Propofol and LR solution

[Kate96]

Hello Everyone!

I had a quick question about this article I came across regarding LR compatibility. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8326865/pdf/10.1177_0018578719888913.pdf

It specifically states the finding that propofol precipitates out with LR and the solutions are not compatible. 

In my ICU, I have seen and run propofol and LR together, pushed Prop with LR during intubation codes, and I feel that most OR fluids include NS or LR and propofol is commonly infused as an induction agent with LR.

I guess my question is has anyone ever noticed a precipitate/incompatibility in regards to LR and propofol? I feel that if this really was an issue it would be more well known?

Thank you to anyone for your time

 

 

[offlabel]

A single invitro observation that doesn't come close to an actual clinical setting? No doubt someone with something to prove would make an issue out of this observational science fair project but there's a reason we've been using propofol with LR for many decades without any problem at all. And how would you notice precipitate with propofol in normal clinical practice, anyway?

[Kate96]

offlabel said:

A single invitro observation that doesn't come close to an actual clinical setting? No doubt someone with something to prove would make an issue out of this observational science fair project but there's a reason we've been using propofol with LR for many decades without any problem at all. And how would you notice precipitate with propofol in normal clinical practice, anyway?

Those are all fair points! I have never witnessed precipitate form with propofol in my practice. Do you mean in that it is a opaque white emulsion, precipitation would be hard to visualize? 

[offlabel]

Kate96 said:

Those are all fair points! I have never witnessed precipitate form with propofol in my practice. Do you mean in that it is a opaque white emulsion, precipitation would be hard to visualize? 

yes

[subee, MSN, CRNA]

Kate96 said:

Those are all fair points! I have never witnessed precipitate form with propofol in my practice. Do you mean in that it is a opaque white emulsion, precipitation would be hard to visualize? 

No, LR with Propofol is not an issue.  I often mixed Propofol in a bag of LR to use as sedation in the OR .  I also have pushed thousands of boluses and I'm looking closely at the injection site and have never seen a precipitate.  If there were a precipitate, it would affect the time unconsciousness occurs and haven't noticed any longer times for the drug to take effect.  After the devasting  hurricane in Puerto Rico, American manufactured Propofol in the US was so affected that we were forced to buy it from Europe and their formulation was a bit different from ours.  We noticed longer times for effect in most patients.  The study you gave us was performed in Europe so maybe that is affecting their results.  Also, even though studies are published with "NIH" on the headline doesn't mean that they are peer reviewed and should be taken with a grain of salt.  I didn't find this out until Covid when I saw a study with an n of 9 and wondered how it ever got published!