Critical care physicians concerned about supply of anesthetic drugs used in large quantities for patients with COVID-19


As public attention centers on the need for ventilators and personal protective equipment in the battle for COVID-19, another looming shortage worries doctors and pharmacists.

Hundreds of coronavirus patients on respirators across the country have become a major puncture of drugs better known for use in the operating room.

Many patients with coronaviruses plugged into breathing apparatus are constantly on sedatives and drugs that paralyze them, both to protect health workers during intubation and to prevent damage to their lungs.

Our consumption of these drugs could increase by an order of magnitude

Even though the intensive care units have yet to be overtaken by a feared increase in coronavirus cases, the drugs are being administered at a much higher rate than usual, according to doctors and pharmacists.

“Some hospitals have reported that they essentially use a 30-day supply of certain drugs in one day,” said Dr. Michael Warner, chief of intensive care at Michael Garron Hospital in Toronto. “Overall, our consumption of these drugs could increase by an order of magnitude.”

Drugs are not yet in short supply nationally, but there is concern that there will be sufficient supply, said Christina Adams, chief of pharmacy at the Canadian Society of Hospital Pharmacists.

The association and Health Canada are working to get more drugs from abroad and more active ingredients than Canadian manufacturers could use, she said. “I have been on many calls in the past two weeks to find out where the supply is, what the supply chain looks like,” said Adams.

“We see more patients who need ventilators, and we also see that they need more of these anesthetics than the average ventilated intensive care patient,” she said. “So it’s kind of a double whammy with these COVID patients. “

Evidence suggests that most of the two to three percent of COVID-19 patients in the intensive care unit are connected to a ventilator.

Most of them are given sedatives and / or paralyzing drugs – similar to the general anesthetic combination used to put patients to sleep.

This is partly to prevent coughing and other actions that could cause aerosolization of the virus, a major risk of infection for health workers who insert breathing tubes.

But it is mainly to make ventilation safer for patients, according to doctors.

To help prevent damage to the lungs from the respiratory system, hospitals are working to prevent intubated patients from coughing or breathing natural air. And many COVID-19 patients are placed in the supine position – placed on their stomachs so that blood, aided by gravity, reaches the least damaged parts of the lungs that can transmit more oxygen.

The process for both is facilitated by drugs like propofol sedative which keeps patients still, said Warner.

“The drugs we use are so fundamental to the care we provide to critically ill patients that we cannot even imagine that they are not available,” he said. “If someone said to me, ‘Sorry, we’re out of Propofol,’ I would say, ‘What the hell are you talking about? … We have not used up any of these drugs, but the burn rate is such that we must actively use conservation strategies. “

Drugs are sometimes used for patients with regular bacterial pneumonia who develop acute respiratory distress syndrome (ARDS). But more COVID-19 patients need treatment and for a longer period on average, said Warner.

“People recognize that more than ventilators are needed to care for C-19 patients in the event of a large increase,” said Dr. Niall Ferguson, chief of intensive care at the University Health Network in Toronto. “We need ventilators, we need doctors and critical care nurses, we need PPE – and we need medicine.”

Adams said the current supply of anesthetics is enough to meet one to one and a half times the demand from hospitals as usual, but the facilities use two to three times more than normal.

Canadian manufacturers typically need two to three months to ramp up production, and must first have access to ingredients made in other countries – which are in demand around the world, she said.

“The potential ramifications are considerable,” said Adams. “The fans are great, but they only work if you have the drugs to make them work.” “

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