An ongoing shortage of several critical anesthesia medications could have serious effects on patient care and safety, according to an article in the December issue of the journal Anesthesia & Analgesia.

Of particular concern to anesthesia providers are the shortages of the sedative propofol and naloxone, an essential drug for managing opioid overdoses. Paralytics and reversal drugs are also reported to be in short supply.

Patients may face treatment delays, canceled procedures, or the use of alternative drugs less effective or more side-effect-laden drugs due to these national shortages, say researchers from Northwestern University in Evanston, Ill. The lack of available and suitable alternatives may even make matters worse.

The researchers urge anesthesia providers to take charge in managing the problem. "Proactive measures must be taken to identify, resolve and possibly prevent a medication shortage before patient care and safety are jeopardized," says Gildasio S. De Oliveira Jr., MD, the article's lead author.

Dr. De Oliveira and colleagues urge you to notify the FDA about potential drug shortages. Depending on the situation, the agency may be able to take steps to alleviate shortages by helping to obtain raw materials or clearing the way for alternatives.

"We have an obligation to report shortages, especially the ones that cause deviations from the best practices of patient care," say the researchers. They urge immediate action - such as increasing inventory, implementing policies and legislation that will boost drug production and enacting regulatory change over drug manufacturing - in order to prevent shortages from becoming a public health issue.

Mark McGraw

Elective general surgery is safe at any time of the day, during any day of the week and in any month of the year, according to a study published in the journal Anesthesia and Analgesia.

Researchers reviewed the 30-day post-op complication and mortality rates of approximately 32,000 elective surgeries performed over a 5-year span at the Cleveland Clinic in Ohio.

Risk of death was less than 0.5%, with no significant difference between cases performed at different times of the day, early or late in the week and at different times of the year. In addition, the researchers discovered no difference in complication risks, regardless of when cases were scheduled.

The study shows facility administrators can add cases late in the day or at the end of the week based solely on potential financial benefits, "because patient safety is not compromised either way," according to Franklin Dexter, MD, PhD, and Alan Marco, MD, MMM, CPE, FACPE, in an accompanying editorial.

Daniel Cook

The range of available hip implant materials - metal-on-metal, metal-on- polyethylene and ceramic-on-ceramic - are all clinically effective, but metal-on-metal options have been linked to a "potential for harm," say researchers at Weill Cornell Medical College in New York City.

After performing an FDA-funded assessment of more than 3,000 patient hips enrolled in comparative studies and 830,000 hip replacement surgeries recorded in national registries, the researchers declined to identify a clear winner among the three options.

They did, however, acknowledge clinical evidence that linked metal-on-metal implants to a greater risk of implant revision, as compared to metal-on-polyethylene implants.

While published reports have highlighted the dangers of metal ions accumulating in patient tissue following metal-on-metal hip replacement surgery, this analysis did not address metal sensitivity or toxicity because its clinical relevance and impact on quality of life has yet to be determined, according to the study, which appears in the December issue of the British Medical Journal.

The researchers are quick to point out, however, the limitations of their analysis based on differences in methodology and reporting across national registries. Before any claims of benefit are made among implant options, "there should be large, peer-reviewed clinical trials comparing these treatments," says Art Sedrakyan, MD, PhD, the study's lead author, director of the Patient-Centered Comparative Effectiveness Program and an associate professor of public health at Weill Cornell.

Daniel Cook

Is your staff getting a bonus this holiday season? Tell us in this week's InstaPoll.

The holidays are weekends this year. With Christmas Eve and New Year's Eve falling on Saturdays and Christmas and New Year's Day on Sundays, we asked whether your facility will close up shop in addition to the weekends. More than three-fourths of the 109 respondents said they will. The results: