Rappie Posted March 25, 2011 Share Posted March 25, 2011 Thio is also a very signifcant danger to sighthounds because it's a barbituate and the amount given according to weight is far too much for sighthound to metabolise. I don't use thiopentone currently, but I have previously. It's a useful drug to use in appropriate patients, but despite all the advances, there is no perfect drug for anaesthesia. Giving an induction agent according only to weight is an anaesthetist problem, not a drug problem - induction agents should always be given to effect. Alfaxan given to a sighthound without sufficient or appropriate premedication is pretty horrible too. In my hands, perivascular irritation should be a non issue because IMHO any patient undergoing a general anaesthesia should have an IV catheter in place, prior to induction. It's also prudent to dilute the thiopentone to 2.5% and in the event of leakage, take measures to dilute further. Link to comment Share on other sites More sharing options...
Inevitablue Posted March 25, 2011 Share Posted March 25, 2011 The hypertension Thio causes compromising the kidneys, the horrible headache many dogs seem to have after it, the whole depression of the cardiocascular system. I do agree that the vet has to be comfortable with whatever they are using, but I still think most dog owners would prefer to pay the little bit more for the extra safety margin. None of us are on DOL using Commodore 64's, times have evolved to a better product, just like anesthesia. Oh..and I was still a littlie when Commodore 64's were in use.... Link to comment Share on other sites More sharing options...
Rappie Posted March 25, 2011 Share Posted March 25, 2011 All anaesthesia causes hypotension to some degree, it's one of the very good reasons to have patients on IV fluids. Propofol can cause temporary but profound hypotension and respiratory depression. Many vets still believe a mask induction is the safest method of anaesthesia, but the potential for catecholamine release makes me cry on the inside. I use Alfaxan because it is the drug I have most experience with, I have very good results with it and it's predictable. If the situation calls for it, such as an epileptic patient, or one with heart disease then I modify my anaesthetic plan to suit. An excellent anaesthesia instructor once told me that the anaesthesia takes the patient one step closer to death. The skill is not in getting them there, it's bringing them back. Was she being blunt? Yes, probably. Was she right? Yes, absolutely. Getting them to sleep is the easy part - but planning and providing a balanced anaesthesia using principles of neuroleptoanalgesia is another thing entirely. Link to comment Share on other sites More sharing options...
stormie Posted March 25, 2011 Share Posted March 25, 2011 The hypertension Thio causes compromising the kidneys, the horrible headache many dogs seem to have after it, the whole depression of the cardiocascular system. I do agree that the vet has to be comfortable with whatever they are using, but I still think most dog owners would prefer to pay the little bit more for the extra safety margin. None of us are on DOL using Commodore 64's, times have evolved to a better product, just like anesthesia. Oh..and I was still a littlie when Commodore 64's were in use.... Ah well, like I said, if it's good enough for Colin and the Specialist Centre to be happy to use, then it's still good enough for me Link to comment Share on other sites More sharing options...
Erny Posted March 25, 2011 Share Posted March 25, 2011 I wrote it down but now can't find my note (if you could see my desk you'd understand why ) .... but when Mandela had his teeth procedure recently, they used something that the nurse described as "ACE". I know it's not spelt that way, but that's apparently what they call it. What's the opinion of that as an anaesthetic? Sorry, somewhat off topic but seems an appropriate place to ask here . Cheers Erny Link to comment Share on other sites More sharing options...
Inevitablue Posted March 25, 2011 Share Posted March 25, 2011 Ah well, like I said, if it's good enough for Colin and the Specialist Centre to be happy to use, then it's still good enough for me hehe... I'd be lost debating this with Colin! but I am surprised (to be honest) that he prefers it over the non barbituates Link to comment Share on other sites More sharing options...
Rappie Posted March 25, 2011 Share Posted March 25, 2011 Acepromazine is a sedative drug. It's a regular feature in most 'normal' premedications, in combination with an opiod drug like methadone. In this combination, it's a reliable drug to use. It's traditionally used for travel sickness / sedation but IMHO there are better drugs to use for both purposes now. Link to comment Share on other sites More sharing options...
Erny Posted March 25, 2011 Share Posted March 25, 2011 (edited) Thanks Rappie. I'm going from memory because I can't find my notes, but I think the nurse said it was used for induction and then they used gas. Does this sound right and is this a good method/combo for a procedure such as teeth cleaning? He came through it ok, so I'm happy enough ..... but just wondering for the future. ETA: I should add that my boy has no fat on him at all. Edited March 25, 2011 by Erny Link to comment Share on other sites More sharing options...
fifi Posted March 25, 2011 Share Posted March 25, 2011 The ace/meth combo would have been the pre-med Erny, and then they would have used an IV induction agent, such as we've been desribing here, then onto gas (Isoflurethane usually) fifi Link to comment Share on other sites More sharing options...
fifi Posted March 25, 2011 Share Posted March 25, 2011 Oh, and back to the topic, yes - the quote sounded way over what I'd consider normal pricing. fifi Link to comment Share on other sites More sharing options...
Rappie Posted March 25, 2011 Share Posted March 25, 2011 (edited) Acepromazine is not used for induction. A 'typical' routine would be acepromazine and methadone (or butorphanol if the procedure is not painful, or buprenorphine) sedation, then induction with an injectable drug (such as alfaxan or propofol), then maintenance on isoflurane (gas). I'm not sure which induction agent they would be referring to that sounds like 'Ace' (which is how we refer to acepromazine). Edited March 25, 2011 by Rappie Link to comment Share on other sites More sharing options...
Erny Posted March 25, 2011 Share Posted March 25, 2011 The ace/meth combo would have been the pre-med Erny, and then they would have used an IV induction agent, such as we've been desribing here, then onto gas (Isoflurethane usually)fifi Thanks. I obviously don't understand this stuff well enough. I'll start a different thread, because I have a question and don't want to veer more off topic than I have already. Link to comment Share on other sites More sharing options...
NBT Posted March 25, 2011 Share Posted March 25, 2011 Hi all,Took my dog to be neutered today - had made the appointment two weeks ago. While standing in the waiting room after he had been led off I was told that he should also undergo a thorough blood test which would ensure that the absolutely right anaesthetic for him could be administered correctly as it would reveal info about his kidney and liver etc. It would also reveal if he had any issues so they could be dealt with promptly. The cost would be $240.00 I declined. They then said that they were now recommending all dogs undergoing a GA to have fluid therapy - they explained the advantages of it to me - and it sounded great. The cost was another $200 I declined They then said that while he was under the anaesthetic they could remove his hind dew claws - at the very cheap rate of $90.00 Again I declined. I came away feeling terrible as most of these procedures sounded like things I should certainly have done for my boy but why on earth didn't they mention them when I made the initial appointment so I could have budgeted so much more? Is this usual practice? PS they did clip his claws free of charge! Change Vets!!! I'd be not going back to him. - Ridiculous prices, and poor professionalism. Link to comment Share on other sites More sharing options...
Flick_Mac Posted March 25, 2011 Share Posted March 25, 2011 I'd have to agree with Stormie, Rappie, and Staff'n'Toller... We're just learning anaesthetics at uni, and while we're being taught what is currently considered 'best practice', including IV catheterisation etc, a lot of us work for vets who don't do what we're being taught. Our anaesthetics lecturer tells us that people get very good at using whatever it is (Thio, draw-over breathing systems etc) and wouldn't be using them if patients were dying. We're also being taught with less than the best systems (in fact we have to learn to use about 4 different types) and use different induction agents, because we don't know what will be available to us at our first job. I agree those prices sound ridiculous, but if the vet has been using Thio for years and years I'd rather them use that on my pet than a drug they're less familiar with. Link to comment Share on other sites More sharing options...
Mrs Rusty Bucket Posted March 25, 2011 Share Posted March 25, 2011 My EH was desexed when I got her, but if a vet did something like this to me for non-urgent surgery, I would say "that's an awful lot to think about, I think I'll go home with my dog now". Ie b*gger the surgery appointment. I think it's best for vets to be upfront about costs. It would be nice if they were a bit more consistent on price, but I guess none of them have the same rent or expenses either and it's up to us to shop around. I think I'd be more angry if I went to pick EH up from surgery and the vet said it will cost $XYZ more than we quoted you because we did all this extra stuff without asking you first and for which we charge way more than anyone else in the area. For emergency surgery I would expect an estimate on price range ie reasonably expected lower range if all goes well and upper range if it doesn't, and an estimate on doggy quality of life post surgery. Some people are ok with spending what ever it takes, no matter what, and some are not. Link to comment Share on other sites More sharing options...
Staranais Posted March 25, 2011 Share Posted March 25, 2011 My anaesthesia lecturer likes Thio for induction in some patients and some circumstances. She's bloody brilliant at what she does, so I trust her judgement. I personally think that what anaesthetic drugs are used (within reason) is the least important part of safety in anaesthesia for a healthy dog or cat. From what I've seen, the ability of the vet to recognise and respond to intra-op problems, intra and post-op nursing care, and especially the quality of patient monitoring during anaesthesia, are much more important for patient outcome. Link to comment Share on other sites More sharing options...
Kiramon78 Posted March 25, 2011 Share Posted March 25, 2011 All animals undergoing an anaesthetic in our practice are placed on iv fluids regardless. If the animal is sick or compromised they may be placed the night before or continue after the procedure, in which case this is additional. They never cost $200! We offer pre-anaesthetic bloods to all our patients to give peace of mind, we recommend them to senior animals or ones that have been unwell. The hind dew claws I can understand as sometimes you don't see the animal until the morning of the procedure and again, it's offered, not pushed. We don't charge for different induction drugs either, all our animals are given an ace/meth premed and are given meth post-op if required at no additional charge. I get really frustrated when people say we are more expensive than XYZ down the road when we actually offer more than they do and like Rappie said in another post, have dedicated experienced & qualified nurses monitoring the GA with all the latest equipment. It's shocking to see that in this age, vet clinics still charge extra for fluids. I am proud of what I do and the way our clinic does procedures. I just wish people would compare apples to apples. These added extras is where the 'cheaper' clinics make their money. Link to comment Share on other sites More sharing options...
Bluefairy Posted March 25, 2011 Share Posted March 25, 2011 When my Aussie Bulldog went in to be desexed, I was also offered a list of extras with it. I opted for the fluids, as they said it helps them recover better. But like most of you it only cost me an extra $25..... But when I went to pick up my poor little baby, her face was swollen up like a balloon, she had an allergic reaction to one of the drugs they used and she had already been given antihistamines....she had her head hanging almost to the floor, she slept for 24hrs without moving, 48hrs later she was back to her old self. So the IV fluids didn't help her recovery at all anyway. As I also have a bad time with GA's I knew how she felt. But that was really scary. They had it printed in red they were never to use that drug again....poor pup. BF Link to comment Share on other sites More sharing options...
Bow Wowy Posted March 26, 2011 Share Posted March 26, 2011 Our clinic explains IV fluids in the desexing letters we send out. We leave it as optional as the extra $61.60 is more than some people can afford unfortunately. My vet says she would rather people have cheaper desexing and have people actually spey/neuter their animals than bump up the price to include fluids and put people off the surgery. If people are enquiring over the phone we quote the price and also inform them of the optional fluids. Fluids are not optional on our non-routine surgeries but are included in any quotes we give. Link to comment Share on other sites More sharing options...
Jumabaar Posted March 26, 2011 Share Posted March 26, 2011 When my Aussie Bulldog went in to be desexed, I was also offered a list of extras with it. I opted for the fluids, as they said it helps them recover better. But like most of you it only cost me an extra $25.....But when I went to pick up my poor little baby, her face was swollen up like a balloon, she had an allergic reaction to one of the drugs they used and she had already been given antihistamines....she had her head hanging almost to the floor, she slept for 24hrs without moving, 48hrs later she was back to her old self. So the IV fluids didn't help her recovery at all anyway. As I also have a bad time with GA's I knew how she felt. But that was really scary. They had it printed in red they were never to use that drug again....poor pup. BF It probably helped her while she was having the reaction!!! Link to comment Share on other sites More sharing options...
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