Shortage of perioperative supplies and drugs: Theory and practical implications

Keywords: Anesthesia, Analgesia, Resource shortage for health, Economics, pharmaceutical, Equipment and supplies, Drugs, generic, Intellectual property of pharmaceutic products and process


During the past three decades the world has been witness to an alarming increase in the shortage of drugs and biomedical products in the field of anesthesia and surgical care. This situation can be particularly challenging when there are no therapeutic alternatives available, as is the case with some supplies and drugs for perioperative use. Anesthesiologists, who play a crucial role in the preparation of the drugs they administer, are particularly aware of these shortages. The reasons for these shortages are diverse and involve problems in supply, demand and government regulation. Among the causes identified are the increase in demand, bidding systems and the sustainability challenges faced by pharmaceutical companies. It is essential to understand these causes in order to seek strategies to reduce the risk of shortages of medicines and supplies. Addressing this challenge requires improving supply chain management, fostering transparency in information on stock-outs, promoting local production of medicines, and strengthening procurement and distribution regulations and policies. The solution to this problem requires a comprehensive and collaborative approach, with multiple stakeholders working together to ensure adequate access to needed medications in the anesthesia and surgical care setting.


Steinbrook R. Drug shortages and public health. N Engl J Med. 2009;361(16):1525-27. doi:

De Oliveira GS, Theilken LS, McCarthy RJ. Shortage of perioperative drugs: implications for anesthesia practice and patient safety. Anesth Analg. 2011;113(6):1429-35. doi:

Fox ER, Sweet BV, Jensen V. Drug shortages: a complex health care crisis. Mayo Clin Proc. 2014;89(3):361-73. doi:

Jensen V, Rappaport BA. The reality of drug shortages. The case of the injectable agent propofol. N Engl J Med. 2010;363(9):806-7. doi:

The Economist. A dire scarcity of drugs is worsening, in part, because they are so cheap [internet]. 2019. Available at:

Leung L. Health economic evaluation: A primer for healthcare professionals. Prim Health Care Open Access. 2016;6(2). doi:

Palmer S, Raftery J. Economics notes: Opportunity cost. BMJ. 1999;318(7197):1551-2. doi:

Mankiw NG. Principles of economics. 9th edition. Cengage Learning, Inc; 2021.

Shukar S, Zahoor F, Hayat K, Saeed A, Gilllani A, Omer S, et al. Drug shortage: Causes, impact, and mitigation strategies. Front Pharmacol. 2021;12:693426. doi:

Scherer FM. Chapter 25 The pharmaceutical industry. En: Handbook of Health Economics. Vol 1. Elsevier; 2000:1297-336.

Milgrom PR, Roberts J. Economics, organization, and management. Prentice-Hall; 1992.

Pharma 50: The 50 largest pharmaceutical companies in the world. Drug Discovery and Development [internet]. 2023. Available at:

Lakdawalla DN. Economics of the pharmaceutical industry. J Econ Lit. 2018;56(2):397-449. doi:

Krugman PR, Wells R. Microeconomía. Editorial Reverté; 2013.

Tirole J. La economía del bien común. Penguin Random House Grupo Editorial España; 2017.

Samuelson P, Nordhaus W. Economía con aplicaciones. McGraw-Hill; 2019.

Cowen T, Tabarrok A. Modern principles: Microeconomics. Worth Publ Incorporated; 2020.

Sowell T. Economía básica: un manual de economía escrito desde el sentido común. Grupo Planeta (GBS); 2013.

Varian HR. Microeconomía intermedia, 8a ed. Antoni Bosch Editor, S.A.; 2011.

Dosi G, Marengo L, Staccioli J, Virgillito ME. Big Pharma and monopoly capitalism: A long-term view. Struct Change Econ Dyn. 2023;65:15-35. doi:

Angell M. La verdad acerca de la industria farmacéutica. Editorial Norma; 2006.

Khachigian LM. Pharmaceutical patents: reconciling the human right to health with the incentive to invent. Drug Discov Today. 2020;25(7):1135-41. doi:

Weiser TG, Haynes AB, Molina G, Lipsitz S, Esquivel M, Uribe T, et al. Size and distribution of the global volume of surgery in 2012. Bull World Health Organ. 2016;94(3):201-9F. doi:

Hanna JS, Herrera-Almario GE, Pinilla-Roncancio M, Tulloch D, Valencia S, Sabatino M, et al. Use of the six core surgical indicators from the Lancet Commission on Global Surgery in Colombia: a situational analysis. Lancet Glob Health. 2020;8(5):e699-e710. doi:

Phuong JM, Penm J, Chaar B, Oldfield LD, Moles R. The impacts of medication shortages on patient outcomes: A scoping review. PLOS ONE. 2019;14(5):e0215837. doi:

Walker J, Chaar BB, Vera N, Pillai A, Lim J, Bero L, et al. Medicine shortages in Fiji: A qualitative exploration of stakeholders’ views. PLOS ONE. 2017;12(6):e0178429. doi:

Fugh-Berman A, Homedes N. How drug companies manipulate prescribing behavior. Colombian Journal of Anesthesiology. 2018:1. doi:

Dranitsaris G, Jacobs I, Kirchhoff C, Popovian R, Shane LG. Drug tendering: drug supply and shortage implications for the uptake of biosimilars. Clin Outcomes Res. 2017;9:573-84. doi:

Fox ER, Tyler LS. Potential association between drug shortages and high-cost medications. Pharmacother J Hum Pharmacol Drug Ther. 2017;37(1):36-42. doi:

Dave CV, Pawar A, Fox ER, Brill G, Kesselheim AS. Predictors of drug shortages and association with generic drug prices: A retrospective cohort study. Value Health. 2018;21(11):1286-90. doi:

Schweitzer SO. How the US Food and Drug Administration can solve the prescription drug shortage problem. Am J Public Health. 2013;103(5):e10-e14. doi:

Mazer-Amirshahi M, Pourmand A, Singer S, Pines JM, Van Den Anker J. Critical drug shortages: Implications for emergency medicine. Acad Emerg Med. 2014;21(6):704-11. doi:

Rincón-Valenzuela DA, Gómez-Ardila C. Cost-benefit relationship of keeping dantrolene stocks from the point of view of healthcare institutions. Colombian Journal of Anesthesiology. 2020;48(2):63-70. doi:

Acosta A, Vanegas EP, Rovira J, Godman B, Bochenek T. Medicine shortages: Gaps between countries and global perspectives. Front Pharmacol. 2019;10:763. doi:

Dill S, Ahn J. Drug shortages in developed countries—reasons, therapeutic consequences, and handling. Eur J Clin Pharmacol. 2014;70(12):1405-12. doi:

Mazer-Amirshahi M, Fox ER. Saline shortages — Many causes, no simple solution. N Engl J Med. 2018;378(16):1472-74. doi:

World Health Organization. Medicines shortages: global approaches to addressing shortages of essential medicines in health systems. WHO Drug Inf. 2016;30(2):180-5.

Emmett D. Supply chains in healthcare organizations: Lessons learned from recent shortages. Hosp Top. 2019;97(4):133-8. doi:

Rowan NJ, Laffey JG. Challenges and solutions for addressing critical shortage of supply chain for personal and protective equipment (PPE) arising from Coronavirus disease (COVID19) pandemic – Case study from the Republic of Ireland. Sci Total Environ. 2020;725:138532. doi:

Kaakeh R, Sweet BV, Reilly C, Bush C, DeLoach S, Higgins B, et al. Impact of drug shortages on U.S. health systems. Am J Health Syst Pharm. 2011;68(19):1811-9. doi:

Ferrière N, Bodenes L, Bailly P, L’Her E. Shortage of anesthetics: Think of inhaled sedation! J Crit Care. 2021;63:104-5. doi:

Ayati N, Saiyarsarai P, Nikfar S. Short and long term impacts of COVID-19 on the pharmaceutical sector. DARU J Pharm Sci. 2020;28(2):799-805. doi:

Badreldin HA, Atallah B. Global drug shortages due to COVID-19: Impact on patient care and mitigation strategies. Res Soc Adm Pharm. 2021;17(1):1946-49. doi:

Maneno JN, Ness GL. Andexanet Alfa, the possible alternative to protamine for reversal of unfractionated heparin. Ann Pharmacother. 2021;55(2):261-4. doi:

Rinaldi F, De Denus S, Nguyen A, Nattel S, Bussières JF. Drug shortages: Patients and health care providers are all drawing the short straw. Can J Cardiol. 2017;33(2):283-6. doi:

Hedlund NG, Isgor Z, Zwanziger J, Rondelli D, Crawford S, et al. Drug shortage impacts patient receipt of induction treatment. Health Serv Res. 2018;53(6):5078-105. doi:

Kornai J. What economics of shortage and the socialist system have to say to the (Hungarian) readers today. Acta Oeconomica. 2012;62(3):365-84. doi:

Baddeley M. Hoarding in the age of COVID-19. J Behav Econ Policy. 2020;4(S):69-75. Available at:

Hantel A, Siegler M, Hlubocky F, Colgan K, Daugherty CK. Prevalence and severity of rationing during drug shortages: A national survey of health system pharmacists. JAMA Intern Med. 2019;179(5):710. doi:

Costelloe EM, Guinane M, Nugent F, Halley O, Parsons C. An audit of drug shortages in a community pharmacy practice. Ir J Med Sci. 2015;184(2):435-40. doi:

Hughes KM, Goswami ES, Morris JL. Impact of a drug shortage on medication errors and clinical outcomes in the pediatric intensive care unit. J Pediatr Pharmacol Ther. 2015;20(6):453-61. doi:

Musazzi UM, Di Giorgio D, Minghetti P. New regulatory strategies to manage medicines shortages in Europe. Int J Pharm. 2020;579:119171. doi:

How to Cite
Rincón-Valenzuela DA, Gómez-Ardila C. Shortage of perioperative supplies and drugs: Theory and practical implications. Colomb. J. Anesthesiol. [Internet]. 2024 Feb. 20 [cited 2024 Apr. 23];52(2). Available from:


Download data is not yet available.
How to Cite
Rincón-Valenzuela DA, Gómez-Ardila C. Shortage of perioperative supplies and drugs: Theory and practical implications. Colomb. J. Anesthesiol. [Internet]. 2024 Feb. 20 [cited 2024 Apr. 23];52(2). Available from:
Narrative review


Article metrics
Abstract views
Galley vies
PDF Views
HTML views
Other views
QR Code

Some similar items: