SCCM Resource Library-Drug Shortage Alert: Alternative Medications for Procedural Sedation

Pdf Summary

The September 2022 Drug Shortage Alert addresses the ongoing shortages of medications commonly used for procedural sedation in adults (18 years and older). These shortages are mostly due to manufacturer discontinuation or increased demand. The document provides alternative medication strategies and management practices for practitioners during this shortage.<br /><br />Key recommendations include considering alternative medications within the same class if shortages arise, and reviewing procedural sedation principles. Practitioners are advised to manage sedation levels ranging from minimal to general anesthesia by understanding each sedative's goals and effects. Strategies for managing drug shortages in critically ill patients include using oral sedation for minimal to moderate sedation, delaying non-urgent procedures, and consulting with anesthesiology for guidance. In cases requiring moderate to deep sedation, combining different agents to minimize the dose of each, using inhaled anesthetics, or employing formulations like ketofol (a mix of ketamine and propofol) can be beneficial.<br /><br />Pharmacotherapeutic considerations emphasize the importance of selecting drugs with predictable pharmacokinetics, rapid onset, and short recovery times. The document stresses the need for awareness regarding patient comorbidities and the synergistic effects of combining benzodiazepines and analgesics, which can alter sedation depth and impose risks such as respiratory depression.<br /><br />Safety implications for unfamiliar medications are noted, underscoring the need for preparedness to rescue patients from unintended sedation depths. Practitioners should ensure reversal agents like naloxone and flumazenil are available when administering opioids or benzodiazepines. Importantly, the document acknowledges that while these shortages affect short-term ICU care, tiered alternatives should sufficiently maintain care continuity with minimal cost impact.

Asset Subtitle

Pharmacology, Crisis Managment, 2022, 0:07:36

Asset Caption

"Updated September 2022.

Medications frequently used for procedural sedation are currently being affected by shortages due to manufacturer discontinuation and/or increased demand. Alternative medication recommendations can be considered when a drug shortage arises within a particular class of medications.

Recommendations and information provided in Drug Shortage Alerts are compiled by experts in the field. Practitioners always are advised to consult with staff to ensure that response to any drug shortage is in line with internal policies and procedures. "

Meta Tag

Content Type Article

Knowledge Area Pharmacology

Knowledge Area Crisis Management

Knowledge Level Foundational

Knowledge Level Intermediate

Knowledge Level Advanced

Membership Level Nonmember

Membership Level Associate

Membership Level Professional

Membership Level Select

Tag Analgesia and Sedation

Tag Resource Allocation

Year 2022

Keywords

drug shortage

procedural sedation

alternative medications

sedation management

anesthesia strategies

pharmacotherapeutics

respiratory depression

reversal agents

ICU care

medication shortages

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