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Anesth Analg 2000;91:1307-1308
© 2000 International Anesthesia Research Society

LETTERS TO THE EDITOR

Any Propofol Compatibility Study Must Include an Emulsion Stability Analysis

Eric L. Chernin, RPh*, and Barry Smiler, MD{dagger}

*Departments of Pharmaceutical Care Services and {dagger}Anesthesia Sarasota Memorial Hospital Sarasota, Florida 34239

To the Editor:

We would like to comment on the recent technical communication by Stewart et al. (1) concerning the stability of a propofol and remifentanil admixture. Any stability study involving emulsions must address not only the chemical stability of the constituent drugs as determined by high-performance liquid chromatography (HPLC), but also the stability of the emulsion vehicle itself before the mixture can be considered safe for clinical use. Any change in the emulsion particle size resulting from admixing propofol may have adverse consequences for patient safety. Fat emulsion particles large enough to cause fat emboli may not be visible to the unaided eye. Laser diffraction and optical microscopy particle size analysis, such as that published by Prankerd and Jones (2) concerning the propofol/thiopental mixture must be performed before using any propofol admixture.

We would also question the authors’ statement that the propofol/remifentanil mixture is safe to store for 36 hours. It is well documented that propofol’s fat emulsion vehicle is an excellent medium for microbial growth (3,4). Studies similar to those conducted with the thiopental/propofol mixture, which have documented that combinations antimicrobial activity because of its high pH (5), need to be performed. However, there is nothing in the physiochemical nature of the remifentanil/propofol mixture that would appear to confer similar antimicrobial properties. Until microbiological and emulsion stability studies are performed, a propofol/remifentanil mixture cannot be assumed to be safe for storage or for administration to patients.

Footnotes

Drs. Stewart et al. did not wish to respond to this letter.

References

  1. Stewart JT, Warren FW, Maddox FC, et al. The stability of remifentanil hydrochloride and propofol in polypropylene syringes and polyvinyl chloride bags at 22°–24°C. Anesth Analg 2000; 90: 1450–1.[Abstract/Free Full Text]
  2. Prankerd RJ, Jones RD. Physiochemical compatibility of propofol with thiopental sodium. Am J Hosp Pharm 1996; 53: 2606–10.
  3. Carr S, Waterman S, Rutherford G, et al. Postoperative infections associated with an extrinsically contaminated intravenous anesthetic agent.; :.
  4. Bennett SN, McNeil MM, Bland LA, et al. Postoperative infections traced to contamination of an intravenous anesthetic, propofol. NEJM 1995; 333: 147–54.[Abstract/Free Full Text]
  5. Crowther J, Hrazdil J, Jolly DT, et al. Growth of microorganisms in propofol, thiopental, and in a 1: 1 mixture of propofol and thiopental. Anesth Analg 1996; 82: 475–8.[Abstract]



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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press