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Purpose There is a paucity of literature on anesthetic drug shortages and their impact on patient safety in lower-middle-income countries. We sought to determine the magnitude of the problem, the effect on patient care and safety, and the adverse patient outcomes witnessed by anesthesiologists in Pakistan Methods We conducted a nationwide, multicentre, cross-sectional survey of a representative sample of anesthesiologists in Pakistan (January 2021 to June 2021). The survey questionnaire was adapted from the American Society of Anesthesiologists (ASA) survey on drug shortages and was modified based on the national essential medication list 2018 of Pakistan. It was distributed through Google Forms to anesthesiologists practicing in both the private and government sector. The names of hospitals or the identity of anesthesiologists was not required. The questionnaire consisted of 20 items and focused on the anesthesiologists’ experience of drug shortages, the availability of drugs, and the impact of drug shortages on their individual practice. Results Two hundred and forty-six responses were received. Approximately 50% (122/246) of anesthesia practitioners in Pakistan reported anesthetic drug shortages. Fifty-seven percent of respondents mentioned using an inferior drug that may have significantly affected the delivery of anesthetic care. Four participants mentioned severe morbidity and another four mentioned observing a mortality associated with drug shortage. Conclusion Anesthetic drug shortages are common in anesthetic practice in Pakistan and they appear to affect patient care and outcomes. Supplementary Information The online version contains supplementary material available at 10.1007/s12630-022-02381-3.

We report mixed germ cell tumour, presented with acute kidney injury in an unmarried 22 years old Asian girl. Our case demonstrated an aggressive approach with multidisciplinary teamwork ascertained outstanding clinical outcome. She managed successfully for fertility-sparing surgery and three cycles of Bleomycin, Etoposide and Cisplatin (BEP) therapy. Patient’s pathophysiology returned to normal within weeks and she converted tumour-free. Furthermore, the three years follow up scans and biomarkers were evident for tumour negativity. Continuous...