The United States began experiencing shortages of certain anesthesia drugs in 2009, and it’s only gotten worse since then. While at first it was just Propofol that anesthesia providers were coming up short on, now it is nearly every anesthesia drug. While not all drugs are in short supply all the time, most drugs are experiencing at least occasional shortages, with some being almost constantly low in stock at hospitals and medical centers.
There has been a big outcry about this among the nation’s anesthesia providers. Anyone who works in the field has probably experienced the problem of not having a drug in stock when it was needed. Sometimes, these shortages are merely inconvenient, while other times they are quite problematic for anesthesiologists as well as patients. More than one surgery in the United States has had to be canceled or postponed due to anesthesia drug shortages.
Shortages in anesthesia drugs has caused anesthesiologists and CRNAs to make due with using drugs that would not have been their first choice and are not the best choice for their given surgery situation. This puts the patient at more risk for anesthesia problems, such as waking up during surgery or not getting an adequate level of pain control during a procedure. Unfavorable health outcomes are much more likely when the right anesthesia drugs aren’t being used.
Anesthesia drugs are among the most difficult to make because they must be absolutely pure. They are being injected directly into a patient’s blood stream, so they cannot be adulterated in any way, and must be entirely sterile. This requires very precise manufacturing conditions. Yet, this is not the primary reason for the shortage of anesthesia drugs the industry is currently experiencing.
The main reason for shortages in anesthesia drugs is that many of the raw materials of these drugs are coming from developing countries, and some of these countries are experiencing political conditions that make it hard to obtain the necessary materials. The manufacturing standards for most anesthesia drugs has also become more stringent, making the labs and factories that make them scramble to comply with new, more difficult production guidelines. On top of all of that, there is a very low profit margin on anesthetic drugs, which has caused some manufacturing companies to stop making them altogether in order to focus on more profitable opportunities in the pharmaceutical field.
Hospitals and surgery centers have started stockpiling the hard to obtain drugs, and they have the clout necessary to get to the correct people in the supply chain to get more when necessary. While some hospitals have been inconvenienced by shortages, the real victims are the smaller surgical centers, which do not have the pull or the contacts in the supply chain necessary to obtain the drugs on a reliable basis. When they are able to get them, they usually pay much higher prices for the drugs than they should.
Anesthesiologists have been forced to ration some drugs and combine them with others to produce a similar effect. However, doing this may result in drugs not wearing off as quickly, so that doctors aren’t able to see to as many surgeries in a day as usual. Patients may also be required to stay overnight in a hospital for a minor surgery now, when they would have gone home the same day before, all because of the on-the-fly combination of available anesthesia drugs and their after-effects. Patient experiences aren’t as good when the right drug isn’t used as it’s meant to be used, and anesthesiologists are becoming aware as they experience more impact from the shortages in anesthesia drugs.
Shortages in anesthesia drugs will not be alleviated any time soon, either. The issues that are causing the shortages now are showing no signs of correcting themselves. It may take years for the situation to improve on its own. In the meantime, anesthesia providers are looking for solutions to allow them to do their jobs better and produce better outcomes for patients.
Some smaller facilities are banding together to group-purchase drugs. Others are using compounding pharmacies to make custom batches of certain drugs as needed, if the pharmacies have access to the materials. Others conserve the most in-demand drugs for the most needed cases, and use other, less desirable anesthesia drugs on most patients.
However, the best solution that most anesthesia providers are seeing to this problem is communication. More anesthesiologists, surgical centers, and hospitals are finding that letting the FDA know as soon as a drug shortage is noticed goes a long way in ensuring they get the drugs before they need them. The same thing goes for informing pharmacies of potential drug shortages as soon as they are noted, and ordering the drugs while the pharmacy can still obtain them (or in the case of compounding pharmacies, what is necessary to make them).
The importance of communication works both ways. Anesthesiologists, surgical centers, and hospitals can better prepare for shortages in anesthesia drugs when the FDA and pharmacies inform them well in advance that shortages are coming. When communication runs both ways, the likelihood of a medical professional or facility discovering they don’t have a needed anesthesia drug at the moment it is needed is greatly reduced. For the time being, effective communication is the thing the industry will have to rely on to make sure they are able to meet patients’ needs and give them a good surgical experience.
abeo Management Corporation (abeo) serves as a leading source of revenue cycle management and practice management with a specialization in anesthesia. The company leverages its people, processes, and software to serve independent practices, surgery centers, hospitals and healthcare systems with a scope of services that include billing, coding, transcription, practice management, and business consulting.