Lake View Veterinary Centre is based near Kettering, Northamptonshire. Their premises are a state-of-the art, purpose built animal care facility, specialising in the treatment of small animals. The team offer exceptional pet care and treatment. Their ethos is very much about providing a great service to pets and their owners – they have a client charter, which encourages staff to listen, ask for feedback and treat pets as if they were their own. Lake View is a member of the IVC veterinary group.
Phil, the clinical director, qualified from the Royal Veterinary College, London in 1974. He is a very experienced small animal clinician with a particular interest in dermatology and reconstructive surgery.
What was your main anaesthetic protocol before you made the move to Alfaxan?
It is important for us to have a practice protocol for most procedures – we have a standard pre-med regime, usually acepromazine, with either buprenorphine or methadone, depending on the procedure. Before Alfaxan we induced patients with propofol but had a few issues with it. We use Sevoflurane as our standard gaseous maintenance agent. We try not to deviate from the protocol, unless patient needs dictate we do so, to avoid confusion for the team.
How did you hear about Alfaxan and what were your initial thoughts about using the product?
We’ve been using Alfaxan here for years, so it is difficult to remember the days before.
We were having some issues inducing patients with propofol, despite us slowing down our administration speed; mainly apnoea and hyper-excitability during transition and occasional hyper-excitation upon recovery. I am always keen to try new approaches if it helps to solve a problem. I was also conscious that a change to an anaesthetic protocol may make the staff nervous and uncomfortable so there had to be a good reason for the move away from propofol. I do read the veterinary press and company correspondence, so am aware of new products when they become available and the company were very supportive when we approached them for more information.
What helped you to make the decision to use more Alfaxan?
We wanted to reduce some of the challenges faced with other induction agents plus we liked the smaller volumes that are needed with Alfaxan. I read the data available on the product, spoke to the company, decided what was best for us and made the switch based on all available information as I felt it was best for our patients.
Did you start using Alfaxan first line immediately or did you use in specific cases first?
We moved over to Alfaxan completely in all appropriate cases. I didn’t see any point in using it just for the odd case as this approach wouldn’t give me the information I needed to assess its true benefits to patients, plus I didn’t want any confusion for the monitoring team. We were confident we already had a good anaesthetic protocol and the change to Alfaxan was just progressing that even further. As it is the veterinary surgeon that administers the induction agent to all patients and is present during the transition phase I felt that our nurses were well supported during this part of the anaesthetic process, so the switch was not a problem for us, plus the company support we had when we switched meant there were no major problems.
Do you use any other induction agents and, if so, in which cases?
Not really – Alfaxan is so versatile we are confident using it in pretty much all cases. We very occasionally use triple combination plus midazolam for routine early neutering of cats
Alfaxan costs more than propofol – why is this not a problem for you?
Anaesthesia should be about what clinicians think is the best option for the animal. Alfaxan is not too expensive – especially when priced as part of the whole protocol. We do find there is much less wastage with Alfaxan as well, which reduces much of the cost differential.
How do you justify using a premium induction agent in price sensitive procedures?
We don’t offer a choice of anaesthetic protocol to pet owner’s as almost every time they will take what we think is best for their pet, even if it costs slightly more. There are many factors involved in fixing the price of “ring arounds” and the use of Alfaxan is not one we consider generally, as its use on clinical grounds over rides cost considerations.
How do you think your patients benefit from being induced by Alfaxan?
Alfaxan is just part of what we consider to be a fantastic anaesthetic protocol, including the premed and maintenance agents. Patients experience a smooth, stress free induction and move to a stable plane of anaesthesia quickly. Recoveries are rapid with little hyper-excitation.
How do you think your staff benefit from using Alfaxan as an induction agent?
The team love using Alfaxan and wouldn’t go back. The whole process is smooth and the team are confident. We all have regular training from Jurox and are very happy with the support we receive.
What advice would you give other practices considering using Alfaxan for the first time?
Go for it! Having worked with a number of induction agents over the years, the protocol we have now is where we want to be. I have no concerns about anaesthetising virtually any patient – age or illness are not barriers now, just points for consideration. I’ve been using Alfaxan for quite a while now and am able to look at the bigger picture for my patients, my practice and for my team.
What advice would you give to practice owners concerned about the cost difference?
Look at the whole process - what are the total costs of all components of the anaesthetic protocol not just the individual induction agent. There are other interesting ways of reducing the cost of anaesthesia, without compromising quality - e.g. an oxygen generator will reduce the costs of cylinder hire, low flow anaesthetic circuits reduce gaseous anaesthesia costs. The benefits of Alfaxan outweigh the increase in costs, which are small compared to the overall anaesthetic fee. Owners and their pets are receiving a high quality anaesthetic protocol, which reflects well on our clinic.
What challenges did you face when changing your induction agent and how did you overcome them?
As long as change confers advantages to our patients and our clinic, we are keen to embrace change and happy be taken out of our comfort zone. The training we received from the company meant switching was easy with few issues.
What pricing adjustments did you make? Has this had a negative effect on turnover or client satisfaction?
It is important to look at the bigger picture - we have a very profitable practice and changing to Alfaxan made no difference to that. We look at the total drugs and consumables bill as a percentage of our sales – this has not changed since we switched to Alfaxan.
In what other ways have Jurox supported your practice?
Apart from support during the switch over, we’ve had a range of CPD talks from a highly trained vet on various topics associated with anaesthesia, a set of scrub tops plus ongoing technical help as we need it. The ongoing anaesthetic support from Jurox – over and above ‘induction’ has been great and very valued by our clinic.