We're hurting for propofol around here. Despite a few of us warning about the coming shortage, no one paid attention until this week. Our Pyxis machines run dry about mid-day, so we have to dash to other rooms between cases for more. Apparently, our pharmacy czar rations our available propofol on a daily basis, regardless of the # & type of cases we do.

I've started adding ketamine (2mg/cc) to my propofol, then attaching a BIS monitor, & chart its reading before I intubate. We draw up propofol in 10 & 5cc syringes in an effort to conserve. Today, I put a 73y/o to sleep w/200mcg fentanyl & 50mg propofol, masked him w/some Sevo, then placed an LMA. GI lab is using versed & fentanyl along w/propofol. I haven't worked in GI lab since the crisis was acknowledged this week, so I'm a bit concerned ... sending patients to PACU is a big damned deal around here mainly because it ties up beds.

I texted our pharmacy director (czar) today, asking if we can use ketamine vials as multi-dose vials, & her response was, "No it is a narcotic". The only ketamine we have is 500mg/5ml vials, usually 2 stocked/Pyxis.

How has the propofol crisis affected you, & how are you handling it?