Le maniement d’usage du propofol prévient la contamination aussi effectivement que la stricte adhésion aux recommandations du fabricant

Abstract

P Pu ur rp po os se e: : Propofol is a potential vector of infection, because it contains no preservative. Thus, the manufacturer's specific recommendations for preparing injections or infusions go beyond the guidelines commonly used in our operating rooms for preparing other iv drugs. The purpose of the present study was to determine whether in the daily routine of an operating theatre a modified propofol handling technique can prevent contamination as effectively as do the manufacturer's handling recommendations. M Me et th ho od ds s: : A total of 160 consecutive neurosurgical patients were allocated to either Group I (manufacturer's handling recommendations: i.e., 1) disinfecting propofol vials and ampoules before filling syringes; 2) replacing empty syringes; 3) discarding all material at the end of surgery); or Group II (modified propofol handling protocol: i.e., 1) refilling empty syringes; 2) renewing only the infusion line to the patient). R Re es su ul lt ts s: : Total contamination rates were comparable in both groups (Group I: 14/160 (8.75%), Group II: 13/160 (8.13%) (P 2 =0.074; P=0.96). Frequency of contamination was not different between groups; either in sample 1 taken at the beginning of the procedure, (Group I: 5/80 (6.25%) vs Group II: 6/80 (7.5%); P 2 =0.098; P=0.76) or in sample 2, taken at the end, (Group I: 9/80 (11.25%) vs Group II: 7/80 (8.75%); P 2 =0.278; P=0.598). C Co on nc cl lu us si io on n: : We conclude that in the daily routine of the operating theatre following a modified propofol handling protocol prevents contamination of propofol syringes as effectively as does adhering to the manufacturer's specific handling recommendations. However, neither of the tested guidelines completely prevented contamination. Groupe I et 13/160 (8,13 %) dans le Groupe II (P 2 = 0,074; P = 0,96). La fréquence de contamination ne diffère pas d'un groupe à l'autre, pour l'échantillon 1 prélevé au début de l'opération (Groupe I : 5/80 (6,25 %) vs Groupe II : 6/80 (7,5 %); P 2 = 0,098; P = 0,76) ou l'échantillon 2 à la fin (Groupe I : 9/80 (11,25 %)vs Groupe II : 7/80 (8,75 %); P 2 = 0,278; P = 0,598 Objectif : Le propofol, ne contenant aucun agent de conservation, est un vecteur potentiel d'infection. C'est pourquoi les recommandations spécifiques du fabricant au sujet de la préparation d'injections ou de perfusions vont au delà des directives habituellement suivies dans nos salles d'opération pour la préparation d'autres médicaments intraveineux. Nous avons voulu déterminer si, en modifiant le maniement du propofol en salle d'opération, nous pouvions prévenir la contamination aussi efficacement qu'en suivant à la lettre les recom

The Safe and Effective Use of Propofol Sedation in Children Undergoing Diagnostic and Therapeutic Procedures: Experience in a Pediatric ICU and a Review of the Literature

“…The syringe was discarded and a new syringe was prepared after 6 hours. [11][12][13] The dosing of propofol was at the discretion of the pediatric intensivist performing the sedation. Adequate sedation was achieved with the administration of an initial bolus dose of 1 to 2 mg/kg of propofol, followed by additional smaller bolus doses as required.…”

Systematic review and meta-analysis of the risk of microbial contamination of parenteral doses prepared under aseptic techniques in clinical and pharmaceutical environments: an update

“…doses from five studies (five records 17,27,30,37,40 ) that had been sampled without administration or prior to administration, of which 252 doses from three studies (three records 27,30,37 ) had been prepared in clinical environments and 168 doses from two studies (two records 17,40 ) had been prepared in pharmaceutical environments. When all the data were combined there was a non-significantly higher frequency of contamination of doses prepared in clinical than in pharmaceutical environments [2.3% (95% CI: 0.5, 10.1; N = 252 doses) (I 2 = 56.45%; P = 0.101) vs 2.1% (95% CI: 0.7, 5.8; N = 168 doses) (I 2 = 00.00%; P = 0.856); P = 0.923].…”

Propofol and the risk of transmission of infection

“…11 They found that the propofol contamination rate by bacteria was similar in the two groups and concluded that their "usual practice" prevented contamination as effectively as the manufacturer's recommendations. Fortunately, the authors stopped short of recommending the use of their routine.…”