Articles  |   May 2013
Medication Shortages: ongoing activity for an ongoing problem
Author Affiliations
  • Richard P. Dutton, M.B.A
    Anesthesia Quality Institute
    M.D.
  • Lisa Pearlstein
    ASA Pain Medicine and Regulatory Lobbyist
    J.D
Article Information
Pain Medicine / Patient Safety / Pharmacology / Practice Management / Advocacy and Legislative Issues / Articles
Articles   |   May 2013
Medication Shortages: ongoing activity for an ongoing problem
ASA Monitor 05 2013, Vol.77, 38-39.
ASA Monitor 05 2013, Vol.77, 38-39.
In the past five years, inability to obtain specific injectable medications has become a daily occurrence in anesthesia practice. Almost every medication we use in anesthesiology has been affected – from propofol to fentanyl to succinylcholine. “What are we missing today?” has become a daily question in the operating room. As the masters of improvisation, we have learned how to substitute the drug we can find for the drug we desire, but there is an obvious risk to our patients.
Sometimes the indicated drug is demonstrably faster, safer or otherwise more efficacious – succinylcholine for rapid-sequence induction in a trauma patient, for example – and the consequence to the patient is a small, but finite, increase in risk for a complication (e.g., aspiration of gastric contents) or a delay in some aspect of care (e.g., subsequent neurologic examination). In other cases, such as substituting dexmedetomidine for propofol in ICU sedation, the clinical result is the same, but the adverse outcome is an increase in the cost of care. Subtle dangers can also accumulate when the anesthesiologist is using an unfamiliar agent. The January 2012 ASA NEWSLETTER reported on a case in which a serious medication error resulted from a change in packaging necessitated by inability to obtain the usual medication from the usual company. That we have not been deluged with such events is a tribute to the flexibility of anesthesiologists and our vigilance in preventing errors from reaching the patient. At the same time, it is our responsibility to speak up about this risk and to seek ways to mitigate it.

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