Case Series of Adaptive Changes in Clinical Practice and Trainee Education for Cesarean Delivery due to Drug Shortages of 0.75% Hyperbaric Bupivacaine in 2018.

Hyperbaric bupivacaine, the local anesthetic routinely selected for single-injection spinal anesthesia for cesarean delivery (CD), was in short supply in 2018. Hospital stocks were significantly less than before and after the shortage period. We developed a contingency plan to communicate with pharmacy and retrieve, restrict, and reallocate remaining stocks of drug to continue performing CD under neuraxial anesthesia, specifically spinal anesthesia for emergency CD, when time appropriate. Retrospective chart review revealed that elective and emergency CDs were performed without delays or increase in rate of general anesthesia during this period. However, trainees had fewer opportunities to perform spinal anesthesia for CD.

Considerations for Management of Bupivacaine Formulation Shortage Affecting Obstetric Anesthesia Services.

Healthcare facilities across North America are experiencing a shortage of several formulations of bupivacaine affecting analgesia and anesthesia care, particularly for obstetric services. This editorial will discuss evidence-based considerations to address the bupivacaine shortage including interprofessional team engagement for planning, alternative anesthetic and analgesic management strategies for the obstetrical patient, and safe drug preparation. As leaders in healthcare, nurse anesthetists are encouraged to work closely with their anesthesia, pharmacy, obstetric, and facility leadership to develop best alternative solutions during this drug shortage to provide safe analgesic and anesthetic care.

Availability of emergency drugs and equipment in general and specialist dental settings in Babol, Iran.

AIM: Medical emergencies can frequently happen in dental settings and it is critical to outfit the clinic by emergency drugs and equipment. The aim of this study was to evaluate the emergency drugs and equipment in general and specialist dental settings in Babol, Iran. MATERIALS AND METHODS: A questionnaire containing closed ended questions about the available emergency drugs and equipment was used in this descriptive-analytical study. Data were subjected to descriptive analysis using SPSS 18.0 to identify the most frequent drugs and equipment. Chi-square and t-test were used to evaluate the correlation between the variables. p < 0.05 was considered statistically significant. RESULTS: One hundred and twelve dentists answered the questionnaire. The most available drug and equipment were epinephrine (67%) and single use syringe (81.3%) respectively. Significant correlation was found between degree of education and availability of first group of emergency drugs and between sex and possession of second group of emergency equipment (p < 0.05). CONCLUSION: Degree of availability of emergency drugs and equipment was moderate to low and training about emergencies should be included in the didactic topics of universities and workshops. CLINICAL SIGNIFICANCE: Information about emergency drug and equipment would help to manage the unwanted emergency situations.

Regional anaesthesia in developing countries.

In modern anaesthesia practice, regional techniques are preferred to general anaesthesia for many types of surgery, particularly in obstetric care. Improved outcomes have been recorded in UK practice, but the techniques remain underutilised in many parts of the world. With encouragement, training and a regular supply of appropriate needles and local anaesthetic agents, the advantages of regional techniques in the developing world could be realised.