on this about anaesthetics in caesars.

I find no significant difference between the two in practice so the decision is initially price led and everything gets propofol until I need more than 20ml in a >40kg dog. Then I use Alfaxan purely on the amount I need to fill the syringe. It is then used at half recommended dose and still works perfectly. At that rate its not too expensive but the extra expense is dwarfed by all the other costs of treating a giant breed anyway.

RE: Human licensed propofols

Yantha Smyth — Wed, 19 Aug 2015 10:23:12 GMT

we used diprivan in NZ and it was the same. back then even that seemed expensive, so we would often co-induce with diazepam which halved the induction dose required

i have used alfaxan a little, and have seen others using it have issues with apnoea on induction. the rep apparently suggested it wasn't due to rate of admin, but they were not giving enough of a dose, which seemed counter-intuitive to me. i think alfaxan has a superior profile with regards to cardiorespiratory depression, BP etc. also if i recall it is possible to administer IM off-label (in Aus is licensed for this?) so quite a good option for a nasty but sick cat!

RE: Human licensed propofols

Catriona MacIntyre — Tue, 18 Aug 2015 00:15:00 GMT

I had sevo induction after I freaked when the venflon jaggy thing appeared! Think sevo maintenance, although they might have cannulated and popped some propofol in before getting a tube down.

Can cope with most things..... except needles pointing towards me!

RE: Human licensed propofols

Sarah Keir — Mon, 17 Aug 2015 19:24:10 GMT

I had propofol induction, iso maint, think was fentanyl premed seconds before induction. Can't remember which circuit they used... I think they knocked me out quickly after they found me asking lots of questions...

RE: Human licensed propofols

David Mills — Mon, 10 Aug 2015 10:26:57 GMT

[quote user="Michael Woodhouse"]propofol as standard and you will breathe iso.[/quote]

Most use sevofluorane of desfluorane these days. Especially if you're a vet or vet nurse - chronic exposure to iso means you build up a resistance to it meaning you need high %s to keep you asleep!

RE: Human licensed propofols

Hannah Wynne Richards — Sat, 08 Aug 2015 13:52:19 GMT

I don't think I've altered speed of injecting when I changed agents - in fact, I' ve always been cautious (slow) when inducing anaesthesia. I haven't altered pre-med (either dom/torb, or dom/methadone) I was reluctant to try alfaxan, because I was happy with propofol, and with anaesthesia, if something goes wrong,there's not much time to put it right, but once I tried alfaxan, I found it definitely better. Everything has BP monitored (external cuff) and an ECG run, and the cardio-vascular system is reassuringly stable.

Wynne

RE: Human licensed propofols

Anthony Todd — Sat, 08 Aug 2015 12:29:00 GMT

[quote user="Evelyn Barbour-Hill"]This is where I wonder if[/quote]

The speed of I/V delivery can make a big difference to apnoea. Given as a bolus versus gradual slow admin and the apnoea may be reduced or eliminated independent of agent used.

Sometimes what folk say they do is not the same as what they actually do.

A bolus of thiopentone would give an alarming apnoea, only about 5 minutes anaesthesia and a similarly rapid full recovery, for example.

RE: Human licensed propofols

Evelyn Barbour-Hill — Fri, 07 Aug 2015 20:33:58 GMT

This is where I wonder if I'm treating different animals! With a little torb/ACP premed (dogs) I don't have an apnoea problem and all the volumes are manageable. Dom/torb premed has its good points, no apnoea problem with that either as long as you carefully titrate the dose, steadiness of anaesthetic plane can then lead the inexperienced to forget to add isoflurane to the oxygen soon enoiugh and a sudden wake-up can result, but we're wise to that now. Cats, mild Dom/Torb premed, everything smooth, again no apnoea problem,very nice. Propofol.

RE: Human licensed propofols

Michael Woodhouse — Fri, 07 Aug 2015 17:46:30 GMT

One place I saw practice as a vet student used ACP only as a premed and you did get quite a profound apnea with propofol and had to give large volumes to induce.

We pre med 0.1ml/10kg of butorphanol and medetomidine. It is rare I use more than 5ml of propofol to induce even the largest dog. With a good pre-med and the analgesic properties from the medetomidine we get smooth anaesthetics and no apnea.

Cost would never be my deciding factor (within reason), but to use something that was significantly more expensive would have to be taken into account when charging out the procedure. I'm not swapping to an induction agent at 5X the cost and a maintenance agent at 6X the cost when what we have work very well.

In humans they use propofol as standard and you will breathe iso.

RE: Human licensed propofols

Hannah Wynne Richards — Fri, 07 Aug 2015 17:01:14 GMT

Less initial apnoea, and my nurse (RVN) says she finds it easier to fine-tune anaesthetic depth.

Wynne

RE: Human licensed propofols

Evelyn Barbour-Hill — Fri, 07 Aug 2015 13:42:40 GMT

[quote user="Hannah Wynne Richards"]

I was initially reluctant to try alfaxan (better the devil you know) but once I'd tried it, I wouldn't go back. My attitude is I work to a standard, not a price! Anyway, I value my life- my nurse would kill me if I went back

Wynne

[/quote]

But what do you find so superior about alfaxan, or inferior about propofol?

RE: Human licensed propofols

Joyce Whitehead — Fri, 07 Aug 2015 12:58:00 GMT

Just to tag on, we ordered some Abbott Propofol from NVS yesterday and it arrived this morning...

RE: Human licensed propofols

Bob Russell — Fri, 07 Aug 2015 12:55:04 GMT

Do people use propofol rather than Alfaxan based on price?

They are both perfectly good induction agents that do their jobs well.

I have used both but prefer propofol! I have no idea how they compare on price, not really a factor in my decision making.

RE: Human licensed propofols

Hannah Wynne Richards — Fri, 07 Aug 2015 12:36:07 GMT

Wynne

RE: Human licensed propofols

Bob Russell — Fri, 07 Aug 2015 12:18:53 GMT

I have never found any propofol product that different from any other. The main reports seem to be related to pain on induction but this is not something I have noticed.

During the first Gulf war, Rapinovet became unavailable (was the only licenced version at that stage), the reason bandied about being that it was being stockpiled for human use in the expectations of massive casualty numbers.

Pre-cascade we quite regularly used human stuff every time Rapinovet was unavailable and found it behaved in the same way as the licenced one.

The real question is whether it is more risky to start using an unfamiliar anaesthetic or accept the small chance that a familiar drug will behave differently.

I consider there is plenty of justification for remaining with standard protocols. I very much doubt Dipravan will be different!