Reconstituted thiopentone retains its alkalinity without bacterial contamination for up to four weeks

• Published in: Canadian journal of anesthesia Vol. 39; no. 5; pp. 504 - 508
• Main Authors: WONG, C. L, BRIAN WARRINER, C, MCCORMACK, J. P, CLARKE, A. M
• Format: Journal Article
• Language: English
• Published: Toronto, ON Canadian Anesthesiologists' Society 01.05.1992
• Subjects: Alkalies; Anesthetics. Neuromuscular blocking agents; Bacteria - isolation & purification; Biological and medical sciences; British Columbia; Costs and Cost Analysis; Drug Contamination; Drug Stability; Drug Storage; Hospitals, Teaching; Hydrogen-Ion Concentration; Medical sciences; Neuropharmacology; Pharmacology. Drug treatments; Refrigeration; Temperature; Thiopental - chemistry; Thiopental - economics; Time Factors; Intravenous administration; General anesthetic; Reconstituted product; Chemical stability; Conservation; Bacteria; Barbituric; Contamination
• ISSN: 0832-610X; 1496-8975
• DOI: 10.1007/BF03008717

The manufacturers of thiopentone recommend that after reconstitution, it should be kept only for 24 hr to reduce the risk of contamination. However, there are no studies to support this practice and compliance with this recommendation has economic implications. The reasons for discarding a reconstituted bottle of thiopentone are related to concerns about chemical and physical (pH) stability, contamination with infectious agents, and contamination with cellular material. We studied the incidence of bacterial contamination and pH stability of thiopentone in clinical use, as well as the pH stability of thiopentone not in clinical use, and surveyed the eight hospitals affiliated with the University of British Columbia to determine their protocols for thiopental preparation and storage. Cost comparisons were made between our current practice of discarding thiopentone when depleted and the practice of routinely discarding it 24 hr after reconstitution. Samples of thiopentone in clinical use were cultured daily and the pH was measured. The bottles had been in clinical use from 1 to 25 days (mean 4.23 +/- 4.32 SD). Of 106 samples there were no positive bacteriological cultures and there were only minor changes in pH. The telephone survey of the eight hospitals revealed that only one had a policy to discard thiopentone after 24 hr. Cost comparisons indicate that discarding thiopentone 24 hr after reconstitution would result in increased cost. In conclusion, reconstituted thiopentone retains its alkalinity for up to four weeks, and has an acceptably low risk of bacterial contamination for periods beyond 24 hr, therefore thiopentone need not be discarded after 24 hr.