How long does Midazolam in a vial keep?

RE: How long does Midazolam in a vial keep?

bob lehner — Fri, 16 Mar 2018 11:56:58 GMT

[quote user="Aisling McGrath"]So this is a follow on question from the above - do we have to record midazolam like we record ketamine?[/quote]

No.

'The following Law and Ethics Bulletin has been issued by the Royal Pharmaceutical Society of Great Britain.Pharmacists are advised that on 1 January 2008, midazolam’s legal classification will change from its current status as a Schedule 4 Part I Controlled Drug to a Schedule 3 Controlled Drug.'

Only Sch 2 CDs have to be recorded in a CD Register.

RE: How long does Midazolam in a vial keep?

Thomas Johnson — Fri, 16 Mar 2018 10:41:48 GMT

[quote user="David Mills"]

[quote user="Thomas Johnson"]I've recently switched from using the triple to quad combo.[/quote]

How are you finding it?

[/quote]

I think it is a little better than triple, particularly the smaller volume to inject, the ability to give the atipamazole sooner so the nurses have to spend less time closely monitoring them, and the recovery is usually a bit smoother. We don't neuter a lot of very small kittens, but I can see that the advantages are probably greater with kittens under 2kg.

RE: How long does Midazolam in a vial keep?

Aisling McGrath — Fri, 16 Mar 2018 08:45:46 GMT

So this is a follow on question from the above - do we have to record midazolam like we record ketamine?

Thanks for all your input, food for thought!

RE: How long does Midazolam in a vial keep?

David Mills — Fri, 16 Mar 2018 00:51:26 GMT

[quote user="Michael Woodhouse"]

Triple combination licenced:

http://www.noahcompendium.co.uk/?id=-462615&template=template_printview

From the NOAH site:

If the responsible veterinary surgeon considers, on the basis of their professional clinical judgement, that changing a patient's treatment under these circumstances could destabilise them, it may be justifiable to continue with the unauthorised product in that patient. New cases would need to be treated with the veterinary alternative. Otherwise, prescribing a human product where a veterinary product is authorised and available is a criminal offence and is contrary to the RCVS Guide to Professional Conduct.

http://www.noahcompendium.co.uk/?id=-312922

I'm sure there may be minor advantages, but I really don't see them over current licensed alternatives. Vet licenced products are absolutely available and authorised for anaesthesia in cats......

[/quote]

Yep, we'll just have to agree to disagree. For me it's like stomogyl/metronidazole debate. We want to use quad (despite your reservations it does have quite significant advantages in safety, recovery and ease of use in a very busy environment (not to mention monitoring for non nurses)) and there are no licensed combinations of that. There's nothing in the cascade that for im anaesthesia we have to use triple, just that we have to use licensed drugs first. it's the combination bit that I think is key. And if we're to talk about evidence there is far more for quad than triple.

I agree that the cascade should be adhered to, and we do, despite the cost implications.

Having said that we stock paracetamol rather than paradale because we don't want the codeine.

RE: How long does Midazolam in a vial keep?

Michael Woodhouse — Fri, 16 Mar 2018 00:14:13 GMT

Triple combination licenced:

http://www.noahcompendium.co.uk/?id=-462615&template=template_printview

From the NOAH site:

http://www.noahcompendium.co.uk/?id=-312922

I'm sure there may be minor advantages, but I really don't see them over current licensed alternatives. Vet licenced products are absolutely available and authorised for anaesthesia in cats......

RE: How long does Midazolam in a vial keep?

David Mills — Fri, 16 Mar 2018 00:04:21 GMT

We keep them open for 2/3 days at most. No issues.

Re legality, I think it's fairly simple. We want to use a quad for a lot of reasons. The licensing of a triple is the individual drugs, but we don't want a triple. Is ACP licensed with propofol? Acp and bupe licensed with propofol? Acp and methadone? Medetomidine and propofol? It's all part of the same GA.

RE: How long does Midazolam in a vial keep?

Michael Woodhouse — Thu, 15 Mar 2018 23:34:42 GMT

I'm sure there was a note in the Vet Record back end of last year regarding a vet licenced midazolam for horses. Under the cascade you'd have to use that over the human vials. Sure it was a multi dose bottle, but can't remember any more.

I'm still not sure using quad is 'legal' in the absolute sense of the word when things like triple combination are licenced together and safe and effective..............

RE: How long does Midazolam in a vial keep?

Rob Loxley — Thu, 15 Mar 2018 20:39:06 GMT

[quote user="Clive Ansell"]

[quote user="robloxley"]It would also get us through the ketamine a bit quicker![/quote]

Don't follow.

[/quote]

We generally use ACP/bup/propofol for cat spays, hence struggle to get through bottles of ketamine in 28 days

RE: How long does Midazolam in a vial keep?

David Mills — Thu, 15 Mar 2018 20:00:21 GMT

[quote user="Thomas Johnson"]I've recently switched from using the triple to quad combo.[/quote]

How are you finding it?

RE: How long does Midazolam in a vial keep?

Clive Ansell — Thu, 15 Mar 2018 19:04:37 GMT

[quote user="robloxley"]It would also get us through the ketamine a bit quicker![/quote]

Don't follow.

The quad uses smaller volumes than the traditional triple (or double in some practices that omit opiates) combination.

RE: How long does Midazolam in a vial keep?

Rob Loxley — Thu, 15 Mar 2018 18:39:00 GMT

[quote user="Clive Ansell"]

[quote user="robloxley"]

[quote user="Clive Ansell"]It's as cheap as chips, just factor it in to the price. [/quote]

A vial costs similar to an iv catheter for the propofol?

[/quote]

Again, just factor it in to the total cost, or charge it out as a consumable. My regular practices factor in the cost of a full vial to the overall price

[/quote]

Exactly. My thought was that if we went down the midazolam route the overall cost of procedure would essentially be unchanged by savings elsewhere. It would also get us through the ketamine a bit quicker!

RE: How long does Midazolam in a vial keep?

Clive Ansell — Thu, 15 Mar 2018 18:22:41 GMT

[quote user="robloxley"]

[quote user="Clive Ansell"]It's as cheap as chips, just factor it in to the price. [/quote]

A vial costs similar to an iv catheter for the propofol?

[/quote]

Again, just factor it in to the total cost, or charge it out as a consumable. My regular practices factor in the cost of a full vial to the overall price

RE: How long does Midazolam in a vial keep?

Aisling McGrath — Thu, 15 Mar 2018 16:51:24 GMT

[quote user="Thomas Johnson"] I worked out that as long as we used 0.3ml of midazolam the reduced cost of the lower volumes of the other components of the quad compared to the triple meant that we saved money despite the wastage.[/quote]

This is interesting and helpful!

RE: How long does Midazolam in a vial keep?

Aisling McGrath — Thu, 15 Mar 2018 16:49:52 GMT

We don't routinely place IV catheters for routine procedures.

RE: How long does Midazolam in a vial keep?

Rob Loxley — Thu, 15 Mar 2018 16:48:05 GMT

[quote user="Clive Ansell"]It's as cheap as chips, just factor it in to the price. [/quote]

A vial costs similar to an iv catheter for the propofol?

RE: How long does Midazolam in a vial keep?

Thomas Johnson — Thu, 15 Mar 2018 16:46:16 GMT

[quote user="Aisling McGrath"]

Question on cat spays - we want to switch from acp/bup/propofol to 4in1 proposed by cpl - medetom/ket/bup/midazolam. It's because the cats and smaller and more difficult to hold, and not having to give iv propofol would make our lives easier. About the midazolam, it seems to only come in vials - have to chuck at the end of the day? Can we keep it in fridge? If so, for how long? Any advice appreciated!

[/quote]

I've recently switched from using the triple to quad combo. I will use the midazolam vial for one morning's ops and then throw away any left over. I worked out that as long as we used 0.3ml of midazolam the reduced cost of the lower volumes of the other components of the quad compared to the triple meant that we saved money despite the wastage.

RE: How long does Midazolam in a vial keep?

Jill Butterworth — Thu, 15 Mar 2018 16:43:18 GMT

The little empty sterile water bottles for vaccines are useful to transfer things into, better than the sellotape and fluff method. I wouldn't keep it long still, though...

RE: How long does Midazolam in a vial keep?

Clive Ansell — Thu, 15 Mar 2018 16:31:29 GMT

2 practices I regularly work in that use the quad combination anaesthetic protocol dispose of unused Midazolam daily. It's as cheap as chips, just factor it in to the price.

That said, I have kept it in the fridge and used it the following day without any known issues.

As an aside, I prefer Methadone in the quad instead of Buph. It seems to give better anaesthesia, and lowers volumes used even more (2kg with Buph 0.1ml each, with Meth 0.08ml)