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Unlu O, Bingul ES, Kesici S, Demirci M. Investigating antimicrobial features and drug interactions of sedoanalgesics in intensive care unit: an experimental study. ADMET AND DMPK 2022; 9:219-226. [PMID: 35300362 PMCID: PMC8920095 DOI: 10.5599/admet.1042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 08/25/2021] [Indexed: 12/02/2022] Open
Abstract
Study Objective Aim of this study was to evaluate antimicrobial effects and interaction between analgesic combinations of fentanyl citrate, dexmedetomidine hydrochloride and tramadol hydrochloride on Staphylococcus aureus, Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa and Candida albicans which are some of the most common nosocomial infection related microorganisms. Design In vitro prospective study. Setting University Clinical Microbiology Laboratory. Measurements In order to evaluate in vitro antimicrobial effects and interaction between analgesic combinations, tramadol hydrochloride, fentanyl citrate and dexmedetomidin were used against S. aureus ATCC 29213, K. pneumoniae, E. coli ATCC 25922, P. aeruginosa ATCC 27853 and C. albicans ATCC 10231 standard strains by microdilution method. Main Results According to microdilution assays tramadol has shown the most efficient antimicrobial activity also it has been observed that 10 μg/ml concentrated dexmedetomidine has antimicrobial effects on S. aureus, K. pneumoniae and P. aeruginosa. Fentanyl has displayed evident inhibitory potency on the pathogens except for Klebsiella pneumoniae, nevertheless our predefined minimum concentration inhibited growth by 9.5 %. Fentanyl and dexmedetomidine together exhibited more antimicrobial effect on P. aeruginosa and E. coli growth. Additionally, when the three drugs examined together, microbial inhibition occurred more than expected on E. coli again and also on C. albicans growth. Conclusions Our results revealed the antimicrobial properties and synergy with the different combinations of fentanyl, dexmedetomidine and tramadol against the most common nosocomial infection agents in the ICU. This is the first study in the literature looking into the microbial “interactions” of opioids and sedative drugs but more research is needed in order to define clinico-laboratory correlation.
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Affiliation(s)
- Ozge Unlu
- Istanbul Atlas University, Faculty of Medicine, Department of Medical Microbiology, Turkey
| | - Emre Sertac Bingul
- Recep Tayyip Erdogan University, Training and Research Hospital, Department of Anesthesiology and Reanimation, Turkey
| | - Sevgi Kesici
- Health Sciences University, Hqamidiye Etfal Training and Research Hospital, Department of Anesthesiology and Reanimation, Turkey
| | - Mehmet Demirci
- Kirklareli University, Faculty of Medicine, Department of Medical Microbiology, Turkey
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Antiviral Efficacy of the Anesthetic Propofol against Dengue Virus Infection and Cellular Inflammation. J Immunol Res 2021; 2021:6680913. [PMID: 33869639 PMCID: PMC8032536 DOI: 10.1155/2021/6680913] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 02/28/2021] [Accepted: 03/21/2021] [Indexed: 02/06/2023] Open
Abstract
Propofol, 2,6-diisopropylphenol, is a short-acting intravenous sedative agent used in adults and children. Current studies show its various antimicrobial as well as anti-inflammatory effects. Dengue virus (DENV) is an emerging infectious pathogen transmitted by mosquitoes that causes mild dengue fever and progressive severe dengue diseases. In the absence of safe vaccines and antiviral agents, adjuvant treatments and supportive care are generally administered. This study investigated the antiviral effects of propofol against DENV infection and cellular inflammation by using an in vitro cell model. Treatment with propofol significantly inhibited DENV release 24 h postinfection in BHK-21 cells. Furthermore, it also blocked viral protein expression independent of the translational blockade. Propofol neither caused inhibitory effects on endosomal acidification nor prevented dsRNA replication. Either the proinflammatory TNF-α or the antiviral STAT1 signaling was reduced by propofol treatment. These results provide evidence to show the potential antiviral effects of the sedative propofol against DENV infection and cellular inflammation.
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Henkel E, Vella R, Behan K, Austin D, Kruger P, Fenning A. The effect of concentration, reconstitution solution and pH on the stability of a remifentanil hydrochloride and propofol admixture for simultaneous co-infusion. BMC Anesthesiol 2020; 20:283. [PMID: 33183219 PMCID: PMC7664089 DOI: 10.1186/s12871-020-01194-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 10/20/2020] [Indexed: 11/29/2022] Open
Abstract
Background There are scenarios where pre-mixing and infusing analgesic and anaesthetic agents as a single intravenous (IV) solution is highly desirable; however, it is important to ensure the agents are compatible when mixed. As such, the long-term stability of a remifentanil-propofol mixture, and means of improving this, were assessed across a range of remifentanil concentrations, diluents, and time points. Methods Remifentanil was reconstituted with ultrapure water, 0.9% saline, 20% saline, or 8.4% sodium bicarbonate solution (the latter two chosen for their pH characteristics, rather than their use in pharmaceutical reconstitution) and then mixed with propofol (1%) or further diluted with water to derive concentrations of 10–50 μg mL− 1. Remifentanil and propofol concentrations were determined initially and then periodically for up to 24 h using high performance liquid chromatography (HPLC). Mass spectrometry (MS) was used to detect degradation products in solutions containing 30 μg mL− 1 of remifentanil. Statistical analysis was performed using ANOVA and Student’s t-test, with a significance value of 0.05. Results Isolated remifentanil (pH < 4) and propofol (pH 7.35) did not degrade significantly when reconstituted with water or saline solution over 24 h, while remifentanil reconstituted with sodium bicarbonate degraded significantly (P < 0.001, pH 8.65). Mixing with propofol substantially increased the pH of the mixture and resulted in significant remifentanil degradation for all reconstitution solutions used, while propofol remained stable (pH 6.50). The amount of degradation product detected in samples containing isolated remifentanil and a mixture of the drugs was proportional to the remifentanil degradation observed. Conclusions Remifentanil stability is affected by both the reconstitution solution used and when mixed with propofol, with pH appearing to be a contributing factor to degradation. If the pH of the solution and concentration of remifentanil are correctly controlled, e.g. through the use of a more acidic diluent, an admixture of remifentanil and propofol may be useful clinically. Supplementary Information Supplementary information accompanies this paper at 10.1186/s12871-020-01194-5.
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Affiliation(s)
- Emily Henkel
- Central Queensland University, School of Health, Medical and Applied Sciences, 554-700 Yaamba Road, Rockhampton, QLD, 4701, Australia.
| | - Rebecca Vella
- Central Queensland University, School of Health, Medical and Applied Sciences, 554-700 Yaamba Road, Rockhampton, QLD, 4701, Australia
| | - Kieran Behan
- Department of Pharmacy and Intensive Care Unit, Rockhampton Hospital, Canning Street, Rockhampton, QLD, 4700, Australia
| | - David Austin
- Intensive Care Unit, Rockhampton Hospital, Canning Street, Rockhampton, QLD, 4700, Australia
| | - Peter Kruger
- Intensive Care Unit, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD, 4102, Australia
| | - Andrew Fenning
- Central Queensland University, School of Health, Medical and Applied Sciences, 554-700 Yaamba Road, Rockhampton, QLD, 4701, Australia
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Kesici S, Demırci M, Kesici U. [Antimicrobial effects of fentanyl and bupivacaine]. Rev Bras Anestesiol 2020; 70:357-363. [PMID: 32819727 DOI: 10.1016/j.bjan.2020.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 04/13/2020] [Accepted: 04/17/2020] [Indexed: 11/16/2022] Open
Abstract
STUDY OBJECTIVE In this study, we aimed to compare the antimicrobial effects of bupivacaine and fentanyl citrate and to reveal the impact on antimicrobial effect potential in the case of combined use. DESIGN In vitro prospective study. SETTING University Clinical Microbiology Laboratory. MEASUREMENTS In our study, in vitro antimicrobial effect of 0.05 mg.mL-1 fentanyl citrate, 5 mg.mL-1 bupivacaine were tested against Staphylococcus aureus American Type Culture Collection (ATCC) 29213, Pseudomonas aeruginosa ATCC 27853, Klebsiella pneumoniae ATCC 13883, Escherichia coli ATCC 25922 and Candida albicans ATCC 10231 as Group F (Fentanyl Citrate) and Group B (Bupivacaine), respectively. S. aureus ATCC 29213, P. aeruginosa ATCC 27853, Klebsiella pneumoniae ATCC 13883 and Escherichia coli ATCC 25922 were cultured onto Mueller Hinton agar (Oxoid, UK) plates and Candida albicans ATCC 10231 were cultured onto Sabouraud dextrose agar (Oxoid, UK) plates for 18-24 hours at 37°C. MAIN RESULTS In terms of inhibition zone diameters, S. Aureus ATCC 29213, P. aeruginosa ATCC 27853, and C. albicans ATCC10231 values obtained after 12 and 24 hours of incubation were significantly higher in Group F than Group B (p < 0.001). In terms of inhibition zone diameters, E. coli ATCC 25922, and K. pneumomiae ATCC 13883 values obtained after 12 and 24hours of incubation were significantly higher in Group B than Group F (p < 0.001, E. coli 12ª hour p = 0.005). CONCLUSIONS Addition of fentanyl to Local Anesthetics (LAs) is often preferred in regional anesthesia applications in today's practice owing especially to its effect on decreasing the local anesthetic dose and increasing analgesia quality and patient satisfaction. However, when the fact that fentanyl antagonized the antimicrobial effects of LAs in the studies is taken into account, it might be though that it contributes to an increase in infection complications. When the fact that fentanyl citrate, which was used in our study and included hydrochloric acid and sodium hydroxide as protective agents, broadened the antimicrobial effect spectrum of LAs, had no antagonistic effect and showed a synergistic antimicrobial effect against E. Coli is considered, we are of the opinion that the addition of fentanyl to LAs would contribute significantly in preventing the increasing regional anesthesia infection complications.
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Affiliation(s)
- Sevgi Kesici
- University of Health Sciences, Hamidiye Etfal Training and Research Hospital, Department of Anesthesiology and Reanimation, Istanbul, Turkey.
| | - Mehmet Demırci
- University of Beykent, Faculty of Medicine, Department of Microbiology, Istanbul, Turkey
| | - Ugur Kesici
- University of Beykent, Faculty of Medicine, Department of General Surgery, Istanbul, Turkey
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Noble RMN, Salim SY, Walker B, Khadaroo RG, Chiarella AB, Gragasin FS, Bourque SL. Survival of Staphylococcus epidermidis in Propofol and Intralipid in the Dead Space of Intravenous Injection Ports. Anesth Analg 2020; 129:e20-e22. [PMID: 29200074 DOI: 10.1213/ane.0000000000002654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We tested whether propofol or Intralipid inoculated with Staphylococcus epidermidis would promote bacterial growth within an intravenous (IV) injection hub, a site prone to bacterial contamination. In tubes incubated under optimal conditions, S epidermidis exhibited growth in Intralipid, but not in propofol. In contrast, within the IV hub incubated with either propofol or intralipid at room temperature, S epidermidis bacterial numbers declined with time, and virtually no contamination remained after 12 hours. These data suggest that certain IV lines are inhospitable for S epidermidis.
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Affiliation(s)
| | - Saad Y Salim
- Surgery, University of Alberta, Edmonton, Alberta, Canada
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Tulgar S, Alasehir EA, Selvi O. The antimicrobial activity of ephedrine and admixture of ephedrine and propofol: an in vitro study. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2018. [PMID: 28870386 PMCID: PMC9391728 DOI: 10.1016/j.bjane.2017.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Introduction Propofol and Ephedrine are commonly used during anesthesia maintenance, the former as a hypnotic agent and the later as a vasopressor. The addition of propofol to ephedrine or administration of ephedrine before propofol injection is useful for decreasing or preventing propofol related hemodynamic changes and vascular pain. This in vitro study evaluated the antibacterial effect on common hospital-acquired infection pathogens of ephedrine alone or combined with propofol. Material and method The study was performed in two stages. In the first, the Minimum Inhibitory Concentration of propofol and ephedrine alone and combined was calculated for Escherichia coli, Enterococcus faecium, Staphylococcus aureus, Pseudomonas aeruginosa, and a clinical isolate of Acinetobacter spp. at 0, 6, 12 and 24 h, using the microdilution method. In the second stage, the same drugs and combination were used to determine their effect on bacterial growth. Bacterial solutions were prepared at 0.5 MacFarland in sterile 0.9% physiological saline and diluted at 1/100 concentration. Colony numbers were measured as colony forming units.mL−1 at 0, 2, 4, 6, 8, 10 and 12th hours. Results Ephedrine either alone or combined with propofol did not have an antimicrobial effect on Escherichia coli, Enterococcus faecium, or Pseudomonas aeruginosa and this was similar to propofol. However, ephedrine alone and combined with propofol was found to have an antimicrobial effect on Staphylococcus aureus and Acinetobacter species at 512 mcg.mL−1 concentration and significantly decreased bacterial growth rate. Conclusion Ephedrine has an antimicrobial activity on Staphylococcus aureus and Acinetobacter species which were frequently encountered pathogens as a cause of nosocomial infections.
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Tulgar S, Alasehir EA, Selvi O. A atividade antimicrobiana de efedrina e da combinação de efedrina e propofol: um estudo in vitro. Braz J Anesthesiol 2018; 68:69-74. [DOI: 10.1016/j.bjan.2017.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 03/23/2017] [Accepted: 06/20/2017] [Indexed: 02/07/2023] Open
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Breedt A, (Jeff) F. Coetzee J, Kluyts H, Scheepers P. A survey of propofol injection practices reveals poor knowledge of and unsatisfactory adherence to the SASA Guidelines for Infection Control. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2017. [DOI: 10.1080/22201181.2017.1336370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Anneme Breedt
- Anesthesiology and Critical Care, Stellenbosch University, Tygerberg, South Africa
| | | | - Hyla Kluyts
- Department of Anaesthesiology, School of Medicine, University of Pretoria, Gezina, South Africa
| | - Pamela Scheepers
- Anesthesiology and Critical Care, Stellenbosch University, Tygerberg, South Africa
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Ripoll Gallardo A, Meneghetti G, Ragazzoni L, Kroumova V, Ferrante D, Ingrassia PL, Ruzza P, Dell’Era A, Boniolo E, Koraqe G, Faggiano F, Della Corte F. Multiple withdrawals from single-use vials: A study on sterility. Int J Pharm 2015; 485:160-3. [DOI: 10.1016/j.ijpharm.2015.03.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 03/05/2015] [Indexed: 10/23/2022]
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Erden IA, Gülmez D, Pamuk AG, Akincia SB, Hasçelik G, Aypar U. The growth of bacteria in infusion drugs: propofol 2% supports growth when remifentanil and pantoprazole do not. Braz J Anesthesiol 2013; 63:466-72. [PMID: 24565344 DOI: 10.1016/j.bjane.2012.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 10/31/2012] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Contamination risks of propofol 2%, remifentanil, and pantoprazole; and in vitro effects of these drugs on the growth of common infective agents in intensive care units were evaluated. METHODS For detection of contamination risk, drugs were prepared ready to use under intensive care unit conditions, were tested. Effects of these three drugs on bacterial growth were also investigated. Drugs were prepared at the concentrations used in the intensive care unit and inoculated with common pathogens after which they were incubated at 4°C, 22°C and 36°C. Subcultures were made at 0, 2, 4 and 8h and colony counts were evaluated. Minimum inhibitory concentration values were determined for all drugs at 4°C, 22°C and 36°C. RESULTS No growth was observed in the drugs prepared in the intensive care unit. Propofol tended to support while remifentanil inhibited bacterial growth. Effect of pantoprozole differed according to the bacteria tested. None of the drugs showed antibacterial activity at the maximum concentrations which may be achieved in blood of the patients. CONCLUSION Propofol strongly supports the growth of the microorganisms tested, although remifentanil and pantoprazole do not. Therefore, it is important to follow the strict aseptic techniques for the preparation of propofol.
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Affiliation(s)
- Ismail Aydin Erden
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
| | - Dolunay Gülmez
- Department of Medical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Almila Gulsun Pamuk
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Seda Banu Akincia
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Hacettepe University, Ankara, Turkey; Department of Medical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Gülşen Hasçelik
- Department of Medical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ulkü Aypar
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Erden IA, Gülmez D, Pamuk AG, Akinci SB, Hasçelik G, Aypar U. Crescimento de bactérias em agentes de infusão: Propofol 2% sustenta o crescimento, enquanto remifentanil e pantoprazol não. Rev Bras Anestesiol 2013. [DOI: 10.1016/j.bjan.2012.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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