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Archive June 2018 XIX, No. 6

Anesthesia Alert: Surviving the Anesthesia Drug Shortages

Key injectable opioids and local anesthetics are nowhere to be found.

James Grant

James Grant


IN SHORT SUPPLY From fentanyl to glycopyrrolate (pictured), anesthesiologists are having trouble accessing many of the drugs they frequently administer.

In operating rooms across the country, anesthesia providers are dealing with an unprecedented shortage of many of the injectable opioids and local anesthetics they rely on to manage patients' pain during and after surgery. It's an opioid crisis that's every bit as serious as the abuse of prescription painkillers plaguing the nation.

We have dealt with drug shortages before, but we've never seen such a prolonged and widespread shortage like the one that we are currently experiencing. The top 5 drugs in shortest supply are injectable formulations of hydromorphone, fentanyl and morphine, as well as bupivacaine and epinephrine, according to an American Society of Anesthesiologists (ASA) member survey (see "Top 10 Drugs in Shortest Supply").

The shortage has forced all of us to improvise, conserving and rationing what drugs we already have and using less familiar IV opioids, such as sufentanil and remifentanil. When we are continually changing protocols and forced to deviate from our usual practices, the chance of dosing errors is an obvious danger.

"I'm having to use much older drugs with more significant side effects that seriously impact efficiency, quality and patient satisfaction," says one ASA survey respondent. "Patient safety is also at risk since many healthcare professionals have little to no experience dealing with these older drugs."

We are all increasing our use of regional anesthesia and other multimodal techniques. The run on local anesthetics has reportedly diminished supplies of bupivacaine, lidocaine and ropivacaine, plunging them into shortage as well.

"The local anesthetic shortage caused us to suspend our acute pain service for nearly 4 weeks, resulting in patients experiencing more pain, higher narcotic usage and unnecessary admission," says a survey respondent.

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