Should we stock propofol in case of seizures?

RE: Should we stock propofol in case of seizures?

Gillian Mostyn — Sun, 03 Mar 2024 21:25:26 GMT

[quote userid="8663" url="~/f/clinical-questions/30905/should-we-stock-propofol-in-case-of-seizures/243900#243900"]

Alfaxolone is licensed for TIVA so should work for status

im going to ask, why use it for everything tho. Isn’t it significantly more expensive than propofol without any evidence of superiority?

[/quote]

I'm a locum so have no say over what drugs are stocked - but I just don't like to see waste. I also assumed alfaxan would be fine to use in refractory status cases, so thanks!

No idea why they only use alfaxan. I prefer propofol anyway. I might have a look at pricing for both tomorrow - I'm curious.

RE: Should we stock propofol in case of seizures?

Virginia Campbell — Sat, 02 Mar 2024 20:59:49 GMT

You can use up any leftover bits of propofol giving a couple of ml to the euths just before the pento (if you place IV cannula+ T connector not doing them off the needle). Owners seem reassured as you talk , "This is an anaesthetic exactly the same as people get, I'm giving this first so things are nice and smooth for her". (What I actually mean is, I'm giving the propofol first to abolish the risk of agonal gasping that would freak you out dear owner, even though your pet would be unaware at that point) Flush, propofol, flush, pento sounds fiddly, but if you have a T connector in you can be back out of the way doing it unobtrusively while the owner cuddles the head end.

RE: Should we stock propofol in case of seizures?

Alasdair Hotston Moore — Sat, 02 Mar 2024 20:40:58 GMT

Alfaxolone is licensed for TIVA so should work for status

im going to ask, why use it for everything tho. Isn’t it significantly more expensive than propofol without any evidence of superiority?

RE: Should we stock propofol in case of seizures?

Neil Wheadon — Sat, 02 Mar 2024 12:29:20 GMT

[quote userid="5012" url="~/f/clinical-questions/30905/should-we-stock-propofol-in-case-of-seizures/243870#243870"]I've never liked propofol for status epileptcus, not long acting enough. I much prefered Pentobarbitone, sagittal as was, lasts for hours. [/quote]

I'm probably getting older, but...

When I first qualified we used this all the time and I seemed to attract fitting dogs OOH. This worked like an absolute dream, the dog would sleep for about 6-7 hours and in many cases reset themselves, rarely fitting again in the next few weeks. Those that fitted again when they woke up were almost impossible to get under control. It was akin to Maropitant and a foreign body dog, almost a diagnostic test.

Why it went out of fashion, I'm not sure, probable because Sagittal went off the market

Neil

RE: Should we stock propofol in case of seizures?

Michael Woodhouse — Fri, 01 Mar 2024 23:45:34 GMT

I've used propofol twice for SE. First dog would have boloused for maybe an hour and then brought out of anaesthesia and was fine. Second was unknown duration of seizure activity, threw the contents of the cupboard at it and couldn't get it to stop as soon as drugs wore off so PTS.

We keep a bit of Levetiracetam (IV) in stock for these dogs - haven't used anything else since. Looks expensive on paper, but losing a morning and using up all your propofol is also awfully expensive. Advantage over diazepam is prolonged action so reduces risk of further cluster seizures.

That said, there is nothing wrong with propofol. Used heavily in human anaesthesia. A few bottles that get rotated keeps everyone familiar with the drug and saves it going to waste.

RE: Should we stock propofol in case of seizures?

Clive Ansell — Fri, 01 Mar 2024 20:58:30 GMT

I've never liked propofol for status epileptcus, not long acting enough. I much prefered Pentobarbitone, sagittal as was, lasts for hours.

Never used Alfaxan, but cannot see why not.

As Beats said, why not keep a small amount Propofol in stock; fairly inexpensive, long shelf life, and can be used before goes out of date

RE: Should we stock propofol in case of seizures?

Gillian Mostyn — Fri, 01 Mar 2024 20:21:00 GMT

[quote userid="12930" url="~/f/clinical-questions/30905/should-we-stock-propofol-in-case-of-seizures/243867#243867"]Logic would dictate that alfaxan would probably be as much use as propofol for refractory status epileptics?[/quote]

That's exactly what I thought .. but was wondering if propofol had characteristics that made it more suitable!

Thanks.

RE: Should we stock propofol in case of seizures?

Beats — Fri, 01 Mar 2024 19:52:47 GMT

Injectable phenobarb way more expensive than propofol to my knowledge, and propofol can surely be used up in GA cases and replaced rather than left to go out of date.

I didn't replace inj phenobarb last time I looked and thought will give propofol instead of came to needing it.

Logic would dictate that alfaxan would probably be as much use as propofol for refractory status epileptics?

RE: Should we stock propofol in case of seizures?

Gillian Mostyn — Fri, 01 Mar 2024 18:05:36 GMT

[quote userid="11249" url="~/f/clinical-questions/30905/should-we-stock-propofol-in-case-of-seizures/243863#243863"]does diazepam and pheno work for you? If it does, I'm not sure I see a reason to change.......[/quote]

I don't think I see enough to judge tbh. Yes, it generally works - and the last status I had that didn't respond to initial treatment (years and years ago) was PTS.

I'm just not familiar with using propofol as a CRI in these cases.

RE: Should we stock propofol in case of seizures?

ian bates — Fri, 01 Mar 2024 16:41:35 GMT

Hi Gillian - does diazepam and pheno work for you? If it does, I'm not sure I see a reason to change.......