Carla qualified and graduated in Spain, from Santiago de Compostela University and then spent time in America volunteering in several hospitals; she subsequently moved to England where she has been working as a vet for 14 years in Yorkshire, Devon and now as a joint venture partner at Vets4Pets Bristol, Emersons Green.
Carla has a passion for cats and is applying for the surgery to have a special feline focus, including specially designed cat kennels (cat condos) that help cats to cope better with stress and recovery while away from their owners. The practice were recently awarded Gold Certificate icatcare status, so they are recognised as a cat friendly clinic.
What was your main anaesthetic protocol before you made the move to Alfaxan?
We use acepromazine and either methadone or buprenorphine as our standard pre-med, although occasionally we will use dexmedetomidine and buprenorphine for brachycephalic dogs so we can reverse the sedative (I have an interest in pugs!) and we adapt the premed to the needs of the patient. We used to use propofol as our main induction agent (although this was a long time ago now) and we maintain with isoflurane.
How did you hear about Alfaxan and what were your initial thoughts about using the product?
We had some issues with propofol and were approached by the company to trial Alfaxan. They offered to come over and support us whilst we used the product in some routine procedures. I was very happy to try Alfaxan to see if it would improve our experience with induction.
What helped you to make the decision to use more Alfaxan?
I really liked the consistent induction – the same every time – especially in cats initially but now for dogs as well. We find the inductions smooth and less erratic than with other agents. We give Alfaxan slowly, often over a minute and we see no cyanosis, little apnoea and there is no need to top it up. I also like the fact that, in my experience, cardiac output and blood pressure remain stable.
Recoveries are fast and so we move the patient into our calm recovery area quickly and extubate there in order to avoid excess stimulation and excitement. This works really well for us and we generally have very smooth recoveries. Of course some of this also depends on the quality and timing of the premed.
Did you start using Alfaxan first line immediately or did you use in specific cases first?
It was quite a few years ago now - I started using Alfaxan in cats and thought it was good, saw the benefits and moved to using for all dogs as well.
Do you use any other induction agents and, if so, in which cases?
We find Alfaxan so simple and versatile that we don’t need another induction agent and I don’t want to create confusion in the practice. We do occasionally use triple combination, with midazolam, in kittens and some very specific cat cases.
Alfaxan costs more than propofol – why is this not a problem for you?
We simply charge out the cost of the Alfaxan for non-routine procedures and we reduced our margins on routine procedures slightly. We have had great feedback from our clients on the quality and speed of their pet’s recovery and lack of hangover, plus the nursing team love using Alfaxan for the quality of the inductions and reduced after care needed. I feel that the extra costs are justifiable.
How do you justify using a premium induction agent in price sensitive procedures such as neutering?
We try to offer the best service and care we can to our patients and clients. We do not want to offer a two tier service or two different experiences for pet owners. They should have consistency of care across all procedures and we are happy to discuss the additional benefits with owners.
How do you think your patients benefit from being induced by Alfaxan?
The whole anaesthetic process is less stressful than with some other agents – they experience less apnoea; a smooth, slow induction; maintained cardiac output with no cyanosis and a rapid recovery.
How do you think your staff benefit from using Alfaxan as an induction agent?
The team like the smooth and consistent induction, which makes monitoring easier. There is less wastage and smaller volumes are needed for each induction. We also don’t see pain on injection, although because we put an i/v catheter in every time, this may be part of the reason.
What advice would you give other practices considering using Alfaxan for the first time?
Ask Jurox to come in for the day and support you to do a trial in some routine procedures – they are great at providing training and support. It is also important to review other aspects of your anaesthetic protocols as well – make sure of the quality of your premeds and that they are timed correctly.
The smooth inductions time after time may mean you don’t want to go back!
What advice would you give to practice owners concerned about the cost difference?
First look at the difference in volumes needed and the reduced wastage that occurs as this reduces the cost difference. You may want to check your margins and make sure these fit the anaesthetic pricing protocol. It may be that you have to put up the price of a routine anaesthetic by £3 to £5 to allow for the use of Alfaxan and charge more for non-routine procedures – but the benefits outweigh any cost increases.
What challenges did you face when changing your induction agent and how did you overcome them?
There were very few challenges. We had to justify the costs to the practice manager and some of the team were very comfortable with propofol - change can be difficult and individuals handle it in different ways - but we made sure they were very familiar with the product and asked them to embrace the change and now they wouldn’t go back!
We made sure we trialled Alfaxan with the company present – in a controlled environment with someone who knows what they are doing so we could see how well it worked.
What pricing adjustments did you make? Has this had a negative effect on turnover or client satisfaction?
None at all!
We are a successful practice and are growing quickly. We offer good customer service and patient care and pet owners understand and appreciate that. Part of this is that pets go home to their owners after a smooth recovery with few effects from the anaesthetic. We feel Alfaxan has had the opposite effect on turnover.
In what other ways have Jurox supported your practice?
Jurox are great for CPD – we’ve had in house training on how to use Alfaxan (the Jurox vets came in for the day to help us out all the way from premedication to induction and recovery). We had some CPD on blood pressure monitoring and we have a meeting booked to receive some training on dental nerve blocks.