Remifentanil shortage and system resilience: from crisis to opportunity

Mahase reports that the ongoing shortage of remifentanil is forcing anaesthetists to relearn techniques from 10 or 15 years ago and that the health service needs to work with manufacturers to prevent future drug shortages.1 While this is undoubtedly important, a chain is only as strong as its weakest link and an excessive reliance on one or two drugs is not a hallmark of resilience.Neither remifentanil nor the equipment needed to use it to its full potential is available in much of the world. Nor does remifentanil appear on the World Health Organization’s current list of essential medicines.23 Although remifentanil would now be considered the first choice agent in many cases, it is helpful to separate the majority of cases in which it is merely useful from those in which it may be considered genuinely irreplaceable.In any event, “relearn” is quite a strong term because anaesthesia practised by experienced anaesthetists…
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