Oakham Veterinary Hospital is a long established practice on the outskirts of Oakham, Rutland. Their premises are purpose built and set in 8.5 acres surrounded by rural countryside. The team are dedicated to deliver the very best of veterinary care and service and have a Tier 3 hospital status, accredited by the Royal College of Veterinary Surgeons. They also have a clinical association with the University of Nottingham School of Veterinary Medicine and Science gaining access to expertise from leading veterinary specialists.
Christopher joined the small animal department in July 2008. He achieved his postgraduate certificate in Veterinary Cardiology in 2014, enabling him to take referrals and work-up cardiovascular cases to a high level.
What was your main anaesthetic protocol before you made the move to Alfaxan?
We always use a good premed. – usually acepromazine and either methadone or buprenorphine, depending on the patient, then we used to induce most dogs and cats with propofol. We use isofluorane as a gaseous maintenance agent.
How did you hear about Alfaxan and what were your initial thoughts about using the product?
We had a visit from the Jurox team, when we discussed Alfaxan in detail and I also spoke to a consultant anaesthetist, who visits the clinic every week (as we are one of the University of Nottingham teaching hospitals). He suggested it was possibly safer than some other induction agents, especially as it has a lower impact on the cardiorespiratory / cardiovascular (CR/CV) system. I have an interest in cardiology so this was particularly important to me.
What helped you to make the decision to use more Alfaxan?
Obviously the fact that Alfaxan has a limited impact on the CR/CV system was a key factor. We also liked the smooth inductions and lack of hyper-excitation at induction. Whilst we do still see some apnoea, there is certainly less than with other induction agents.
Did you start using Alfaxan first line immediately or did you use in specific cases first?
We started using Alfaxan when we couldn’t get hold of any propofol – so we switched pretty quickly. We had already been discussing the possibility of moving to Alfaxan and this was a good opportunity to bring it to first line use.
Do you use any other induction agents and, if so, in which cases?
Alfaxan is used as our first line induction agent, but we do still use some propofol where we think it is right to do so and we also use ketamine / triple combination in specific patients.
Alfaxan costs more than propofol – why is this not a problem for you?
We feel the benefits outweigh the increased cost. We get a smoother induction than with some other agents and a quicker wake up. As a business we did not feel it was dramatically more expensive and we aren’t trying to be the cheapest veterinary clinic – our aim is to provide a good service and great value for clients and their pets.
How do you justify using a premium induction agent in price sensitive procedures such as neutering?
As above, we offer good service and value for all surgeries, not just the ‘high end’ ones. We point out to pet owners that we have a team of fully qualified RVNs and have a nurse monitoring the anaesthetic and another watching patients through the recovery period. We feel we are offering the most up-to-date anaesthetic protocol that is the best for us. The extra costs are not as much as you may think and we are happy to talk owners through this.
How do you think your patients benefit from being induced by Alfaxan?
The reduced impact on the CR/CV system is a benefit to patients, along with the smooth inductions and recoveries. We feel it is safer, especially in specific cases, than some other induction agents.
How do you think your staff benefit from using Alfaxan as an induction agent?
The team find the smooth inductions helpful as they are able to focus their time on effective anaesthetic and patient monitoring. The rapid, uneventful recoveries mean nurses aren’t sitting for long periods of time with patients and can be working on other things. On one occasion we had to re-anaesthetise a cat that had complications following surgery and so it was good to be able to use Alfaxan in the same patient twice in one day.
What advice would you give other practices considering using Alfaxan for the first time?
Jurox are really good at supporting practices – let them come in and spend a day with you whilst you make the switch or use it for the first time. Change can be difficult but practices should give Alfaxan a try. One year ago we were using propofol in most of our inductions, now that has changed to Alfaxan and no-one in the clinic has had any major concerns.
What advice would you give to practice owners concerned about the cost difference?
To be honest, if you are really worried about the costs then you shouldn’t use Alfaxan, but I suggest you don’t get bogged down in the costs as the difference is very small.
We added up how much extra it cost us to switch to Alfaxan and assessed the cost-benefit, which for us, came out in favour of Alfaxan. Every practice has experience of different induction agents and they should select the one that works for them.
What challenges did you face when changing your induction agent and how did you overcome them?
We had our consultant anaesthetist present when we converted and a vet from Jurox came over as well. There were some nerves but we had lots of people to help – then we found it easy to use. Jurox offered to come over a further two or three times but actually we didn’t need them!
What pricing adjustments did you make? Has this had a negative effect on turnover or client satisfaction?
To start with the clinic absorbed the extra costs, although we may make a price adjustment to our anaesthetic fees in the future. I’m not convinced the small extra cost has had a negative impact on turnover at all – there are so many factors that influence turnover in a veterinary business that it is impossible to assess if that specific change to Alfaxan made any difference at all.
In what other ways have Jurox supported your practice?
Apart from coming in to help us when we switched, we have had some really good CPD meetings from Jurox. One of the veterinary team came and gave a great talk on capnography – this was really useful and I have had some good feedback from members of the team.
We have arranged for Jurox to come back to give a talk on dental nerve blocks at their next CPD session.