F. ÜLGER, A. DİLEK, Ö. DARKA, M.Z. YILMAZ, H. SARIKAYA, Ş. ESEN, D. KARAKAYA

Günlük anestezi pratiğinde kullanılan propofol flakonlarının bakteriyel kontaminasyon riski ve lidokainin antibakteriyel etkinliğinin değerlendirilmesi

Amaç: Bu çalışma ile ameliyathane şartlarında günlük pratikte kullanılan propofol flakonlarının kontaminasyon riskinin ve enjeksiyon ağrısını önlemek için eklenen lidokainin antibakteriyel etkinliğinin değerlendirilmesi amaçlandı. Yöntem: Propofol flakonları Grup P (n=55) Propofol ve Grup PL Propofol + 5 mL Lidokain % 2 (n=54) olarak ikiye bölündü. Flakonlar sabah erken saatte açıldı ve günlük anestezi pratiğinde kullanıldı. Günlük kullanımı biten flakonlar, izleyen günde 24 saat oda ısısında bekletildi. 109 propofol flakonu toplanarak kültürler alındı. Örnekler aerobik hemokültür tüplerine ekildi. Her bir flakon 15 gün süre ile izlendi. Bulgular: Her iki grupta da bakteriyel kontaminasyon izlenmedi. Tüm kültür tüpleri erken ve geç üreme açısından izlendi ve üremeye ait pozitif bulguya rastlanmadı. Sonuç: Çalışmamızda 24 saat oda sıcaklığında bekletilen propofol flakonlarının (lidokainli ya da lidokainsiz) hiç birisinde üreme görülmemiştir. Bu nedenle propofol flakonlarına eklenen lidokainin bakteriyel kontaminasyondan koruma etkileri üzerine yorum yapılamamıştır.

Anahtar Kelimeler:

Propofol, Kültür ortamı, Değerlendirme çalışmaları, Lidokain, İlaç kontaminasyonu

Bacterial contamination risk of propofol vials used in anesthesia practice and evaluation of antibacterial effect of lidocaine

Objective: This study was performed to examine the bacterial contamination risk of propofol vials that are used for routine anesthesia practice and the antimicrobial effects of lidocaine which is added for prevention of injection pain in the operating theatres. Method: The samples were divided into two groups as propofol (Group P, n=55) or propofol plus 5 mL lidocaine 2 % (Group PL, n=54). Vials were opened early in the morning and used for a number of patients in routine anesthesia practice. The last used vials of the day were left in the room temperature for 24 hours on the following day. One hundred nine Propofol vials were collected and cultured samples were drawn into an automated aerobic hemoculture tube. Each culture tube was observed for microbial growth for fifteen days. Results: There was no bacterial contamination in all groups. All hemoculture tubes were observed for early and late bacterial growth, yielding no positive result. Conclusion: In our study, vials were kept at room temperature for 24 hours and no bacterial contamination was observed in any of the vials with or without lidocaine. Therefore, we cannot comment on the effect of lidocaine on bacterial contamination rate.

Keywords:

Propofol, Culture Media, Evaluation Studies, Lidocaine, Drug Contamination,

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1. Gillis MC. Diprivan. In: Gillis MC, (Ed.). Compendium of Pharmaceuticals and Specialties 34th ed. Ottawa, Ontario: Pharmacists Association; 1999: 539–43.
2. Sosis MB, Braverman B. Growth of Staphylococcus aureus in four intravenous anesthetics. Anesth Analg 1993; 77(4): 766-8.
3. Crocker KS, Noga R, Filibeck DJ, Krey SH, Markovic M, Steffee WP. Microbial growth comparisons of five commercial parenteral lipid emulsions. JPEN J Parenter Enteral Nutrition 1984; 8(4): 391-5.
4. Gajraj RJ, Hodson MJ, Gillespie JA, Kenny GN, Scott NB. Antibacterial activity of lidocaine in mixtures with Diprivan. Br J Anaesth Br J Anaesth 1998; 81(3): 444-8.
5. Berry CB, Gillespie T, Hood J, Scott NB. Growth of micro-organisms in solution of intravenous anaesthetic agents. Anaesthesia 1993; 48: 30-2.
6. Schimidt RM, Rosenkranz HS. Antimicrobial activity of local anesthetics; lidocaine and procaine. J Infect Dis 1970; 121(6): 597-607.
7. Fazly Bazaz BS, Salt WG. Local anesthetics as antimicrobial agents: structure–action considerations. Microbios 1983; 37(147): 45-64.
8. Silva MT, Sousa JC, Polonia JJ, Macedo PM. Effects of local anesthetics on bacterial cells. J Bacteriol 1979; 137(1): 461-8.
9. Thompson KD, Welykyj S, Massa MC. Antibacterial activity of lidocaine in combination with a bicarbonate buffer. J Dermatol Surg Oncol 1993;19(3): 216-20.
10. Diprivan injection. Wilmington, Del, Stuart pharmaceuticals, 1993 (packace insert)
11. Henry B, Plante-Jenkins C, Ostrowska K. An outbreak of Serratia marcescens associated with the anesthetic agent propofol. Am J Infect Control 2001; 29(5): 312-5.
12. Kuehnert MJ, Webb RM, Jochimsen EM, et al. Staphylococcus aureus blood stream infections among patients undergoing electroconvulsive therapy traced to breaks in infection control and possible extrinsic contamination by propofol. Anesth Analg 1997; 85(2): 420-5.
13. Bennet SN, McNeil MM, Bland LA, et al. Postoperative infections traced to contamination of an intravenous anesthetic, propofol. N Engl J Med 1995; 333(3): 147-54.
14. Veber B, Gachot B, Bedos JP, Wolff M. Severe sepsis after intravenous injection of contaminated propofol. Anesth 1994; 80(3): 712-3.
15. Sosis MB, Braverman B, Villaflor E. Propofol, but not thiopental, supports the growth of Candida albicans. Anesth Analg 1995; 81(1): 132-4.
16. Dunne WM Jr, Case LK, Isgriggs L, Lublin DM. In-house validation of the BACTEC 9240 blood culture system for detection of bacterial contamination in platelet concentrates. Transfusion 2005; 45(7): 1138-42.
17. Pearson ML. Guideline for prevention of intravascular device related infections. Part I. Intravascular device related infections: an overview. The Hospital Infection Control Practices Advisory Committee. Am J Infect Control 1996; 24(4): 262-77.
18. Berry AJ. Recommendations for Handling Parenteral Medications Used for Anesthesia or Sedation. Pittsburg: PA. Anesthesia Patient Safety Foundation; 1995.
19. Lorenz IH, Kolbitsch C, Lass-Flörl C, et al. Routine handling of propofol prevents contamination as effectively as does strict adherence to the manufacturer’s recommendations. Can J Anaesth 2002; 49(4): 347-52.
20. Ozer Z, Ozturk C, Altunkan AA, Cinel I, Oral U. Inhibition of bacterial growth by lignocaine in propofol emulsion. Anaesth Intensive Care 2002; 30(2): 179-82.
21. Aydin ON, Aydin N, Gultekin B, Ozgun S, Gurel A. Bacterial contamination of propofol: the effects of temperature and lidocaine. Eur J Anaesthesiol 2002; 19(6): 455-8.
22. Kaya K, Rota S, Dogan B, et al. Comparison of the antibacterial effects of two local anesthetics: Lidocaine and Articaine. Turk J Med Sci 2007; 37: 7-10.