The antimicrobial activity of ephedrine and admixture of ephedrine and propofol: an in vitro study

Serkan Tulgar; Elcin Akduman Alasehir; Onur Selvi

doi:10.1016/j.bjane.2017.06.004

Scientific Article

The antimicrobial activity of ephedrine and admixture of ephedrine and propofol: an in vitro study

A atividade antimicrobiana de efedrina e da combinação de efedrina e propofol: um estudo in vitro

Serkan Tulgar; Elcin Akduman Alasehir; Onur Selvi

http://dx.doi.org/10.1016/j.bjane.2017.06.004 Braz J Anesthesiol, vol.68, n1, p.69-74, 2018

PDF

Downloads: 0

Abstract

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.

Keywords

Ephedrine, Propofol, Antimicrobial

Resumo

Resumo Introdução Propofol e efedrina são fármacos comumente usados durante a manutenção da anestesia, o primeiro como agente hipnótico e o segundo como vasopressor. A adição de propofol à efedrina ou a administração de efedrina antes da injeção de propofol é útil para diminuir ou prevenir alterações hemodinâmicas e dor vascular relacionadas ao propofol. Este estudo in vitro avaliou o efeito antibacteriano de efedrina, isolada ou em combinação com propofol, em patógenos comuns implicados em infecção hospitalar. Material e método O estudo foi feito em duas etapas. Na primeira, a concentração inibitória mínima (CIM) de propofol e de efedrina isolada e em combinação foi calculada para Escherichia coli, Enterococcus faecium, Staphylococcus aureus, Pseudomonas aeruginosa e um isolado clínico de Acinetobacter spp às 0, 6, 12 e 24 horas, com o método de microdiluição. Na segunda etapa, o mesmo fármaco e sua combinação foram usados para determinar seus efeitos no crescimento bacteriano. As soluções bacterianas foram preparadas em soro fisiológico a 0,9% em 0,5 McFarland e diluídas a uma concentração de 1/100. Os números das colônias foram medidos como ufc.mL-1 às 0, 2, 4, 6, 8, 10 e 12 horas. Resultados Efedrina isolada ou em combinação com propofol não apresentou efeito antimicrobiano sobre E. coli, E. faecium ou P. aeruginosa, um resultado semelhante ao de propofol. Porém, efedrina isolada e em combinação com propofol apresentou efeito antimicrobiano sobre Staphylococcus aureus e Acinetobacter spp, em concentração de 512 mcg.mL-1, e redução significativa da taxa de crescimento bacteriano. Conclusão Efedrina tem atividade antimicrobiana em S. aureus e Acinetobacter spp, patógenos frequentemente identificados como causa de infecções nosocomiais.

Palavras-chave

Efedrina, Propofol, Antimicrobiano

References

Magee L, Godsiff L, Matthews I. Anaesthetic drugs and bacterial contamination. Eur J Anaesthesiol Suppl. 1995;12:41-3.

Begec Z, Yucel A, Yakupogullari Y. The antimicrobial effects of ketamine combined with propofol: an in vitro study. Braz J Anesthesiol. 2013;63:461-5.

Chen SH, Kung CC, Fung ST. Endotoxemia due to propofol contamination in four consecutive patients. J Formos Med Assoc. 2014;113:328-9.

Klein J, Huisman I, Menon AG. Postoperative infection due to contaminated propofol. Ned Tijdschr Geneeskd. 2010;154:A767.

Franci P, Dotto G, Cattai A. Lethal septic shock after dental scaling in a healthy dog due to Ochrobactrum anthropi-contaminated propofol. J Small Anim Pract. 2015;56:345-7.

Wachowski I, Jolly DT, Hrazdil J. The growth of microorganisms in propofol and mixtures of propofol and lidocaine. Anesth Analg. 1999;88:209-12.

Ozer Z, Ozturk C, Altunkan AA. Inhibition of bacterial growth by lignocaine in propofol emulsion. Anaesth Intensive Care. 2002;30:179-82.

Keles GT, Kurutepe S, Tok D. Comparison of antimicrobial effects of dexmedetomidine and etomidate-lipuro with those of propofol and midazolam. Eur J Anaesthesiol. 2006;23:1037-40.

Unlugenc H, Turktan M, Evruke IC. Rapid fluid administration and the incidence of hypotension induced by spinal anesthesia and ephedrine requirement: the effect of crystalloid versus colloid coloading. Middle East J Anaesthesiol. 2015;23:273-81.

Masjedi M, Zand F, Kazemi AP. Prophylactic effect of ephedrine to reduce hemodynamic changes associated with anesthesia induction with propofol and remifentanil. J Anaesthesiol Clin Pharmacol. 2014;30:217.

Gilani MT, Bameshki A, Razavi M. Efficacy of ephedrine in the prevention of vascular pain associated with different infusion rates of propofol. Anesth Essays Res. 2014;8:345-8.

Cheong MA, Kim KS, Choi WJ. Ephedrine reduces the pain from propofol injection. Anesth Analg. 2002;95:1293-6.

Cetinkaya D, Balaban O, Aydin T. Can adding ephedrine to admixture of propofol & lidocaine overcome propofol associated hemodynamic changes and injection pain. Int J Anesth Res. 2016;4:213-8.

Zhao Y, Jia L, Wang J. Microcalorimetry with correspondence analysis for studying the antibacterial effect of ephedrine on Escherichia coli. Thermochim Acta. 2013;557:50-4.

Clinical and Laboratory Standards Institute (CLSI). .

Bátai I, Kerényi M, Tekeres M. The growth of bacteria in intravenous glyceryl trinitrate and in sodium nitroprusside. Anesth Analg. 1999;89:1570-2.

Erden IA, Gulmez D, Pamuk AG. The growth of bacteria in infusion drugs: propofol 2% supports growth when remifentanil and pantoprazole do not. Braz J Anesthesiol. 2013;63:466-72.

Vidovich MI, Peterson LR, Wong HY. The effect of lidocaine on bacterial growth in propofol. Anesth Analg. 1999;88:936-8.

Masaki Y, Tanaka M, Nishikawa T. Physicochemical compatibility of propofol-lidocaine mixture. Anesth Analg. 2003;97:1646-51.

Apan TZ, Apan A, Sahin S. Antibacterial activity of remifentanil and mixtures of remifentanil and propofol. J Clin Anesth. 2007;19:346-50.

Vazquez C, Lago N, Mato MM. Microcalorimetric study of the growth of Enterococcus faecalis, Pseudomonas aeruginosa and their mixtures in an enriched culture medium. J Therm Anal Calorim. 2015;121:463-8.

Astasov-Frauenhoffer M, Braissant O, Hauser-Gerspach I. Microcalorimetric determination of the effects of amoxicillin, metronidazole, and their combination on in vitro biofilm. J Periodontol. 2014;85:349-57.

Chow MY-H, Sim K-M, Sia AT-H. Haemodynamic effects of adding ephedrine to propofol and alfentanil. Can J Anaesth. 1998;45:597-8.

Gopalakrishna MD, Krishna HM, Shenoy UK. The effect of ephedrine on intubating conditions and haemodynamics during rapid tracheal intubation using propofol and rocuronium. Br J Anaesth. 2007;99:191-4.

Kol IO, Kaygusuz K, Gursoy S. The effects of intravenous ephedrine during spinal anesthesia for cesarean delivery: a randomized controlled trial. J Korean Med Sci. 2009;24:883-8.

Farhan M, Hoda MQ, Ullah H. Prevention of hypotension associated with the induction dose of propofol: a randomized controlled trial comparing equipotent doses of phenylephrine and ephedrine. J Anaesthesiol Clin Pharmacol. 2015;31:526-30.

Thomas DG. Ephedrine is the vasopressor of choice for obstetric regional anaesthesia. Int J Obstet Anesth. 2002;11:278-81.

Kee WDN, Khaw KS, Tan PE. Placental transfer and fetal metabolic effects of phenylephrine and ephedrine during spinal anesthesia for cesarean delivery. Anesthesiology. 2009;111:506-12.

The antimicrobial activity of ephedrine and admixture of ephedrine and propofol: an in vitro study

A atividade antimicrobiana de efedrina e da combinação de efedrina e propofol: um estudo in vitro

Serkan Tulgar; Elcin Akduman Alasehir; Onur Selvi

Abstract

Keywords

Resumo

Palavras-chave

References

Links

Share

Braz J Anesthesiol