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ANESTHESIA ALERT
It depends. If you think the increased risk of morbidity or mortality is negligible, there's no need to discuss the issue when
obtaining informed consent. But if you think the added risk may be
significant, the discussion and plans should be part of the informed
consent process. Some medications may be virtually seamless substitutes for the usual drug, such as the antihypertensive metoprolol for
labetalol or the muscle relaxant cisatracurium for vecuronium. Others
can have a definite and profound impact on the patient's experience.
They might, for example, increase the risk of PONV, or, because they
have longer half-lives, increase overall effects. The shortage of succinylcholine, for which there is no substitute, could lead to prolonged
paralysis in the recovery room. Not having enough epinephrine on
hand could lead to inadequate hemodynamic control after major surgery.
A.
Is there anything I can do to make my supply last longer?
Q.
A.
When you're faced with shortages, it makes sense to reassess
use patterns and look for ways to minimize waste. You might,
for example, question whether all possible emergency drugs need to
be drawn into syringes. It may be sufficient to keep them available in
their original packages. You might also be able to use smaller vials,
when available. The thing you must never do, however, is create your
own rules for dividing ampules or bottles, with the goal of sharing the
drugs among multiple patients. There are strict guidelines for how to
do that, and if those rules don't make sense to you, the best approach
is to advocate for amending them.
