Anesthesiologists report drug shortages

In an effort to address the declining flow of much-needed medications used during surgery, the American Society of Anesthesiologists is calling on federal regulators and pharmaceutical industry leaders to take action quickly to end the nationwide shortage of anesthetic agents.

According to the ASA, the organization has been receiving reports from its anesthesiologist members and hospital pharmacists about anesthetic shortages throughout the country since December of 2000. Anesthesiologists are reporting that painkillers and other medicines that were in "limited supply" only two months ago have now reached "critical shortages" in urban, metropolitan and rural medical facilities.

A sampling of anesthesiology practices across the country indicates widespread shortages of fentanyl, sufentanil and alfentanil. In addition to their importance in controlling pain during and after surgery, these synthetic narcotics are commonly used to manage chronic and cancer pain as well as the pain of childbirth. Other drugs in short supply include muscle relaxants, anti-nausea medications and even local anesthetics.

According to Bruce F. Cullen, ASA vice president for scientific affairs, it is time for federal regulators and the pharmaceutical industry to take immediate and decisive action to end these shortages.

"While the temporary unavailability of certain vaccines may be an inconvenience, these anesthetic agents that are quickly dwindling in hospitals everywhere are vital for safe and painless surgical care for our patients," Cullen said. "We cannot wait any longer for the situation to correct itself."

Other shortages

While the FDA states that manufacturers of fentanyl are currently able to meet basic supply demands for the drug, there is no information about when other drug shortages will be resolved.

The ASA has reported shortages of the muscle relaxant succinylcholine, which is used frequently for trauma cases and other emergency procedures. More recently, physicians who use a newer, fast-acting muscle relaxant called rapacuronium are reporting that it is in short supply as well. This drug is often used for children and certain high-risk patients, Cullen said.

The drug shortages are having an impact on the way hospitals schedule surgeries and distribute these anesthetics throughout their facilities. Some institutions have had to reschedule elective surgeries, and others are reporting critical shortages of even alternate medications. The ASA has observed that smaller institutions seem to be hit hardest because of their limited inventory, but even large medical centers are experiencing critical shortages.

Explanations for the shortages continue to be unsubstantiated, but manufacturing difficulties and a shortage of raw materials may have contributed to the problem.

"We are not looking to assign blame or chastise any organization," Cullen said. "For the sake of our patients, we are looking for a quick resolution to the immediate shortages and a way to avoid this crisis recurring in the future." PR