CSA Online First

CSA Online First is a weekly blog featuring insights from CSA members themselves.

Edited by Rita Agarwal, MD, FAAP, with contributions from CSA’s Committee on Professional and Public Communications, Online First is a place where knowledge and opinion from any one of our 3200 plus physician-anesthesiologist members can be shared, discussed and deliberated to advance the specialty of anesthesiology, the practice of medicine and society in general.

"Better solutions to difficult problems are usually made when all sides are heard."

Steven Goldfien, MD

 

Anesthesiologists on the Frontlines of the Drug Shortage

by
  • Nguyen-Buckley, Christine, MD
| Aug 06, 2018

nguyen_buckley_christine_90x125“When you have a finite supply, how do you allocate that supply?” asks Joe Hong, MD, a UCLA anesthesiologist who serves as a liaison to the pharmacy department. He is one of the many anesthesiologists who is on the front lines of alleviating the effects of the drug shortage and maintaining patient safety. Dr. Hong notes that the drug shortage has significantly impacted our practice, especially the shortage of long-acting opioids. This shortage makes it challenging to match the appropriate opioid duration for individual patients.

Christine Trieu, MD, a pediatric anesthesiologist, recalls the impact of sodium bicarbonate shortage on the care of a toddler with end-stage renal disease undergoing an extensive urological procedure. The intraoperative management of the patient’s worsening hyperkalemia and acid-base status required significant communication and coordination between nephrology, pharmacy, and anesthesiology teams to control the child’s tenuous acid-base status. A sodium acetate drip was used and plans were made for immediate post-operative hemodialysis in the pediatric intensive care unit.

Cathy Cha, MD, an obstetric anesthesiologist, has been continually evaluating the supply of medications in obstetric operating rooms, to the point of knowing the exact count of bupivacaine bottles on a daily basis. She created a supply of spinal kits containing bupivacaine for medical emergencies and raised awareness among her subspecialty team regarding drugs that are running low.

Dr. Hong is working with pharmacists in identifying situations where shortages may affect clinical care. This includes keeping on top of changes in medication vials, in an effort to avoid drug errors, and informing pharmacists of medically necessary medications used in the operating room, ranging from magnesium to eye lubrication. 

Anesthesiologists have also been at the forefront of advocacy about drug shortages. ASA members have written a letter on behalf of the ASA to the FDA commissioner and Secretary of Health and Human Services, leading to a formation of an FDA drug shortages task force. The ASA also developed a registry to report drug shortages.

What is one step that anesthesiologists can all take to help with the shortage of essential medications? According to Dr. Hong, anesthesiologists can help in decreasing the burden of the drug shortages by being mindful in avoiding unnecessary wastage of medications.

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