Joint Commission rules is their seeming lack of common sense. Waste baskets have to be five feet apart in the operating room? Who made up that one? But the most tedious demands for anesthesiologists are the necessity of labeling each and every syringe we draw up, even something as obvious as a vial of propofol. Let's face it, no other drugs in our arsenal looks like propofol. It is milky white as opposed to all other drugs which are clear and translucent. When asked about this nonsense, the standard response has been that it could get mixed up with intralipids. That is absurd of course because a) we rarely have intralipids hanging in the operating room during an operation and b) we would know if we had drawn up intralipids in a syringe, which is never.
Well now there is a legitimate reason for labeling a propofol syringe. In the latest issue of the Anesthesia Patient Safety Foundation's newsletter, Bruce Kleinman, MD of the Hines VA Hospital pointed out there is a new drug that looks exactly like propofol, Cleviprex. Cleviprex (Clevidipine) is a new calcium channel blocker that is supposed to be specific for arterial smooth muscle. It also has similar characteristics to propofol. It has a limited shelf life after it's opened, 12 hours. It should be avoided in patients with egg or soy allergies. And it can cause acute pancreatitis in patients with hyperlipidemia.
Luckily for me, our hospital is too cheap to offer any drugs that new in our pharmacy. We still have to make do with such lowly substitutes as nifedipine. But we still have to keep labeling our propofol syringes.