醫師授權
是規範還是緊箍咒！
麻醉科的用藥，最普遍的是嗎啡類止痛藥，所有臨床醫師都會也常常使用，又比如局部麻醉劑，更是如此！不過最近發現，麻醉科用藥快要淪陷光了！ 急診醫師插管，以前只會打valium，接著會打midazolam，現在已經在打 etomidate ＋ esmeron了！外科開刀後，以前都自己打morphine infusion，現在ICU 不是只有 propofol sedation, 已經出現 fentanyl infusion了！
有了JCI 評鑑，醫院也知道所謂醫師授權的事，所以為了IV sedation, 也辦了一系列的授權演講會，說穿了也就是為臨床醫師開一堂，快速學分授予課程，真不知道，要為麻醉科感到驕傲還是悲哀？
最近美國FDA發現麻醉藥物濫用的問題，因此興起所謂醫師處方授權的規範辦法。
F.D.A. to Place New Limits on Prescriptions of Narcotics
WASHINGTON — Many doctors may lose their ability to prescribe 24 popular narcotics as part of a new effort to reduce the deaths and injuries that result from these medicines』 inappropriate use, federal drug officials announced Monday.
新聞來源：NewYork Times
限縮的藥物包括：extended-release opioids like OxyContin, fentanyl patches, methadone tablets and some morphine tablets.
第二個有關授權的新聞：FDA發布有關持續性輸注局麻藥的安全警告
Local Anesthetics, Continuously Infused (marketed as bupivacaine, chlorprocaine, lidocaine, mepivacaine, procaine, ropivacaine) - Chondrolysis
上面的標題，少了一個字：intra-auticularly關節腔內注射，我想不用解釋，這一定是骨科醫師幹的，局部麻醉藥，從來沒有核准可以用於關節腔內注射，尤其是長時間輸注！ 一般的臨床醫師不會注意到局麻藥物的毒性，所謂藥即是毒，善用者為藥，濫用者為毒，斯之已矣！
[Posted 11/13/2009] FDA notified healthcare professionals of 35 reports of chondrolysis (necrosis and destruction of cartilage) in patients given continuous intra-articular infusions of local anesthetics with elastomeric infusion devices to control post-surgical pain. The local anesthetics (with and without epinephrine) were infused for extended periods of time (48 to 72 hours) directly into the intra-articular space using an elastomeric pump. Joint pain, stiffness, and loss of motion were reported as early as the second month after receiving the infusion. In more than half of these reports, the patients required additional surgery, including arthroscopy or arthroplasty (joint replacement).不過，南枳北橘，制度到了這裡都變得什麼鳥都不是了，不是嗎？
Local anesthetics are approved as injections for the production of local or regional anesthesia or analgesia. The approved drug labels for local anesthetics do not include an indication for continuous intra-articular postoperative infusions or use of infusion devices, such as elastomeric pumps. The FDA has not cleared any infusion devices with an indication for use in intra-articular infusion of local anesthetics. Health care professionals are encouraged to follow the instructions for use of elastomeric infusion devices, and to not use these devices for continuous intra-articular infusion of local anesthetics after orthopedic surgery.
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