5 February 2020
Statement from our Pharmacy Professional Advisory Group
The COVID-19 pandemic has seen unprecedented pressure on demand, supply and manufacture of key medicines used in critical care. A supply disruption alert (SDA) for propofol formulations commonly used in critical care (1% and 2% in 50mL and 100mL) was issued on 3rd February 2021. This represents a key risk in that critical care units that routinely use a particular strength or formulation may be required to switch between strengths and/or formulations at short notice. To mitigate the risk of over or under dosing, any formulation or strength change that users may be unfamiliar with should be coordinated locally by a multidisciplinary group with representation from pharmacists, medical and nursing staff. Considerations should be given to appropriate adjustment of order sets, order panels or paper prescriptions to support this switch. Synchronising communications, stock availability and prescribable formulations on individual units will be a key element to mitigating these risks. Please be mindful, some Trusts may be procuring commercial pre-filled syringes of propofol. If pre-filled syringes are to be used in a syringe pump, ensure the pump is compatible. Discard and replace the administration set and the reservoir of any undiluted propofol after a maximum of 12 hours from the start of the infusion.>
Propofol use may be supplemented or substituted early on with the use of other sedative agents (including benzodiazepines and alpha 2 agonists) however there are key limitations to these e.g. delirium, prolonged duration of mechanical ventilation and cardiovascular instability. The benefits and limitations of this approach should be considered extremely carefully. Also, these agents may be subject to disrupted manufacture or supply chains.