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Anaesthetists and ICU clinicians respond to media reports of drug shortages

The Faculty of Intensive Care Medicine, the Intensive Care Society, the Association of Anaesthetists and the Royal College of Anaesthetists have responded to media reports of a shortage in vital medicines.

In a joint statement, the four organisations said they recognise the concerns of members in relation to the supply of medicines but reassured the public that anaesthetic and intensive care staff are familiar with using alternative medications and techniques in order to manage drug stocks.

Recommendations have been produced to guide clinicians in using alternatives to medicines that may be subject to demand pressures.

The guidelines advise that some first-line drugs can continue to be used but departments should consider plans for the use of alternatives.

To avoid waste, only draw up what you will use, including emergency drugs, the guidelines say. Clinicians should also work with pharmacists to devise safe ways to use all the contents of drug vials and ampoules e.g. fentanyl 50 micrograms/ml x 10 ml.

Although counter to normal good practice, the organisations say there may be a need to share vials/ampoules between patients to minimise waste.

It recommends that inhalational anaesthesia should be used for maintenance and restrict usage of propofol infusion for maintenance wherever possible.

The guidelines include recommendations on alternative options to standard drugs.

For induction, propofol can be replaced by thiopental sodium/etomidate and ketamine can be replaced with propofol/thiopental sodium/midazolam.

For RSI neuromuscular blockade, rocuronium can be replaced with suxamethonium, while for routine neuromuscular, vecuronium/atracurium/cisatracurium/pancuronium.

For maintenance of anaesthesia, sevoflurane/isoflurane/desflurane can be substituted for propofol (TIVA) and isoflurane/desflurane can be used as an alternative to sevoflurane.

When a short-acting opioid is required, alfentanil/remifentanil can be substituted for fentanyl alfentanil/remifentanil although there is no substitute for remifentanil. Oxycodone/diamorphine/pethidine can be used instead of morphine where a longer-acting opioid is required.

For non-opioid analgesia, paracetamol oral or suppository can be used instead of IV paracetamol. ketorolac, diclofenac, parecoxib can be used instead of ibuprofen.

For sedation and transfer, midazolam/lorazepam/diazepam/dexmedetomidine is an alternative to propofol target-controlled infusion (TCI). Lorazepam/diazepam can substitute for midazolam.     

Phenylephrine/ephedrine can be used instead of metaraminol for vasopressor by bolus and metaraminol/dopamine/vasopressin/terlipressin can substitute for noradrenaline when vasopresser is administered by infusion.

The full guidelines are available here.


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