How Are You Dealing With the Propofol Shortage?

As everyone is aware by now there is a propofol shortage due to manufacturing problems at the 2 big manufacturers; TEVA and Hospira. I sat in on the FDA conference call last week and it sounds like there may be a 25% shortage for some time to come even as the manufacturers come back on line during the next few weeks. There are reports of price gouging. I am paying 33% more to get Diprivan and the quantities seem limited if available at all! There is also a shortage of Sodium Pentothal.

During the conference call one caller asked about dividing up the 50cc or 100cc vials under aseptic conditions into single use 10 or 20cc syringes to be used within several hours on different patients. (one syringe for one patient) The FDA rep. and the ASA rep. would not endorse this technique even in lieu of the shortage. FDA, ASA and AANA have position statements "discouraging" this practice developed in the wake of the harm done to patients in NV where practitioners reused syringes and vials on multiple patients.

Has the current shortage caused your anesthesia providers to re-evaluate their use of single dose vials using aseptic technique, for multiple patients? If not, what do your anesthesia providers consider the vector of contamination to be?

Started by: Jay Horowitz (Other) at November 11, 2009 (12:48 pm)

Comments and Responses

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It is quite a challenge. First of all... Propofol is used in MAC (monitored anesthesia care) which traditionally encompasses a depth of sedation greater than "conscious sedation". It typically targets deep sedation.
Our group was one of the first in the country to use Lusedra ( fospropofol). We are targeting a higher dosing range to get desired depths of sedation. It has worked very nicely. In addition, welcome discussions on a blog we are setting up: propofolshortage.com so that we can get some true dialogue without limitations.
Thanks very much.
Stanford P. MD

Stanford P. (Anesthesiologist/Nurse Anesthetist) at July 6, 2010 (10:49 am)

we use fentanly and versed instead
Susanna Shipman, RN

Susanna Shipman (Director, Surgical Services/Director of Nursing) at July 6, 2010 (10:33 am)

Our Surgery Center is using Propoven and our anesthesia group has not complained. The cost is relatively the same as propofol and the affects are equally the same. I would like to see these drugs made in smaller use so less waste takes place. It is so wasteful to use 20 ml of propofol or propoven on one patient who only requires 5 or 10 ml. The company needs to re-evaluate the single use dosage.
Jane D. (Clinical/OR Director) July 6, 2010

Jane D. (Administrator/Director/Manager/Owner/Exec. Officer) at July 6, 2010 (7:47 am)

Our facility is using the new IV product Lusedra (it's the prodrug of Propofol) It has a slower onset than Propofol, but it's VERY SMOOTH and we have very little changes in pt's hemodynamics. We are using Lusedra with a modified inhalation induction technique (with N2O) to induce general anesthesia. Thought we would try it because of an acute Propofol shortage and have fallen in love with it. No need for infusion pumps and multiple vial usage of Propofol. We have been giving small doses (a couple of minutes prior to bolus) to eliminate perineal puritis side effect.

DARYL C. (Anesthesiologist/Nurse Anesthetist) at June 23, 2010 (1:16 am)

We ordered Propoven and our CRNAs haven't complained.

Aimee V. (Director, Surgical Services/Director of Nursing) at March 3, 2010 (9:04 am)

We just ordered a large amt. to hold us over but know finding out they are only giving so much to each facility. We are looking into other options. OUr challenge is what to do with the single dose vial issue... there is so much waste and it is so costly. Kim M. (Nurse Adm.)

Kim Merrill (Director, Surgical Services/Director of Nursing) at February 24, 2010 (8:24 am)

Our ASC is using Amidate currently. We did learn of having propofol ordered from the UK which a local hospital is doing. However; the cost is 3x as much.

Debbie Perry (OR Manager/Supervisor) at February 23, 2010 (12:12 pm)

Our hospital went back to using older agents such as Brevital, cheaper and has the similar actions.

David K. (OR Manager/Supervisor) at February 7, 2010 (11:31 am)

Relevant story on www.outpatientsurgery.net:

http://www.outpatientsurgery.net/news/2009/11/8

Stan Herrin (Other) at November 17, 2009 (5:30 pm) [last edited on November 18, 2009 (9:15 am)]

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