How are you planing to use Calmivet?

Re: How are you planing to use Calmivet?

Evelyn Barbour-Hill — Sat, 22 Oct 2011 22:02:07 GMT

Draw the Torbugesic into conventional separate-needle 1ml syringe. Draw up ACP using 0.5ml insulin syringe. Take needle off Torbugesic syringe, draw plunger back considerably, inject ACP into it through hub. Put fresh needle on syringe. Inject patient. Keeping a little air in the syringe will aid accuracy as it will blow most of the fluid out of the hub. No cross-contamination. Simple.

Re: How are you planing to use Calmivet?

Mark Hedberg — Sat, 22 Oct 2011 21:19:40 GMT

Oh!

Well, the road to hell is paved with good intentions. We draw up the calmivet first, then the bupe - the idea being if you accidentally contaminate the bupe, a vial of bupe is cheaper to toss than a bottle of ACP!

(Will spread this around work like wildfire on monday!)

Re: How are you planing to use Calmivet?

Rob Loxley — Sat, 22 Oct 2011 11:57:40 GMT

[quote user="Karen-Anne Smith"]NB beware the nurses that draw up the calmivet then the vetergesic in a 1ml syringe - they accidently draw the extra 0.06mls that was in the hub of the syringe into the mix.[/quote]

Yup, took me a little head scratching to work this was what was going on when some people were complaining of excessive effects of ACP...

Re: How are you planing to use Calmivet?

Anonymous — Sat, 22 Oct 2011 08:56:31 GMT

We have been using calmivet for months now

our doses are as follows - mixed with standard vetergesic doses - healthy fit pets only

cats under 2kg dont give {we just use vetergesic on its own then}

cats 2-4 kg 0.02mls {2 units on insulin syringes - NOT the caninsulin ones}

cats 4kg + 0.03mls

dogs under 5 kg dont give {just vetergesic}

dogs 5-10 kg 0.03mls

dogs 10-15kg 0.05mls

bigger dogs max dose 0.1mls

this all works well and we vary to the case. they all have vetergesic and usually metacam as well.

NB beware the nurses that draw up the calmivet then the vetergesic in a 1ml syringe - they accidently draw the extra 0.06mls that was in the hub of the syringe into the mix. If they want to do a mix -do the vetergesic 1st then the calmivet . or use an insulin syringe

Re: How are you planing to use Calmivet?

David Mills — Sat, 22 Oct 2011 00:24:40 GMT

[quote user="Laurence Webb"]

Do others combine medetomidine with buprenorphine instead of butorphanol? If so what dose do you use?

[/quote]

Yes. 0.02mg/kg. always give 'high' dose as the bell shaped curve is total baloney - something the cambridge anaesthetists misled us about.

Think a lot of the fear re alpha2s is historic based when the dose rates were through the roof - still are on data sheets. they are fantastic. and incredibly versatile. it pains me to see a cat struggling on induction after being given acp/vet. totally counter productive.

Re: How are you planing to use Calmivet?

David Mills — Sat, 22 Oct 2011 00:19:11 GMT

[quote user="SteveOwen"]

David: Does this mean that your practice doesn't obey the rules re disposal?

[/quote]

If only we didn't. We had three bottles open last month - total of 2 thrown away. cost a fortune. we now have 1 bottle for a hospital of 13 vets.

Re: How are you planing to use Calmivet?

Laurence Webb — Fri, 21 Oct 2011 21:34:31 GMT

Still got ACP2mg/ml left, but I use medetomidine as a pre-med in bouncy dogs at 0.01ml/kg. It often flattens them, but if they are slow to recover then can be given atipamezole. I prefer not to as it gets rid of the analgesic effect though.

I used to hate the idea of it (anaesthetists at Bristol in the 90s frowned on alpha2 agonists to say the least) but the more I use it the happier I am with it.

Do others combine medetomidine with buprenorphine instead of butorphanol? If so what dose do you use?

Re: How are you planing to use Calmivet?

SteveOwen — Fri, 21 Oct 2011 20:05:44 GMT

David: Does this mean that your practice doesn't obey the rules re disposal?

Re: How are you planing to use Calmivet?

David Mills — Fri, 21 Oct 2011 17:26:26 GMT

[quote user="Bob Russell"]

[quote user="robloxley"]

[quote user="Bob Russell"] standard chart doses[/quote]

I'd suggest that's your problem, try much lower medetomidine doses.

We're getting on ok with calmivet, having pursuaded people to use insulin syringes for accurate dosing.

[/quote]

Absolutely! that is why I asked the question . I wanted to know what doses people were using. we can all read a chart! I think we will go with Calmivet and insulin syringes so I can get on with operating without getting flack from the nurses.

[/quote]

Try medetomidine at 0.1-0.15ml/10kg for dogs and 0.05-0.1ml per cat IM (not SC) and it shouldn't knock them flat. Incidentally, this is the touted IV dose to knock them flat. We use it here and it works wonderfully, but then, I love domitor esp in cats.

Calmivet is horrendously expensive cf ACP so if you're the type of practice that throws things out after 28 days then caution. We use it at around 0.1ml per 10kg for dogs and cats.

Re: How are you planing to use Calmivet?

Bob Russell — Fri, 21 Oct 2011 13:26:16 GMT

[quote user="robloxley"]

[quote user="Bob Russell"] standard chart doses[/quote]

I'd suggest that's your problem, try much lower medetomidine doses.

We're getting on ok with calmivet, having pursuaded people to use insulin syringes for accurate dosing.

[/quote]

Re: How are you planing to use Calmivet?

Mark Hedberg — Thu, 20 Oct 2011 19:19:00 GMT

Yeah, i use 10 micrograms/kg instead of 20 for cats, 20 made them too sleepy. Treat the patient, make a clinical decision, the color's fine at 10. :)

Re: How are you planing to use Calmivet?

Rob Loxley — Thu, 20 Oct 2011 18:23:37 GMT

[quote user="Bob Russell"] standard chart doses[/quote]

I'd suggest that's your problem, try much lower medetomidine doses.

We're getting on ok with calmivet, having pursuaded people to use insulin syringes for accurate dosing.

Re: How are you planing to use Calmivet?

Hannah Wynne Richards — Thu, 20 Oct 2011 18:10:37 GMT

I hate domitor-will only use it on ferals-nasty dogs and short-nosed dogs.Use insulin syringes to pre-med with either domitor or calmivet

Wynne

Re: How are you planing to use Calmivet?

Mark Holmes — Thu, 20 Oct 2011 14:49:02 GMT

I use domitor/torb in most things and its fabulous. Get over the colour, under ga the blood is where its supposed to be and not wasting its time in the extremities. It also helps conserve body temperature and you suffer less chilling, though whether this is marked enough to be significant I'm not sure. (It is particularly useful if your nurses cannot count over ten as you usually get a heart rate in single figures! ) The heart rate slows as does the respiratory rate but do just keep on going fine. I cannot recall a case I have lost on DT, which is not the case on acp/vet. Additionally I think the combination may have renoprotective effects. I worked in 2 practices, one spaying hundreds of cats on DTK (low cost rack em up clinic) and saw no acute post op ARF. The next practice I worked at (quality practice) used acp/vet and spayed far fewer cats, whilst I still did not see much ARF there were possibly 1-2 a year. Given the difference in numbers of ops that amounted to a significant difference in risk, given that all other things were equal. (Actually the other things being equal thing might not be quite right, surgical time was far less in the rack em up practice due to the lower levels of faffing around)

Seriously fabulous premed, the nurses just need to understand it. I usually give at 0.1/0.1 per 10kg for premed, iv where possible but this is just for expediency, although I have not problems converting a full sedation (0.25D, 0.1T) to ga and running with that.

Re: How are you planing to use Calmivet?

Bob Russell — Thu, 20 Oct 2011 14:11:44 GMT

Just to wake up an old thread we have made our ACP supplies last as long as possible but finally have changed to buprenorphine/meditor. So far we hate it!

Once pre-medicated our patients are flat out within minutes so need fairly constant supervision. The nurses don't like it because of the colour they go. This is at standard chart doses, weights are carefully measured.

The combination is not new to us but previously has been restricted to the overly bouncy or overly bolshie! Are people using lower doses? I suspect it will be Calmivet for us!

Re: How are you planing to use Calmivet?

Rob Loxley — Sun, 16 Jan 2011 12:18:17 GMT

[quote user="Michael Woodhouse"]How small a dose are you giving a 3kg cat? What about drawing it up in a half ml insulin syringe rather than mixing it and having it sat there?[/quote]

Or use 0.3ml insulin syringes which have even finer graduations?

Re: How are you planing to use Calmivet?

Michael Woodhouse — Sun, 16 Jan 2011 11:47:43 GMT

How small a dose are you giving a 3kg cat? What about drawing it up in a half ml insulin syringe rather than mixing it and having it sat there? I don't believe anyone knows for sure how stable it is made up etc. I always thought ACP seemed sort of oily when mixed in with torb, WFI might not even be the best solvent.

Re: How are you planing to use Calmivet?

Mark Hedberg — Sun, 16 Jan 2011 10:34:20 GMT

Interesting idea; made up fresh each day, I hope! (That said, older patients get a lower dose of ACP here.)

Re: How are you planing to use Calmivet?

Edward Jones — Sun, 16 Jan 2011 08:56:37 GMT

I would not suggest diluting each dose individually. Firstly, significant error can be made with the volume of liquid that resides in the hub of the syringe (especially if the ACP is drawn up before the diluent), and secondly it doesn't really solve the problem of drawing up a tiny volume of concentrated solution!

At one previous workplace we used to make a bottle of pre-made premed, a mixture of ACP and torbugesic and kept in the torbugesic bottle. It worked well. The nurses weren't required to make it, only vets would do it. If you make it up all at once any small error in drawing up the volumes gets 'diluted' out