Anesthesiologists are scrambling for sedation medications across the country, in some cases postponing or changing surgical procedures because of shortages. And in a few cases, patients have died because a needed medication wasn't available.
Those are stark responses to a survey sent out recently by the American Society of Anesthesiologists, which said it captured views from 3,033 anesthesiologists from 50 states and six nations.
Of all the responders, 97.6% said they were currently experiencing a shortage of at least one drug.
Fentanyl appeared to be the drug that was the biggest problem, reported by 66.3% of survey respondents. Other drugs included thiopental, said to be in short supply by 40.3%; succinylcholine, 21.2%; propofol, 19.2%; and pancuronium, 15.2%.
“The 2012 ASA Drug Shortages Survey demonstrates the tremendous toll the shortages of anesthetics are taking on our members and ultimately patients,” said ASA President Jerry A. Cohen, M.D. “The survey confirms that the crisis continues to worsen in its severity and depth across the nation. Tragically, the shortages now may be leading to instances of mortality,” said Dr. Cohen.
According to a similar survey conducted in April, 2011, the percentage of doctors reporting sedation and anesthesia drugs has increased from 90% to 97.6%.
The ASA said that 96% of survey respondents said they had "been forced to use an alternative drug to their preferred drug for a particular patient and procedure," and that 50% have altered a procedure to accommodate for the drug shortage. About 7% said they had postponed procedures and 4% said they had cancelled them.
Six survey respondents reported that the shortages resulted in a death of a patient, although it was unclear how many have patients died.
That could occur which when a rescue drug is needed, but isn't on the anesthesiology cart, said Robert Hertzka, MD, a practicing anesthesiologist in San Diego and former president of the California Medical Association, who was not involved in the survey. He emphasized he doesn't know why the patients of the responding anesthesiologists died.
Normally, he said, anesthesiologists should anticipate all the medications they'll need and have them ready and in place during surgery, but on rare occasions there's an emergent need for a rescue drug that because of its scarcity, has been removed from the cart and locked up.
In addition to deaths, the ASA said, the shortage has resulted in other "less optimal" outcomes for patients, such as post-operative nausea and vomiting. Two-thirds of respondents said they had noted these negative outcomes in their patients during this survey period, compared with 49.2% in the prior year's survey.
Drug substitutions or changes in administration of the medications has also resulted in increased costs for patient sand the healthcare system, the ASA said. Longer operating room recovery times are another negative consequence stemming from the use of less optimal anesthesia medications, with 49% of respondents reporting that impact.
Anesthesia medications were identified as one of three categories of medications, along with oncology and anti-infective drugs, according to a U.S. Government Accountability Office report on drug shortages in December.
"Our analysis of the causes of 15 sterile injectable drug shortages (involving 5 anesthesia drugs, 5 anti-infective drugs, and 5 oncology drugs) showed that manufacturing problems were the primary cause of most shortages, and over half were exacerbated by multiple difficulties after the drug initially went into short supply," the report said.
The GAO recommended that "Congress should consider establishing a requirement for manufacturers to report to FDA any changes that could affect the supply of their drugs. In addition, FDA should enhance its ability to respond to drug shortages, for example, by developing an information system to manage data about shortages. HHS outlined actions it plans to take that are consistent with GAO’s recommendations."