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Canadian Journal of Anesthesia 48:714-715 (2001)
© Canadian Anesthesiologists' Society, 2001

Correspondence

Syringe contamination by propofol: a possible mechanism

Amitabh Dutta, MD and S.K. Malhotra, MD

Chandigarh, India

To the Editor:

Propofol, though a most popular induction agent providing an early awakening of anesthetized patients,1 has been shown to promote the growth of bacteria2 and fungi3 which might result in postoperative infection and sepsis. Breaking of ampoules, without taking aseptic measures, is the most common mode of extrinsic contamination.4 We report another possible source of such a contamination, which often goes unnoticed.

While administering propofol through an iv cannula, a residual amount of medication stays in the drug port. The residual propofol, measured randomly in 50 patients, ranged between 0.05–0.15 mL. When a subsequent drug is injected through the same port, the residual propofol migrates up into the syringe. Eventually, during prolonged procedures, the migrated propofol may lead to extrinsic contamination of subsequent drugs. This phenomenon is better noticed initially when propofol travels up in form of a thin streak followed by a "mushrooming effect" a la nuclear fission (FigureGo). Such contamination may contribute to postoperative infection and sepsis.



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  		FIGURE Thin streak and "mushrooming effect" following migration of propofol into the subsequent drug syringe.

 
Manufacturers recommend that propofol be used within six hours of its handling, in a single patient, and not be stored thereafter. Sosis and Braverman3 demonstrated that the number of colony forming units of staphylococcus aureus were significantly greater when inoculated in sterile 0.9% saline when compared to solutions containing other anesthetics and summarized that saline does not possess any bacteriostatic property. Since water for injection and 0.9% saline are routine diluents for anesthetics, contamination by entrapped propofol is quite possible.

In conclusion, we endorse the recommendation to use a dedicated iv cannula for administration of propofol not only to avoid its incompatibility with other anesthetic drugs,5 but also to prevent its own contamination and that of the drugs in subsequent syringes.

References

1 Sebel PS, Lowdon JD. Propofol: a new intravenous anesthetic. Anesthesiology 1989; 71: 260–77.[Medline]

2 Thomas DV. Propofol supports bacterial growth (Letter). Br J Anaesth 1991; 66: 274.[Free Full Text]

3 Sosis MB, Braverman B. Growth of staphylococcus aureus in four intravenous anesthetics. Anesth Analg 1993; 77: 766–8.[Abstract/Free Full Text]

4 Zacher AN, Zornow MH, Evans G. Drug contamination from opening glass ampoules. Anesthesiology 1991; 75: 893–5.[Medline]

5 Lamontagne C, Brouillette D, Hardy J-F. Incompatibility of propofol emulsion with anesthetic drugs (Letter). Anesthesiology 1998; 89: 1609.[Medline]





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