Dr Daniel Katz presents on drug and equipment shortages at @SOAPHQ’ #SOAPAM2023. He’ll focus on why they occur, how we can prepare and discuss alternatives & substitutions. #OBAnes
Why shortages occur (1): Generic drug manufacturing poses strain on supply chains, drugs require precursors (80% manufactured outside US). Supply chain has upstream and downstream components - removing precursors hampers upstream supply chain (before the drug is even… twitter.com/i/web/status/1…
A case study: Fludarabine. Generic 2003: 12 application holders, 6 actively marketing. But who is actually making it? No real time database explaining who is making the product. All May have the precursors stocked. #SOAPAM2023
Why shortages occur (2): increased demand, natural disasters, regulations (maximum stores), no minimums, no stockpiles, cannot mandate production, and finally public opinion. #SOAPAM2023
Why shortages occur (3): they build on eachother. The case of Akron. Knock on effects tend to multiply. multiple drugs affected by one company. #SOAPAM2023
What’s different about equipment? Nothing really - a few extra choice points. #SOAPAM2023
What can you do about shortages (1): communication is key, have multidisciplinary approach to planning, conservation when aware of shortage, multilevel advocacy… #SOAPAM2023
What can you do about shortages (2): substitutions. Be flexible, know what’s available, drugs probably easier than equipment? #SOAPAM2023
What can you do about shortages (3): drugs continued. Triage/ prioritization required. For antibiotics: know local sensitivity patterns, appropriate dosing of alternatives. #SOAPAM2023
Next up at #CASAM2023 - fittingly keeping the most important academic session to last: #OBAnes @ValZaph moderating the Maternal Experience and Outcomes: Improving the care we provide. @DrWesleyEdwards
Dr Christina Lamontagne kicks off the session with: Use of Dexmedetomidine in improving maternal experience and outcomes. Nothing to disclose. Then an important disclosure: All indications discussed are OFF LABEL in Canada. Objectives. #OBAnes#CASAM2023
Why does Dr Lamontagne use a lot of dexmedetomidine (not only in #OBAnes mind)? Clinical pharmacology of dexmedetomidine (1): highly selective alpha-2 agonist; sedation WITHOUT amnesia at locus coeruleus. #CASAM2023
Dr Ning Nan Wang introduces @harshamd5 to open the chronic pain session: Perioperative use of opioid in the context of Opioid Epidemic. #CASAM2023
The opioid crisis isn’t new - China probably remembers the Opium wars that helped establish a British foothold on the continent. Opioids and OUR crisis. Is what we fear the real crisis? Are opioid-related deaths due to surgical prescriptions? No, mostly due to street fentanyl.… twitter.com/i/web/status/1…
Opioid use around the time of surgery. Understanding nociception vs pain. Does eliminating opioids during surgery make a difference - no definitive conclusions. #CASAM2023
PPH: a focus on coagulation is kicked off by Dr Karine Doyon (a hematologist). Objectives. Canada ranked 39th in world in maternal mortality - not sure if that’s good. We’re doing better than USA. #OBAnes#CASAM2023
Causes of coagulopathy in pregnancy - Dr Doyon won’t be discussing inherited disorders. The focus will be on the acquired hemorrhagic disorders. #OBAnes#CASAM2023
Pregnancy-associated mortality ≈ maternal mortality. #OBAnes 0.2% - doing well (wonder what the denominator is?), so Elmo could ask why are we worried? #SOAPAM2023