Sevoflurane: Is it time to switch?

Long gone are the days of halothane anesthesia and its associated long recovery times and lower safety margin compared with other anesthetics. Now many practices are considering changing from isoflurane to sevoflurane. One practitioner who's extremely happy with sevoflurane's rapid induction and shortened recovery time is Veterinary Economics Editorial Advisory Board member Dr. Fred Metzger, DABVP, owner of Metzger Animal Hospital in State College, Pa.

THE FIRST STEP

About eight years ago, Dr. Metzger decided that sevoflurane would improve his dental patients' quality of care. So he purchased a sevoflurane vaporizer, received in-house training from the manufacturer, and, along with his staff, learned the necessary monitoring techniques. To get the word out, he sent clients an e-mail (see example) outlining the benefits of this new service and included information in the clinic's ads.

However, most clients heard about the change in the exam room, where veterinarians could explain the improved anesthetic experience directly to pet owners. "We had clients who were reluctant to have a dental procedure done on their pets because they'd had to deal with groggy pets in the past, or they'd been told by other veterinarians that anesthesia wouldn't be safe for their pets," Dr. Metzger says. "Now we could explain that this new anesthetic agent was very safe and would speed up recovery."

A COMPLETE CHANGEOVER

Metzger Animal Hospital now has six sevoflurane vaporizers and no longer uses isoflurane at all. The practice performs five to 10 surgeries a day using sevoflurane and has yet to experience a bad reaction. To cover his increased costs (sevoflurane costs $200 per 250 ml, while isoflurane costs about $22 for the same amount), Dr. Metzger has increased his anesthesia charge by $5 to $10 per patient. Has the practice experienced any client complaints about the increase in cost? Quite simply, no. Dr. Metzger says it has actually increased compliance with dental procedures.

Dr. Metzger notes that there's nothing wrong with using isoflurane—it provides good anesthesia with minimal problems. "The jump from isoflurane to sevoflurane is nothing like the giant leap from halothane to isoflurane," he says. "It's more like switching from film to digital X-rays."

But he does believe that the key to successful anesthesia in any practice is keeping things simple and consistent. He felt that having his technicians switch back and forth between isoflurane and sevoflurane was asking for problems. So he decided to use sevoflurane exclusively.

MAKING THE SWITCH YOURSELF

While implementation costs are not insignificant, the changeover might not be as difficult or costly as most veterinarians think, Dr. Metzger says. Many clinics are overdue for having their isoflurane vaporizers serviced or replaced, which makes it a good time to upgrade to sevoflurane. And a distributor might be willing to provide a discount on a vaporizer—or even throw it in for free—if a practice purchases a large quantity of sevoflurane up front, he says. New sevoflurane vaporizers range from $1,000 to $2,000, while refurbished ones can be purchased for a little less.

Team members and doctors will need to become familiar with different vaporizer settings and patient monitoring, but training is available from most suppliers and online, Dr. Metzger says. And implementation costs are soon recovered through slightly higher anesthetic charges, more procedures being performed due to better client compliance, and a reduction in the technician and kennel time needed for recovery and hospitalization of surgical and dental patients. Perhaps most important, better surgical and postsurgical patient experiences make for reassured, pleased clients.