Anesthesiologists in Victoria hospitals discovered in November that their cupboards were bare of key drugs. It’s a pattern rippling across Canadian hospitals, and doctors are warning it could get worse.
Ian Courtice, a Victoria anesthesiologist, said a standard drug used at the start of anesthesia was unavailable. Remifentanil is a short-acting narcotic for day surgery and neurosurgery. Although it can be replaced with alternatives, patients like it because it causes little nausea and they recover quickly from its effects. The shelves were restocked within a week or two, but he said hasn’t been the only shortfall.
More worrying, he said, was a critical shortage of thiopentone, a fast-acting barbiturate. “There is nothing else to replace it with.” He said Victoria hospitals were able to re-supply before they ran out, so it didn’t have a clinical impact.
But if similar shortages in the United States continue, Canadian hospitals could be in trouble, cautioned Brian Warriner, head of anesthesiology, pharmacology and therapeutics at the University of British Columbia.
He said Vancouver hospitals have been with without thiopentone for months. Although it is used in only a minority of procedures, it is especially useful in certain cases such as brain trauma. “That drug is virtually unavailable,” he said.
The shortfalls, experienced in some hospitals across the country, are mostly an inconvenience. Dr. Warriner said he’s more concerned with the U.S. shortage of propofol, which is the most common drug used to take patients through the first stage of anesthesia.
“A loss of remifentanil would not be devastating to our practice. A loss of propofol would be,” he said. “It’s a drug we use by the gallon every day. It would be tough to live without.”
He said it is not clear the U.S. shortages will be felt in Canada, but if production of propofol doesn’t catch up, non-emergency operations could be affected.
“If this becomes a real threat, we will have to stockpile propofol, and we have to consider if we can continue to do elective surgery.”