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Running on Empty - August 2019 - Subscribe to Outpatient Surgery Magazine

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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A U G U S T 2 0 1 9 • O U T PA T I E N T S U R G E R Y. N E T • 3 9 10mg/ml) can vary, making dosing errors more likely. • Fentanyl. With sufentanil in short supply, you can switch to remifentanil and alfentanil. Lack of experience with the alternate drugs, especially for conscious sedation administered by non- anesthesia staff, increases risks of improper dosing and poten- tially serious side effects. • Morphine. Poses similar risks to hydromorphone with varia- tions in available dosages (0.5mg/ml, 1 mg/ml, 10 mg/ml, 25 mg/ml, 50mg/ml). Read the label carefully to make sure you know the dose you're giving, as it might change from day to day. • Bupivacaine. If bupivacaine isn't available, use another local anesthetic such as ropivacaine or add lidocaine with epinephrine to your limited supply of bupivacaine to increase volume and duration with the epinephrine component. Exparel (liposomal bupivacaine) for single injections can eliminate the need for the large volumes of local anesthetic required to fill pain pumps and provide excellent analgesia for a variety of blocks, including those used off-label. • Ketorolac. There is no equivalent substitute to give intra- venously. Some facilities are resorting to combinations of p.o. NSAIDs and p.o. or IV acetaminophen as part of a multimodal regimen. • Dextrose. If 50% dextrose isn't available, you can use 25% dextrose in its place. Glucagon is also an effective alternative, but at the cost of an increased side-effect profile. You can also administer Lactated Ringer's and 5% Dextrose Injection, which has a much longer response to increase blood glucose. The other alternative is to give p.o. glucose when the patient is alert enough to swallow it. — Daniel Cook

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