Growth of microorganisms in propofol and methohexital mixtures.

PURPOSE: The purpose of this study was to evaluate the growth of 4 different microorganisms in propofol, methohexital, and 1:1 and 1:3 mixtures of propofol and methohexital. MATERIALS AND METHODS: The microbial growth of Staphylococcus aureus, Pseudomonas aeruginosa, Candida albicans, and Escherichia coli in 1:1 and 3:1 mixtures of methohexital and 2 types of propofol was measured for 48 hours after mixing the solutions. Two of the 4 test solutions were composed of 1% methohexital combined with Diprivan (AstraZeneca Pharmaceuticals, Wilmington, DE), which uses EDTA as a microbial growth inhibitor. The growth of the same 4 microorganisms was also evaluated in 1:1 and 3:1 mixtures of 1% methohexital and a recently introduced generic propofol marketed by Baxter Pharmaceuticals (Deerfield, IL) that uses sodium metabisulfite as a preservative. RESULTS: Combining either Diprivan or generic propofol with methohexital in a 1:1 or 1:3 mixture ratio resulted in a solution that, like methohexital alone, significantly resisted the growth of C albicans, E coli, S aureus, and P aeruginosa for 48 hours. CONCLUSION: The results of our study suggest that 1:1 and 1:3 mixtures of propofol (either Diprivan or generic propofol) and methohexital behave similarly to methohexital alone by resisting growth of the microorganisms studied over the 48-hour time period. If, as has been reported elsewhere, the mixture of these 2 agents results in a solution with desirable anesthetic properties, its ability to resist microbial growth becomes clinically significant by extending the shelf-life of propofol in these mixtures.

The chemical and physical stability of a 1:1 mixture of propofol and methohexital.

Anesthetic drugs are frequently mixed or coadministered to optimize anesthetic effects while minimizing adverse effects. Methohexital advantages include its low cost and rapid onset, while propofol provides improved airway anesthesia and extremely rapid clearance from the plasma. Therefore, a mixture of these agents might well be superior to either drug given alone. We wished to determine whether a mixture of methohexital and propofol is chemically and physically stable. A 1:1 mixture of propofol 10 mg/ml and methohexital was prepared. At times varying from 0 to 48 hours, mixtures with an internal standard of thymol kept at room temperature were thrice extracted with a 2:1 v/v mixture of diethyl ether:pentane, dried under nitrogen, and treated overnight with bis-trimethylsilyl-trifluoroacetamide. The resultant derivatives were transferred to microsample vials and analyzed by GC-MS. Drug stability was quantified by electronic integration of peak areas representing characteristic ions for each drug. For each sample, the peak area of the methohexital ion (m/z 239) or propofol ion (m/z 235) relative to the corresponding thymol ion (m/z 207) served as an index of the concentration of the drug in the sample. At times varying from 0 to 48 hours, mixtures without thymol were used to determine mean droplet size of the particles. This was accomplished using both an Accusizer and a Nicomp 370 Particle Sizer. One way ANOVA tested for significant changes in drug concentrations and mean particle size as a function of time. There was no significant breakdown of propofol or methohexital when combined in a 1:1 mixture and allowed to stand for 48 hours, nor was there an increase in particle size suggestive of emulsion instability. We concluded that a 1:1 mixture of propofol and methohexital was stable up to 48 hours after mixing.

Do barbiturates and their solutions suppress FMLP-induced neutrophil chemiluminescence?

The dose-response relationship of four commercially available barbiturates (methohexitone, pentobarbitone, phenobarbitone and thiopentone) and of their drug-free solutions on the production of oxygen radicals by neutrophils were tested by N-formylmethionyl-leucyl-phenylalanine (FMLP)-induced granulocyte chemiluminescence and in a cell-free chemiluminescence system. Methohexitone had no effect on neutrophil chemiluminescence. Pentobarbitone, phenobarbitone and thiopentone dose-dependently decreased FMLP-induced chemiluminescence and cell-free chemiluminescence. Suppression of neutrophil chemiluminescence by pentobarbitone and phenobarbitone was due to effects of the drug-free solutions and an osmolality greater than 360 mosmol kg-1. Only thiopentone suppressed granulocyte chemiluminescence drug-specifically. The physicochemical properties of commercially available barbiturate preparations and their solutions, as well as free radical scavenging capacity, have to be considered if these preparations are used to evaluate drug-specific effects on the production of oxygen radicals by neutrophils.

Stability of reconstituted methohexital sodium.

The purpose of this study was to determine the stability of reconstituted solutions of methohexital sodium over a 6-week period. Stability of methohexital was examined using reversed-phase high-performance liquid chromatography. The results indicate that reconstituted methohexital is extremely stable for up to 6 weeks when stored at 4 degrees C. When stored at room temperature, reconstituted solutions of methohexital contained increasing levels of degradation products and showed a corresponding decrease in methohexital over a 6-week period. However, the rate of degradation of the drug was slow, with less than 10% of the methohexital undergoing breakdown. In addition, tests for microbial contamination of the solutions stored at room temperature and under refrigeration were negative for up to 6 weeks. This study demonstrates that methohexital, when stored under refrigeration for up to 6 weeks, is virtually chemically identical to a freshly reconstituted solution of the drug. When stored at room temperature, there is some degradation of the drug, but it is not known whether the small amount of degradation is clinically significant. This study emphasizes the importance of obtaining scientific data to support changes in guidelines related to handling and storage of drugs.