Opioid Shortages

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We run out of everything temporarily. LR, syringes, blades, etc.
 
banister said:
Opioid shortages leave US hospitals scrambling - CNN

Does anyone else's hospital have this problem? We've been out of dilaudid for over a month now and are critically low on fentanyl, morphine, and ketamine. Many of us are moving onto IV methadone, demerol, alfentanil...
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Same here. Methadone, Toradol, alfentanil, pre-op tylenol and gabapentin, regional when feasible are some of the options we are using.
 
Um, didn’t you get the memo, opioids are bad, especially fentanyl, it’s in street drugs now.... I’m convinced a lot of this fentanyl/dilaudid shortage is reactionist propaganda driven. Though it could just be the run of the mill off patent, low profit margin, single manufacturer deciding their facilities are better used generating profit scenario.

If you had a factory that was making fentanyl for small gains would you continue making it in the current PR situation?
 
POW16 said:
Same here. Methadone, Toradol, alfentanil, pre-op tylenol and gabapentin, regional when feasible are some of the options we are using.
Click to expand...
Coming soon to a PACU near you: biting down on wood.

iu
 
We are in a critical shortage of fentanyl but part of this is being generated by locational allocation- all our 2ml vials in the main OR were replaced with 5ml vials (we rarely use more than 1-2 ml per case, so we end up wasting most of each vial) and the heart rooms were given 2ml vials and all their 5ml vials were removed. So for hearts, they are opening 7-14 vials per case. I told the pharmacy director about this 2 1/2 weeks ago but there have been no changes......go figure.
 
How is everyone dosing methadone? What kinds of procedures are you using it for? Just curious, I've actually never used it in the OR
 
algosdoc said:
We are in a critical shortage of fentanyl but part of this is being generated by locational allocation- all our 2ml vials in the main OR were replaced with 5ml vials (we rarely use more than 1-2 ml per case, so we end up wasting most of each vial) and the heart rooms were given 2ml vials and all their 5ml vials were removed. So for hearts, they are opening 7-14 vials per case. I told the pharmacy director about this 2 1/2 weeks ago but there have been no changes......go figure.
Click to expand...

That makes no sense. Our heart rooms get 20ml fentanyl vials. General OR gets 2
 
FactorV said:
How is everyone dosing methadone? What kinds of procedures are you using it for? Just curious, I've actually never used it in the OR
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.1-.15 mg/kg, have gone up to 20mg. Very useful in bigger cases or opiod tolerant cases.

Dose it up front. Quick onset, about 10 minutes.
 
FactorV said:
How is everyone dosing methadone? What kinds of procedures are you using it for? Just curious, I've actually never used it in the OR
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We have no IV methadone either
 
I think the methadone idea isn't too bad. It does look like the kinetics/atypical effects might be useful to reduce post-op opioid usage.

Use of Methadone in the Perioperative Period

Intraoperative methadone: Rediscovery, reappraisal, and reinvigoration?
"20 mg methadone as an IV bolus following induction of anesthesia"

You could probably get away with a pre-operative oral dosing as it is absorbed very well throughout the upper GI tract, although I would probably opt for a lower dose/conversion in the 15 - 30 mg PO rather than the 2:1 normally used for PO:IV.
Revisiting methadone: pharmacokinetics, pharmacodynamics and clinical indication
"It may be detected in the plasma 30 minutes after oral dose, and time to reach plasma peak concentration is 2.5h for oral solution and 3h for tablets"
 
I think all the drug shortages are from the Puerto Rico issues. Most our drugs are made there.

I lived in Manati for a while - you could smell the factories pouring crap into the air. They have much less stringent rules about the environment, so I assume that is while all the companies go there so they can dump their waste into the PR aquifer and into the caribbean air.
 
facted said:
.1-.15 mg/kg, have gone up to 20mg. Very useful in bigger cases or opiod tolerant cases.

Dose it up front. Quick onset, about 10 minutes.
Click to expand...
probably would be pretty useful in a CV case....unless i'm getting my pharmacodynamics confused
 
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