Several case reports of patients suffering from chills, fever, and body aches shortly after receiving propofol (Diprivan), an IV sedative-hypnotic used to induce and maintain general anesthesia or sedation, have been submitted to the U.S. Food and Drug Administration (FDA). Testing performed by the agency has not identified any contaminated lots or vials of the drug. In several of the facilities where patients developed acute febrile reactions, single-dose vials of propofol had been used in the sedation of more than one patient, in neglect of the protocol indicated in the drug labeling. Propofol contains a constituent that retards but does not eliminate microbial growth, and it would seem that improper administration technique allowed bacteria to grow in vials that were used later in the sedation of other patients.

It's important that nurses follow label instructions when administering propofol and other IV drugs that have no added antimicrobial agents. Strict aseptic technique is essential (see "Handling Procedures" in the "Dosage and Administration" section). The stopper end of the vial or the prefilled syringe should be swabbed with 70% isopropyl alcohol before access to the medication is gained immediately with a sterile vent spike. Once the vial is opened, administration of the medication should begin promptly and be completed within six hours in general anesthesia or 12 hours for sedation in the ICU; any excess medication should be discarded. Only a single patient should receive the drug contained in any single vial or syringe, and all lines should be either flushed or discarded after administration. If a patient has an acute febrile reaction shortly after receiving propofol, she or he should be evaluated for bacterial sepsis and treated if it is confirmed, and nurses should notify the FDA Medwatch program of the incident, at http://www.fda.gov.medwatch/report.htm.