Proprofol shortage?

[moster]

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Our Hospital has decided to start rationing Propofol.
The pharmacy also says there is shortage of Thiopental.

The pharmacy claims we use 120 vials per week and only have 12 vials left. I think they are way low on their estimate of 120 vials per week. I would estimate that with nine anesthesiologists working 10 hour days, we use at least 500 vials per week. They claim there will be no more Propofol until January 2010. The pharmacy also says there is shortage of Thiopental, which was what I used as a resident before Propofol was wildly available.

Is anyone else experienced this type of shortage, or is the Administration trying to save money by forcing us to practice third world anesthesia?

 

[modelslashactor]

rumor around here is that we run out in a week or so, there was some sort of recall for diprovan specifically as i understand it. icu has already been cut off and is stuck with fentanyl for sedation. haven't heard about thiopental being pulled out but it would certainly make things interesting.

 

[seamonkey]

have not heard of this yet. have weathered the remi shortage, and thiopental shortage still in effect, but propofol? this is like OPEC holding back petroleum. WTF? Drug manufacturers seem to know what kind of leverage they have, unfortunately.

 

[moster]

rumor around here is that we run out in a week or so, there was some sort of recall for diprovan specifically as i understand it. icu has already been cut off and is stuck with fentanyl for sedation. haven't heard about thiopental being pulled out but it would certainly make things interesting.

Hospira recalled some of their Propofol vials due to manufacturing issues and will not be making any more until January 2010.


last week we threw out dozens of vials from the contaminated Hospira lot numbers.

 

[thegasman]

there was also a teva pharmaceuticals production problem contributing to the shortage. Our hospital was able to get some brevital so i guess i will play around with that now that we are out of prop.

 

[Ashers]

I learned about this on my last week of my anesthesia elective last month. The hospital was taking propofol from a surgicenter. Here's a link that explains a little bit of why:
http://www.pharmacypracticenews.com...w=dept&ses=ogst&issue_id=572&article_id=14114

 

[cchoukal]

http://www.asahq.org/news/asanews110909.htm

 

[tucker27705]

Like everyone else our hospital is responding to this shortage. We cont to use for GI, but in lower quantities, and splitting 20ml vials among pts with clean draw/syringe techniques.
As for the OR. No STP, when prop went on back order, everyone scooped up the avail STP.
Personally, I have cut my usage down to about 25% of nl. I use it on true RSI situations. Otherwise, I have been getting away with fent/midaz and inhalational inductions. It takes time, but it works and the bp is remarkable stable. Only a few comments from pts about "something stinks". They don't remember it later due to the versed.
Has been a great opportunity to learn. Have done some "single inhalation" inductions. I.e., prime the circuit with Sevo8, total exhalation, then breath deep and hold breath until asleep or need second breath. Only suituable for certain pts, but fun, and haven't done it since residency. I'm glad I learned these techniques from one attending who actually said, you may be one day without propofol.
What is everyone else doing?
T

 

[urge]

Nobody using etomidate or ketamine for inductions?

 

[thegasman]

we have been using some etomidate - if prefer not to however. All the patients are throwing up in pacu.

 

[Noyac]

We do sedation for our Totals, GI cases, Spines, etc. I have always mixed some ketamine in with my propofol but now I am mixing even more. I did totals yesterday. The surgeon is moderately slow (tourniquet time of >60min). I managed to use only 3 20cc bottles for 3 cases. Normally it would have been 6 bottles or more. So ketamine is a good choice for supplementing your propofol and cutting own your usage. I mix it normally at 1mg K/1cc Prop. Yesterday it was more like 3-4mg K/1cc Prop. No ill SE's.

 

[dhb]

I suppose that if you add some precedex/clonidine you can use even less propofol.

 

[foxtrot]

We do sedation for our Totals, GI cases, Spines, etc. I have always mixed some ketamine in with my propofol but now I am mixing even more. I did totals yesterday. The surgeon is moderately slow (tourniquet time of >60min). I managed to use only 3 20cc bottles for 3 cases. Normally it would have been 6 bottles or more. So ketamine is a good choice for supplementing your propofol and cutting own your usage. I mix it normally at 1mg K/1cc Prop. Yesterday it was more like 3-4mg K/1cc Prop. No ill SE's.

Just be careful using the 3-4mgK/1cc Prop. I used a mix like this for joints when I was a resident because I had an attending who was in love with Ketamine (I think because of first hand experience) but anyway, I gave a total of 5 mg of Versed prior to starting the infusion on a very nice healthy middle aged lady. Everything seemed to be fine until the PACU called me stating that they could not get the patient stop hiding under the blanket because she felt like aliens were trying to find her. Low and behold when I went to the PACU she was peeking over the blanket telling me that they were looking for her. It took 45 minutes to calm her down.

 

[Pilot Doc]

I wonder how many kg of propofol get used in the US on a typical day.

 

[seamonkey]

I probably used a gallon of propofol in the past week on endoscopies and TIVA cases. Nobody at my program seems to have any concern about availablilty issusues. Our pharmacy will hand me a case of it without batting an eye......potential explanations: 1) the shortage ain't so bad, 2) our program is slow to recognize a potential shortage, or 3) we have a whole crapload hidden somwhere in the basement

 

[Mofeen]

We have 34 OR's and a very large endoscopy suite at my Hospital. They are telling us we have a month supply. They must also have a stockpile somewhere.

 

[foxtrot]

Better get used to it because I am sure on page 1034 of the senate's healthcare bill, it says something about how an appointed task force consisting of chiropractors and dentists will determine the frequency each individual patient will be allowed to have propofol during their lifetime.

 

[Licoricestick]

Better get used to it because I am sure on page 1034 of the senate's healthcare bill, it says something about how an appointed task force consisting of chiropractors and dentists will determine the frequency each individual patient will be allowed to have propofol during their lifetime.

Well, I'm currently working the scoialised healthcare system here - and we don't know what you're talking about. Got a great propofol supply here. There was a shortage of thio a few years ago, but that seems to not be an issue now either. Nor were we affected by the Remi shortage that existed in the US earlier this year.

 

[Narcotized]

This is temporary and will all get straightened out as soon as they figure out where Conrad Murray stashed it all away.

 

[DOAnestMan]

I think the shortage only applies to generic Propofol. My program supplies us with the name brand Diprivan, of which there was no interruption in production. Good thing too because I use it like it's going out of style.

 

[Noyac]

We never saw a shortage.

 

[lane]

they stopped putting propofol in our boxes but we can get fresenius propoven from the pyxis