Drug shortages

[cincincyreds]

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Any of you guys dealing with drug shortages. Now we have Neostigmine.

 

[somedumbDO]

Any of you guys dealing with drug shortages. Now we have Neostigmine.

neostigmine, propofol, vec, etomidate...

 

[Direct Laryngoscopy]

There is NO succ in the hospital I'm working at today.

 

[Mman]

There is NO succ in the hospital I'm working at today.

I'd call that no surgery happening at the hospital today.

I'm in a small hospital on a critical shortage of succinylcholine right now. We are doing every case we can without it and trying to get by as long as possible until we get restocked. But I'm not starting elective cases if there isn't a vial in the room. That's a patient safety issue.

 

[deleted87051]

There is no succ in the entire country of Mexico. They get along fine without it.

 

[deleted126335]

I'd call that no surgery happening at the hospital today.

I'm in a small hospital on a critical shortage of succinylcholine right now. We are doing every case we can without it and trying to get by as long as possible until we get restocked. But I'm not starting elective cases if there isn't a vial in the room. That's a patient safety issue.

Why not start an elective case? Having a nondepolarizer immediately available is perfectly acceptable in lieu of Sux.

 

[Mman]

Why not start an elective case? Having a nondepolarizer immediately available is perfectly acceptable in lieu of Sux.

Do you change your laryngospasm algorithm to go positive pressure to propofol to vecuronium?

What about unanticipated difficult intubate/ventilate patients? Succinylcholine isn't a great drug and we can very often get by without it, but there are several scenarios you can easily imagine whereby harm can come to a patient if you don't have it.

I'd hate to be in court describing a bad outcome from a postextubation laryngospasm and they ask why you didn't try succinylcholine and your answer was that there was none in the hospital.


Would you do elective cases with no atropine or epinephrine in the hospital?

 

[Mman]

There is no succ in the entire country of Mexico. They get along fine without it.

So I'll assume you've reviewed the risk adjusted surgical/anesthetic morbidity and mortality numbers from Mexico and determined an adequately level of safety exists compared to how we practice in the United States.

 

[deleted126335]

Do you change your laryngospasm algorithm to go positive pressure to propofol to vecuronium?

What about unanticipated difficult intubate/ventilate patients? Succinylcholine isn't a great drug and we can very often get by without it, but there are several scenarios you can easily imagine whereby harm can come to a patient if you don't have it.

I'd hate to be in court describing a bad outcome from a postextubation laryngospasm and they ask why you didn't try succinylcholine and your answer was that there was none in the hospital.


Would you do elective cases with no atropine or epinephrine in the hospital?

Low dose rocuronium or vecuronium will quickly break laryngospasm Maybe not as quick as sux. So I would simply give he nondepolarizer sooner than I normally would otherwise if I had Sux. In the absence of Succinylcholine I would make do with these. Certainly wouldn't cancel elective cases.

If they are unanticpated cant intubate and can't ventilate I will have already given an intubating dose of nondepolarizer. I don't "test" to see if you can ventilate. I don't use Sux routinely.

The only instance that I would consider cancelling would be the known or strongly suspected difficult airway where I suspected both difficulty with ventilation and intubation.

I would cancel electives for no atropine or epi.

 

[Mman]

Low dose rocuronium or vecuronium will quickly break laryngospasm Maybe not as quick as sux. So I would simply give he nondepolarizer sooner than I normally would otherwise if I had Sux. In the absence of Succinylcholine I would make do with these. Certainly wouldn't cancel elective cases.

If they are unanticpated cant intubate and can't ventilate I will have already given an intubating dose of nondepolarizer. I don't "test" to see if you can ventilate. I don't use Sux routinely.

The only instance that I would consider cancelling would be the known or strongly suspected difficult airway where I suspected both difficulty with ventilation and intubation.

I would cancel electives for no atropine or epi.

Personally I would not start an elective case without access to what I consider emergency drugs including succinylcholine. It's elective for a reason. Doesn't need to be done in a situation where you could increase the risk of a bad outcome.

 

[deleted126335]

Personally I would not start an elective case without access to what I consider emergency drugs including succinylcholine. It's elective for a reason. Doesn't need to be done in a situation where you could increase the risk of a bad outcome.

I think that it is something that reasonable people can disagree about.

 

[Oggg]

Would you cancel all 300lb patients because there's no sux?

 

[Oggg]

Gosh it would suck if you were out of sux and neostigmine. Then you'd have lots if residual weakness or lots of inadequate intubating conditions

 

[Arch Guillotti]

If they are unanticpated cant intubate and can't ventilate I will have already given an intubating dose of nondepolarizer. I don't "test" to see if you can ventilate. I don't use Sux routinely.

The only instance that I would consider cancelling would be the known or strongly suspected difficult airway where I suspected both difficulty with ventilation and intubation.

I don't routinely test ventilate either. I think it's stupid.

Would you cancel a case instead of doing an awake intubation?

 

[deleted126335]

I don't routinely test ventilate either. I think it's stupid.

Would you cancel a case instead of doing an awake intubation?

The key word was "consider". Depends on clinical impression and extensive informed consent discussion.