Impact of a national propofol shortage on duration of mechanical ventilation at an academic medical center*

Roberts, Russel J.; Ruthazer, Robin; Chi, Amy; Grover, Aarti; Newman, Matthew; Bhat, Shubha; Benotti, Stacey A.; Garpestad, Erik; Nasraway, Stanley A.; Howard, William R; Devlin, John W.

doi:10.1097/ccm.0b013e31822f0af5

Cited by 19 publications

(22 citation statements)

References 8 publications

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“…6 Adverse effects of drug shortages in oncology, 7,8 psychiatry, 9 and infectious disease 10,11 have been reported, but there is a paucity of data reflecting the effects of drug shortages on the practice of anesthesia or critical care. 4,5,12 In a 2011 survey conducted by the American Hospital Association, 95% of respondents indicated that drugs for anesthesia and surgery were in short supply. 13 Another survey conducted by the American Society of Anesthesiologists (ASA) revealed that drug shortages in anesthesia were associated with adverse patient outcomes, including death.…”

Section: Résumémentioning

confidence: 99%

Drug shortages in Canadian anesthesia: a national survey

Hall

Bryson

Flowerdew

et al. 2013

Can J Anesth/J Can Anesth

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Background Canadian physicians are faced with an increasing frequency of drug shortages. We hypothesized that drug shortages have a clinical impact on anesthesia care in Canada. Methods We conducted a self-administered survey of anesthesiologists in Canada using the membership list of the Canadian Anesthesiologists' Society. For survey development, we identified key domains, including types of drug shortages, impact on the ability of anesthesia practitioners to provide general anesthesia care, and impact on patient outcomes. We undertook assessments of face validity, clinical sensibility, and content validity. Respondents were surveyed from January-April 2012. Results Completed valid questionnaires were submitted by 1,187 respondents (61.4%), and 779 (65.7%) of respondents described a shortage of one or more anesthesia or critical care drugs. Changes in anesthesia practice resulting from drug shortages were common; 586 (49%) respondents thought they had given an inferior anesthetic, and 361 (30%) reported administering medications with which they were unfamiliar. Respondents also reported that drug shortages were, at times, responsible for changes in the conduct of patient care, with 28 (2.4%) noting cancellation or postponement of surgery and 92 (7.8%) witnessing a drug error. One hundred sixty-five (13.9%) respondents regarded drug shortages as having prolonged recovery from anesthesia, and 124 (10.5%) viewed drug shortages as resulting in an increased number of postoperative complications, such as postoperative nausea and vomiting. Interpretation Drug shortages are common in anesthetic practice in Canada. This state of affairs may have a negative effect on how anesthesiologists practice anesthesia and may be associated with adverse patient outcomes. 123Can J Anesth/J Can Anesth (2013) 60:539-551 DOI 10.1007/s12630-013-9920-z Résumé Contexte Les me´decins canadiens font de plus en plus souvent face a`des pe´nuries de me´dicaments. Nous avons e´mis l'hypothe`se que les pe´nuries de me´dicaments avaient un impact sur les soins en anesthe´sie au Canada. Méthode Nous avons re´alise´un sondage auto-administreá upre`s des anesthe´siologistes au Canada en nous fondant sur la liste des membres de la Socie´te´canadienne des anesthe´siologistes. Lors de la mise au point du sondage, nous avons de´termine´des domaines cle´s, notamment les types de pe´nuries de me´dicaments, l'impact sur la capacite´des fournisseurs d'anesthe´sie a`offrir des soins d'anesthe´sie ge´ne´rale, et l'impact sur les devenirs des patients. Nous avons e´value´la validite´apparente, la sensibilite´clinique, et la validited u contenu. Les re´pondants ont reçu le sondage entre janvier et avril 2012. Résultats Au total, 1187 (61,4 %) re´pondants ont comple´ted es questionnaires de façon valable, et 779 (65,7 %) de ces re´pondants ont de´crit une pe´nurie d'un me´dicament ou plus utilise´en anesthe´sie ou en soins critiques. Les changements dans la pratique de l'anesthe´sie dus a`des pe´nuries de me´dicaments e´taient courants; 586 (49 %) re´...

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Section: Résumémentioning

confidence: 99%

Drug shortages in Canadian anesthesia: a national survey

Hall

Bryson

Flowerdew

et al. 2013

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

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“…Realizing that the ECMO tubing and the membrane oxygenator of the ECMO circuit increase the drug volume of distribution and provide a large surface area for drug adsorption, further research is needed to evaluate the effect of the ECMO circuit on sedative pharmacokinetics and sedative response . Future ECMO sedative investigations will need to consider the complex distribution of sedatives between different body compartments, the various genomic and dynamic factors that affect sedative removal and clearance, and the numerous factors that will affect sedative response and patient outcome …”

Section: Discussionmentioning

confidence: 99%

“…The maximum amount of sedation administered in any 6‐hour period was therefore deemed, for the purposes of the study, to reflect the time during each patient's ICU stay during which sedative therapy first reached the desired therapeutic sedation goal and served as the primary outcome for the investigation. This 6‐hour window was based on the expected high frequency of benzodiazepine infusion use in the study population and has been used to characterize periods of ICU sedative exposure in other studies . Other important sedation‐related secondary outcomes compared between the two groups included the time to reach the maximum amount of sedation administered, the total cumulative amount of sedation administered to reach this maximum, and the total cumulative amount of sedation administered during the defined period of data collection.…”

Section: Methodsmentioning

confidence: 99%

“…A literature review was used to identify factors other than ECMO use that could influence the maximum amount of sedation administered over a 6‐hour period to patients with severe ARDS . At the time of ICU admission, these included the following: age, weight, severity of illness (as characterized by both the Sequential Organ Failure Assessment [SOFA] and APACHE II scores), and history of either a major psychiatric disorder or chronic alcohol use.…”

Section: Methodsmentioning

confidence: 99%

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Effect of Extracorporeal Membrane Oxygenation Use on Sedative Requirements in Patients with Severe Acute Respiratory Distress Syndrome

et al. 2016

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“…Ideally, audits will be immediately initiated to monitor the consequences of shortages as they occur. As an example of good practice, intensivists in Boston were able to show that restricted use of propofol sedation during a period of shortage did not adversely effect patient outcome [23].…”

Section: What Can Anaesthetists Do Now?mentioning

confidence: 99%