Propofol and postoperative infections

The package insert for propofol states in several places the importance of strict aseptic technique in the preparation and handling of the drug, and the potential for infection if these procedures are not followed. In the US, the product has been reformulated to contain disodium edetate 0.005% as a microbial growth retardant to inhibit the growth of microorganisms in the event of accidental contamination. However, this new formulation is not considered an antimicrobially preserved product under USP standards. What effect, if any, this has had on the risk of postoperative infections is not known. Strict aseptic technique is still required when handling the new formulation. When propofol is used as an anesthetic, it is recommended that the dose be prepared just prior to administration, and that the infusion be completed within 6 hours after the ampul or vial is opened. Any unused portion of propofol must be discarded at the end of the procedure or at 6 hours, whichever occurs sooner. In the ICU, if propofol is administered directly from its original container, the tubing and any unused portion must be discarded after 12 hours. If propofol is transferred to another container, administration lines and unused drug should be discarded after 6 hours. The occurrence of postoperative infections is usually thought to be related to the surgeon or the surgical procedure. However, based on the available microbiologic and clinical evidence, the use of propofol appears to be an additional risk factor. Hospital personnel involved in the preparation and handling of propofol must be educated on, and adhere to, the recommendations outlined by the manufacturer to prevent further outbreaks of infections.