Shortage of drugs worrying anesthesiologists; 2 hospitals nixed heart surgery

The drug shortage gripping Canada has anesthesiologists across the country worried they won’t have enough drugs to perform surgery or the sedatives and painkillers needed to keep patients comfortable before and after their procedures.

“I’ve been getting a lot of emails from colleagues right across the country,” said Dr. Rick Chisholm, president of the Canadian Anesthesiologists’ Association.

“What I’ve heard from the rest of the country is (hospitals are) sort of taking stock of what inventory they have, what their typical usage is, trying to figure out how long their stocks are going to last, looking up what supplies Sandoz has told them they’re going to be able to ship.”

Sandoz Canada is at the centre of an escalating drug shortage, resulting from the company cutting production of more than 100 medications after the U.S. Food and Drug Administration raised concerns about quality standards at the company’s Boucherville, Que., plant.

A fire March 4 also affected the plant, which makes 90 per cent of injectable medications used in Canada, among them anesthetics, painkillers, cancer drugs and antibiotics.

Chisholm, an anesthesiologist at the Chalmers Regional Hospital in Fredericton, said he’s been contacted by colleagues elsewhere in Canada who say they are looking for alternatives for medications that are running short, even turning to old-style anesthetics that haven’t been used for years.

“I’ve seen planning where they’re talking about when they get down to a week of essential drugs that they have left, they’re going to have to start looking at possibly curtailing some elective surgery,” he said.

Such a cancellation occurred Tuesday when two Vancouver hospitals postponed elective heart surgeries for nine patients over fears the dwindling stock of a critical medication would leave doctors without enough to deal with emergency cardiac cases.

The drug protamine is the only drug anesthesiologists have to reverse the effects of the blood-thinner heparin, which is given during heart bypass surgery. Sandoz is one of only two companies that makes the medication and the primary supplier to Canadian hospitals.

As it turned out, it wasn’t necessary for St. Paul’s and the Vancouver General hospitals to cancel the surgeries, said Gavin Wilson, a spokesman for Vancouver Coastal Health.

“They weren’t cancelled due to a shortage of drugs. They were cancelled because of some miscommunication and a failure to follow the process that we’ve established here to deal with the Sandoz situation,” Wilson said Wednesday from Vancouver.

The joint cardiac surgery program for the two hospitals decided to put off the scheduled operations after being told there were only about two weeks’ worth of protamine left in stock.

“In fact, we have several weeks’ supply of protamine available, so the surgeries that were cancelled, we’re trying to reschedule them as quickly as possible, and some are already rescheduled,” he said. “Aside from yesterday’s misunderstanding, we haven’t had any impact on patient care.”

Like his fellow anesthesiologists, Chisholm is concerned about supply gaps for other medications given to patients, specifically pre-surgical sedatives to reduce anxiety and post-operative narcotics to alleviate pain.

“I can swap them around, but I’m limited because Sandoz makes most of them,” he said. “I think they make fentanyl, they make morphine.” Both are on the list of Sandoz products in short supply.

While Chisholm is confident he has anesthetics in his drug arsenal made by companies other than Sandoz, there are some he needs that only the Quebec plant provides, such as medications to prevent nausea and vomiting.

Some of the agents he uses to reverse the effects of other drugs needed for surgery — such as muscle relaxants — also are made by Sandoz.

“Everything I use is a sterile IV injectable. Everything I use is a generic IV injectable — and 85 per cent of the drugs in my cart are from Sandoz,” he said.

“So if I don’t have it, I’ve got to go look for something else.”

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