More on the Sux shortage

[Intubate]

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So, we're basically out of sux now and dont expect any more until maybe Feb. We've got 6 vials at the hospital and 2 at our surgery center. We've had to stop doing ECTs (can't really think of a way around this, other than smoking it on the vent until roc wears off). Even though we really don't NEED it most of the time, it seems like substandard care to not have it available at all. How is this going to hold up in court if there is a problem in an elective case that could have been solved/averted by having sux around? I'm concerned. Anyone else?

 

[deleted126335]

So, we're basically out of sux now and dont expect any more until maybe Feb. We've got 6 vials at the hospital and 2 at our surgery center. We've had to stop doing ECTs (can't really think of a way around this, other than smoking it on the vent until roc wears off). Even though we really don't NEED it most of the time, it seems like substandard care to not have it available at all. How is this going to hold up in court if there is a problem in an elective case that could have been solved/averted by having sux around? I'm concerned. Anyone else?

Have a syringe of Rocuronium always around. It will work for laryngospasm. You just have to make do with what you have.

 

[pgg]

We're down to 4 bottles, reserved for peds emergencies (and not drawn up in advance). We keep one on the OB cart. Roc is the routine RSI drug for us now.

What can you do? I don't think safety is compromised. We really haven't had much trouble with patients needing postop intubation until they're reversible from a 1.2 mg/kg dose of roc.

 

[dbiddy808]

How often do you REALLY need to do a RSI (bowel obstruction with NG pouring out). I work 70-80 hours a week at a level one trauma center/county hospital and REALLY need to do it once every 3-4 months. Preoxygenate, give 20-30 of roc and wait a minute. If they cough a bit once the tube is in it is not a big deal. If you give 1.2 mg/kg to everyone you will be bringing a lot of patients to the pacu intubated.

 

[deleted162650]

Anyone tried Alfentanil 30mcg/kg in lieu of muscle relaxant for induction?

 

[lord_jeebus]

Anyone tried Alfentanil 30mcg/kg in lieu of muscle relaxant for induction?

I have tried this twice in the past month. It worked, but both times the cords were completely closed on laryngoscopy (about 60 seconds after alfentanil) and I had to wait 30-60 seconds before they opened enough to advance the ETT atraumatically. In the future I may try higher doses.

 

[Mman]

So, we're basically out of sux now and dont expect any more until maybe Feb. We've got 6 vials at the hospital and 2 at our surgery center. We've had to stop doing ECTs (can't really think of a way around this, other than smoking it on the vent until roc wears off). Even though we really don't NEED it most of the time, it seems like substandard care to not have it available at all. How is this going to hold up in court if there is a problem in an elective case that could have been solved/averted by having sux around? I'm concerned. Anyone else?

Did your hospital restrict use prior to having so little around? When we got down to 200 vials or so, we greatly put the brakes on the use of sux. Stopped all ECTs and really only used it on cases that needed a true RSI. We got through for 2 weeks like that and got a relatively large shipment, but we are still trying to avoid as best we can until stock is back to normal.

 

[urge]

I have done ECTs with atracurium in a MH patient. Worked ok. Took a little longer before you zapped them. Recovery wasn't so long.

 

[Apollyon]

I have done ECTs with atracurium in a MH patient. Worked ok. Took a little longer before you zapped them. Recovery wasn't so long.

"Malignant hyperthermia" or "mental health"? Or something else?

 

[cchoukal]

I have tried this twice in the past month. It worked, but both times the cords were completely closed on laryngoscopy (about 60 seconds after alfentanil) and I had to wait 30-60 seconds before they opened enough to advance the ETT atraumatically. In the future I may try higher doses.

I saw a poster at SAMBA a couple years ago showing data for prop/remi for RSI. I can't say I remember a ton of the details, but the authors concluded similar views/intubating conditions w/ the remi...

 

[Arch Guillotti]

Anyone tried Alfentanil 30mcg/kg in lieu of muscle relaxant for induction?

That seems like a lot of alfenta - are you giving some propofol as well - and how much if you are?

 

[Arch Guillotti]

"Malignant hyperthermia" or "mental health"? Or something else?

Both😀.

MH refers to malignant hyperthermia (no sux for ECT's).

 

[Arch Guillotti]

How often do you REALLY need to do a RSI (bowel obstruction with NG pouring out). I work 70-80 hours a week at a level one trauma center/county hospital and REALLY need to do it once every 3-4 months. Preoxygenate, give 20-30 of roc and wait a minute. If they cough a bit once the tube is in it is not a big deal. If you give 1.2 mg/kg to everyone you will be bringing a lot of patients to the pacu intubated.

I agree that honest to god full blown RSI's are probably overrated and that you can probably do the trick with less roc than the usual 1.2 mg/kg - but 20-30 sounds low, why not give the whole 50?

 

[Apollyon]

Both😀.

MH refers to malignant hyperthermia (no sux for ECT's).

Well, I figured, but I had to ask.

 

[seinfeld]

I saw a poster at SAMBA a couple years ago showing data for prop/remi for RSI. I can't say I remember a ton of the details, but the authors concluded similar views/intubating conditions w/ the remi...

Did that once, ended up with sever muscle rigidity and had to use NMB anyway.

 

[pjl]

You may be able to have your pharmacy draw the vials up under a sterile hood in small volume syringes for you pediatric emergencies, and then you wouldnt waste a whole vial by contaminating the remaining. And then stick with roc for adults.

 

[Frank Rizzo]

How often do you REALLY need to do a RSI (bowel obstruction with NG pouring out). I work 70-80 hours a week at a level one trauma center/county hospital and REALLY need to do it once every 3-4 months. Preoxygenate, give 20-30 of roc and wait a minute. If they cough a bit once the tube is in it is not a big deal. If you give 1.2 mg/kg to everyone you will be bringing a lot of patients to the pacu intubated.

Must be a slow level one center if your not dealing with multiple as$clowns with GSW's to the abdomen everynight.

 

[deleted162650]

Arch,

It is alot of alfenta but still goes away pretty quick. Still give propofol, usually a normal induction dose (maybe a little less). The alfenta basically just replaces the NMB.

 

[lord_jeebus]

Arch,

It is alot of alfenta but still goes away pretty quick. Still give propofol, usually a normal induction dose (maybe a little less). The alfenta basically just replaces the NMB.

This is how I do it as well. I have given higher doses of alfentanil for rigid bronchs with tracheal stenting without significant residual narcotic effects afterwards.

 

[sevo85288]

Hospira has restarted full production as of last week. Will take 2 month to finish "channel stuffing" of product. Should be back to normal in Jan. In the meantime, Sandoz makes and has some Sux available to distribution.

 

[dbiddy808]

Must be a slow level one center if your not dealing with multiple as$clowns with GSW's to the abdomen everynight.

Most of the time you can wait a minute even if someone was shot or stabbed in abdomen was my point, or push 50 of roc like someone else mentioned.