In the past five years, inability to obtain specific injectable medications has become a daily occurrence in anesthesia practice. Almost every medication we use in anesthesiology has been affected – from propofol to fentanyl to succinylcholine. “What are we missing today?” has become a daily question in the operating room. As the masters of improvisation, we have learned how to substitute the drug we can find for the drug we desire, but there is an obvious risk to our patients.
Sometimes the indicated drug is demonstrably faster, safer or otherwise more efficacious – succinylcholine for rapid-sequence induction in a trauma patient, for example – and the consequence to the patient is a small, but finite, increase in risk for a complication (e.g., aspiration of gastric contents) or a delay in some aspect of care (e.g., subsequent neurologic examination). In other cases, such as substituting dexmedetomidine for propofol in ICU sedation,...
