Comparison of antimicrobial effects of different propofol ketamine combinations

Abstract

Introduction: The combined use of ketamine and propofol has been frequently preferred in general anesthesia applications in recent years. The aim of this study was to determine the reliable combination to prevent infection development by comparing different combinations of ketamine and propofol and safe usage period of the combination. Methods: In the present study S. aureus, K. pneumoniae, E. coli, P. aeruginosa and C. albicans microorganisms were used. The turbidity data obtained at different hours and the zero-hour turbidity data were compared to determine the effect of microorganisms when they were kept at room temperature following the contamination of ketamine, propofol, and different ketamine + propofol mixtures by these microorganisms. Results: For each microorganism studied, the growth rate within the first 36 hours was observed to be higher in the propofol group compared to the ketamine group and other ketamine + propofol groups. For each microorganism studied, the growth rate was observed to be lower at all time periods in the ketamine group compared to the propofol group and other ketamine + propofol groups. The growth rate was observed to be less when the ketamine ratio increased in the ketamine + propofol mixture for all microorganisms. Conclusion: The growth rate was observed to be less in ketamine + propofol combinations due to the antibacterial effect of ketamine, compared to the group in which only propofol was used.

Keywords

• Antimicrobial
• propofol
• ketamine
• ketofol
• intravenous anesthesia, sedation, intensive care

References

1. 1. Jalili M, Bahreini M, Doosti-Irani A, et al. Ketamine-propofol combination (ketofol) vs propofol for procedural sedation and analgesia: systematic review and meta-analysis. Am J Emerg Med. 2016;34:558-69.
2. 2. Aberra B, Aregawi A, Teklay G, Tasew H. Effect of ketofol versus propofol as an induction agent on ease of laryngeal mask airway insertion conditions and hemodynamic stability in pediatrics: an observational prospective cohort study. BMC Anesthesiol. 2019;20:19:41.
3. 3. Abdelmalak BB, Bashour CA, Yared JP. Skin infection and necrosis after subcutaneous infiltration of propofol in the intensive care unit. Can J Anaesth. 2008;55:471-73.
4. 4. Muller AE, Huisman I, Roos PJ, et al. Outbreak of severe sepsis due to contaminated propofol: lessons to learn. J Hosp Infect. 2010;76:225-30.
5. 5. Kruszewska H, Zareba T, Tyski S. Search of antimicrobial activity of selected non-antibiotic drugs. Acta Pol Pharm. 2002;59:36-9.
6. 6. Gocmen S, Buyukkocak U, Caglayan O. In vitro investigation of the antibacterial effect of ketamine. Upsala J Med Sci. 2008;113:39-46.
7. 7. Rapeport DA, Martyr JW, Wang LP. The use of ‘’ketofol’’ (ketamine-propofol admixture) infusion in conjunction with regional anaesthesia. Anaesth Intensive Care. 2009;37:121-23.
8. 8. Weatherall A, Venclovas R. Experience with a propofol ketamine mixture for sedation during pediatric orthopedic surgery. Paediatr Anaesth. 2010;20:1009-16.

9. 9. Andolfatto G, Willman E. A prospective case series of singlesyringe ketamine-propofol (ketofol) for emergency department procedural sedation and analgesia in adults. Acad Emerg Med. 2011;18:237-45.
10. 10. Aydogmus MT, Türk HS, Oba S, Gokalp O. A comparison of different proportions of a ketamine-propofol mixture administered in a single injection for patients undergoing colonoscopy. Arch Med Sci. 2015 ;11:570-76.
11. 11. Kip G, Atabek D, Bani M. Comparison of three different ketofol proportions in children undergoing dental treatment. Niger J Clin Pract. 2018;21:1501-7.
12. 12. Ghojazadeh M, Sanaie S, Paknezhad SP, et al. Using Ketamine and Propofol for Procedural Sedation of Adults in the Emergency Department: A Systematic Review and Meta-Analysis. Adv Pharm Bull. 2019;9:5-11.
13. 13. Bennett SN, McNeil MM, Bland LA, et al. Postoperative infections traced to contamination of an intravenous anesthetic, propofol. N Engl J Med. 1995;20:147-54.
14. 14. Muller AE, Huisman I, Roos PJ, et al. Outbreak of severe sepsis due to contaminated propofol: lessons to learn. J Hosp Infect. 2010;76:225-30.
15. 15. Henry B, Plante-Jenkins C, Ostrowska K. An outbreak of Serratia marcescens associated with the anesthetic agent propofol. Am J Infect Control. 2001;29:312-15.
16. 16. Altan HA, Bonabi E, Kesici S, et al. The growth of microorganisms in propofol and mixture of propofol, lidocaine and fentanyl. J Coll Physicians Surg Pak. 2019;29:828-32.
17. 17. King CA, Ogg M. Safe injection practices for administration of propofol. AORN J. 2012;95:365-72.
18. 18. Jansson JR, Fukada T, Ozaki M. Propofol EDTA and reduced incidence of infection. Anaesth Intensive Care. 2006;34:362-68.
19. 19. Begec Z, Yucel A, Yakupogulları Y, et al. The antimicrobial effects of ketamine combined with propofol: An in vitro study. Rev Bras Anestesiol. 2013;63:461−65.