If supply problems force anesthesiologists to switch from shorter-acting to longer-acting drugs, it can be harder to bring some patients out of anesthesia. More than half of doctors who answered the ASA survey questions said they'd altered procedures to accommodate shortages. Those changes could have included switching from general anesthesia to epidural or regional anesthesia. Among survey respondents, 7 percent said shortages forced them to postpone a procedure; 4 percent said they had to cancel procedures.
Sometimes, second-choice drugs have unwanted side effects, said Cohen, an associate professor emeritus at the University of Florida in Gainesville. If fentanyl isn't available, he can substitute morphine, but "morphine causes nausea and vomiting systemically. If I use morphine in an epidural, it creates itching."
He might try Dilaudid, but "it doesn't quite have the same safety margin" and it lasts longer, he said. "I will have a delay in waking the patient up."
The association undertook the survey, in part, to have something to share with the Congress and other policymakers grappling with a nationwide crisis that has sent hospitals scrambling for antibiotics and anesthetics and brought them to the brink of being unable to treat some childhood cancers. Other medication shortages have forced parents to drive among pharmacies looking for medications to help their hyperactive children sit still and pay attention in class
President Obama issued an executive order in the fall that, among other things, gave the Food and Drug Administration power to respond more quickly to drug shortages. The FDA has since begun allowing overseas imports of key drugs for leukemia and cancer, and approved new suppliers to alleviate shortfalls.
But no one has yet determined how to alleviate a perfect storm of manufacturing problems, shrinking numbers of generic drug makers and increasing demand.
"One solution I think is to have a supply of drug that is not going to go away if we have several days of delay in a component for a drug reaching the manufacturer," Cohen said. "The only way to get around that is to stockpile."
"I've seen a lot more of this that I never dreamed would happen," said Cohen, who completed his residency in 1977. "When I started practicing, I thought whatever drugs I needed would always be there. Now I open the drawer and occasionally something isn't there."