VNJ Volume 40 (3) June 2025 | Page 37

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Finances

Financial concerns hindering practices from purchasing alfaxalone have been highlighted both in this study and by Sano et al. [ 35 ]. The same findings could be relevant to the popularity of isoflurane [ 36, 37 ]. Arguably, if prices were reduced, protocols would become more flexible; however, recommending price reductions requires reviewing evidence, which is difficult with minimal literature [ 37 ]( Table 1).

Table 1. Prices of induction and maintenance agents [ 35, 37 ].

Agent Cost(£/ kg) Cost(£/ hour)

Isoflurane

Sevoflurane

Information not provided

Information not provided

Improving patient safety

0.85

8.61

Opinions are divided on the effects of alfaxalone and propofol during the induction of anaesthesia. Scales and Clancy [ 34 ] and Amengual et al. [ 38 ] claim that both agents inevitably cause post-induction apnoea. However, when examining the differences between non-brachycephalic and brachycephalic dogs, no significant differences were identified between these agents in terms of their effects on laryngeal motion [ 39 ]. On the contrary, there is evidence to suggest that respiratory depression and hypotension are diminished when using alfaxalone, suggesting that this agent may be preferred for the induction of brachycephalic patients, which pose a higher anaesthetic risk [ 40 ].

Welsh [ 41 ] discusses the mean alveolar concentration( MAC) and blood gas solubility( BGS) of both sevoflurane and isoflurane( Table 2).

Table 2. Blood gas solubility( BGS) coefficients and minimum alveolar concentration( MAC) values of volatile anaesthetic agents [ 41 ].

Agent BGS coefficient MAC Isoflurane 1.5 1.15 % Sevoflurane 0.68 1.85 %

Isoflurane has a lower MAC, meaning less is required to maintain a surgical plane of anaesthesia. This could be argued to be beneficial for brachycephalic patients as the occurrence of cardiovascular depression is minimised due to the reduced volume of anaesthetic gas in the patient.

By contrast, sevoflurane has a lower BGS, which results in a faster onset of action and quicker changes in the depth of anaesthesia [ 42, 43 ]. Similarly, cardiovascular depression is reduced, which could be argued to be beneficial for brachycephalic patients that present with respiratory difficulties [ 34, 44 ].

Further analysis of the relationships between anaesthesia maintenance agents and cardiovascular depression in brachycephalic dogs would provide solid evidence as to which maintenance agent is better suited for these patients.

Relationship between experience and confidence

In 2020, the most common pathway into veterinary nursing was the diploma route [ 45 ]. By contrast, in this study, the most common route into the profession was the BSc( Hons) degree. The relationship between degrees and diplomas has been repeatedly discussed. Vivian et al. [ 20 ] argue that the diploma does not provide the effective problem-solving skills that can be learned while studying for a degree. Similarly, Catterall et al. [ 46 ] suggest that vocational routes lack the deep learning skills that are acquired through a degree. In this study, Bonferroni correction tests revealed no significant differences between degree VNs and diploma VNs in their confidence levels with the anaesthesia of brachycephalic patients, which runs contrary to these previous studies. Additional Bonferroni correction tests also revealed that VNs who had been qualified for 11 years or longer were more confident than those who had been qualified for less than a year. Therefore, it could be argued that VNs ' confidence levels are highly influenced by experience in practice.

There is an apparent consensus that newly qualified veterinary professionals lack self-esteem and confidence. Musk et al. [ 47 ] reported that, among veterinary students, confidence increased over time. However, they focused on only three skills, which were not anaesthesia-related. On the other hand, VNs who have been qualified for long periods of time may feel less confident monitoring brachycephalic patients if they do not frequently manage them. The concept of experience increasing confidence is stated throughout the literature, but further studies are required to solidify this statement.

Despite this debate, it is important to note that gaps in confidence and knowledge should be addressed to enable higher confidence levels. This could be achieved by colleagues providing more support to newly qualified VNs [ 48, 49 ]. In the field of human nursing, the use of CPD has been claimed to improve confidence, develop nursing care and improve patient safety [ 50 ].

Volume 40( 3) • June 2025

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