To the Editor

I am reporting a cut injury which occurred whilst opening a Propofol ampoule (Fresenius Propoven 1%). In preparation to anaesthetize, the Propofol ampoule was opened which resulted in a laceration of 2 cms long and 0.5 cm in width and 0.5 cm in depth on the left thumb area (fig 1).

Figure 1

Figure 1: Laceration measuring 2cmsx 0.5cmx0.5cm

It was seen by a plastic surgeon, he sutured the cut and said the laceration had just missed the digital nerve, and also I could not work as an anesthetist with that wound for almost 7 days.

Injuries while breaking ampoule is not uncommon. In Parker's study (₁), the incidence of hand laceration secondary to opening glass ampoules was 6% and the prevalence of visible old hand laceration was 26%. In another study published (₂), the incidence density for ampoule injury was 4.1 per person year (PPY), which was similar to needle stick injury (4.5 PPY) with health care workers. There has been a report of laceration secondary to opening Propofol ampoule which required plastic surgery (₃). Ali (₃) continued to experience numbness in his finger. There has also been a lot of debate on how to open Propofol ampoule (₄, ₅), and this was probably triggered by anecdotal evidence of Propofol ampoule injury. Palmer et al (₆) highlighted that opening of Propofol ampoule left spikes in 51.7% which can potentially cause injury.

Although breaking an ampoule has been made easy by having markers and using flip method, there is still a risk of injury which can occasionally cause permanent disability of the hand(₃). Propofol ampoule is the most commonly used large ampoule amongst anesthetists, hence we should take necessary precaution to avoid a potentially irreversible damage to the hand.