Category Archives: News

My Trip to Washington: Speaking Out Against Drug Shortages

From left to right: Daniel Teich (Fairview Pharmacy Services), Dr. Peter Adamson (Children’s Hospital of Philadelphia), Senator Susan Collins, me, and Brian Marden (MaineHealth Pharmacy)

On November 5, 2019, I had the opportunity to participate in a Congressional briefing related to drug shortages at the Capitol in Washington, DC. Senator Susan Collins (R-ME) opened the session and co-sponsored the MEDS Act with Senator Tina Smith (D-MN). I was one of only two physicians on the panel and tried to represent the voice of clinicians involved in perioperative care and the patients we care for. Below are the notes from my presentation.

As a physician specializing in anesthesiology, this ongoing crisis of drug shortages in the United States is frankly terrifying.

Anesthesiology is a unique specialty within medicine. Our patients are the most vulnerable in the hospital. Patients under general anesthesia cannot advocate for themselves and trust us with their lives.

We do not know what the next drug shortage will be or how long it will last. This week it is prefilled syringes of lidocaine, a life-saving emergency medication we give in case of a dangerous heart rhythm. Two weeks ago it was phenylephrine, a routine medication we use to increase blood pressure when it goes down after inducing anesthesia.

Last year, we had complete shortages of common injectable opioids and local anesthetics used for numbing injections. This directly affected surgical patients in terms of anesthesia and pain management. For 3 months in 2018, we did not have the local anesthetic indicated for spinal anesthesia. We know this is the safest anesthetic for patients having certain surgeries. During this shortage, we used an alternative anesthetic in order to continue providing spinal anesthesia, but our patients experienced more side effects. The reasons for this shortage were complex and involved a limited number of manufacturers and quality issues.

Thankfully, the shortage of spinal local anesthetic ended. We do not know when or if the rest of our current drug shortages will end. All we know for sure is that there will be another one.

The predictably unpredictable cycle of drug shortages puts physicians in an impossible position. Medicine is a calling, and we physicians have sworn an oath to support the well-being of our community and humanity in general.

Not having access to the right drugs at the right time for every patient and being forced to use less acceptable alternatives, if any exist at all, represents a form of moral injury. Moral injury “is being unable to provide high-quality care and healing in the context of health care” and is now recognized as a contributor to the epidemic of physician burnout.

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New VA Palo Alto Anesthesiology Website

 

We recently launched the first website for the Anesthesiology and Perioperative Care Service at the VA Palo Alto Health Care System.  As our patient population gets more connected with instant access to information via the incimg0057ternet, it is more important than ever for us to reach out to them.  We know that going through the surgical process is a stressful experience for patients and families.  Through this website, we hope that our Veteran patients will be able to learn more about the cutting-edge anesthesia and pain management services we have to offer them.  We also want our prospective staff, trainees, and colleagues to see the great things we’re doing at the VA Palo Alto these days.  Please visit us at online!

 

 

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Welcome

va_flagsWelcome to EdMariano.com! 

I am an anesthesiologist at the VA Palo Alto Health Care System (VAPAHCS) in Palo Alto, California.  My specialty is regional anesthesia which involves performing a variety of specific nerve block techniques to numb areas of the body for pain control.  Our research has shown that nerve blocks provide patients with the best possible form of pain management after surgery.  At the VAPAHCS, we even use nerve blocks as the primary anesthetic for outpatient surgeries so patients can wake up faster, pain-free, and without the nausea and other side effects associated with general anesthesia.

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