Anesthetic shortage worries hospitals

Some Canadian hospitals are experiencing shortages of critical drugs used in operating rooms to anesthetize patients during surgery, CBC News has learned.

Anesthesiologists are worried because some have already run out of pentothal,a backup drugoccasionally used in the operating room for induction putting patients under for surgery.

Hospitals still have a supply of their standard anesthetic called propofol. But there are shortages of that drugin the U.S., and worries about shortages in Canada.

"That would actually be pretty catastrophic to our day-to-day work," said Dr. Eric Goldszmidt, chief ofanesthesiology at Mount Sinai Hospital in Toronto. "Because that's used in every operating room here and all over the country every day. How we would deal with that, I'm not actually sure."

There aren't a lot of alternatives, said Neil MacKinnon, president of the Canadian Society of Hospital Pharmacists in Halifax.

"For many of the drugs that are short in the community pharmacy setting, there are other drugs available in the same classes," McKinnon said. "For drugs used for anesthesiology, the drugs are more limited."

Many hospital pharmacies have been unable to get pentothal for months.

"We went from adequate stocks with no real concern that we were going to run out of them to having none of it virtually overnight," said Dr. Brian Warriner, head of anesthesiology, pharmacology and therapeutics at the University of British Columbia in Vancouver.

There aretwo firms currently producing propofol for the U.S., APP and Hospira,said Karen Riley,a spokeswoman for the U.S. Food and Drug Administration.

Teva Pharmaceutical announced in May 2010that it won't make more of the sedative, because propofolis hard to manufacture and the company gets little or no profit from it, company spokeswomanDenise Bradley said at the time.

Hospira has had intermittent backorders but supplies continue to improve, Riley said.The FDA anticipatesfirms will returnto normal distributionsoon.

Hospira is also working to resolve a manufacturing issue for pentothal, the FDA said.

Other drug shortages occurring

Both the anesthetic shortages and those of other medications filled at community pharmaciescan becaused by a variety of problems along the drug supply change, including:

• Manufacturing problems.
• Supplies of raw materials.
• Companies that cease making a drug that has becomes less profitable.

Theshortages have notharmed patient health. But both doctors and pharmacists point to the inconvenience of finding substitutes and looking for new prescriptions.

"A couple of weeks ago, you couldn't get a very basic penicillin prescription, which has only been available since the First and Second World War," said Dr. Howard Conter, a family physician in Halifax. "All of a sudden we can't get penicillin. So that was a little concerning. I think they've resolved that. But that's something I've never heard of in my previous 26 years of practice."

Likewise, pharmacist Tim Brady in Windsor has struggled through unprecedented shortages.

"I've had a woman now who is on a heart medication," said Brady, president of the Essex County Pharmacists' Association. "There's no supply, so then you end up trying to call every single store basically in the county trying to find the medication."

Pharmacists and doctors alike are calling for a national drug monitoring system so they will at least know about shortages in advance and put plans in placeto deal with them, MacKinnon said.

"It seems that there is not a surveillance program in place in Canada to watch for drug shortages," Dr. Richard Chisholm, president of the Canadian Anesthesiologists' Society, said from Fredericton Thursday.

Chisholm plans to write Health Minister Leona Aglukkaq about his concerns.

"The minister believes there is need for improved management of drug shortages in Canada,"said Stphane Shank, senior adviser for media relations at Health Canada.

"Currently, manufacturers are not required to notify Health Canada of potential or occurring drug shortages. However, if the department becomes aware of a shortage it works with manufacturers and the medical community to minimize the impact of the shortage and facilitate access to alternatives," he added in an email.