So as with the numerous and beyond ridiculous drug shortages what are some alternative induction/mac regimens you are using or will use?
Because propofol in our area is severely restricted creativity has been a necessity. Here are some things I have been doing depending on length of surgery and other factors.
For nml inductions.
1. My favorite has been an extra dose of versed upon arrival in room then 2 fentanyl with nitrous/sevo inhalation induction. Works great in the correct patient.
2. If looks like it is needed an extra dose of versed with fentanyl then <1mg/kg Ketamine and mask the rest of the way down.
3. Versed/fentanyl/Etomidate. Least favorite
Rapid Sequence inductions.
1. Versed/fentanyl/Etomidate / Roc
2. extra versed with Ketamine 1mg/kg and Rocc
3. Brevital with Rocc.
Succ is substituted for the Rocc if needed.
They have been pushing Lusedra at our site but it has NOT been a favorite due to perineal burning and less predictability. It was suggested by a rep to give 1/2 cc in holding to prime receptors as a way of preventing the burning. I tried that only one time and the patient tried to climb out of the bed. We had not left holding yet!! This also happened to many of my colleagues when they tried it and therefore I don't know anyone using this tech. Heavy dosing of versed prior to Lusedra use seems to be the only reliable method.
This has left us with the following options for MAC.
Although I used it all the time in school nobody has used precedex at our clinical site. I tried to use some recently but was unable to get it or it would also be a great option
We have reserved the majority of remaining supplies of propofol for GI. They were not happy with Lusedra and we have to keep them happy.
Would love to hear any other favorites you might have.