Main Article Content
Abstract
Background: Anaesthesia drugs are often divided into other syringes to be soluted or mixed with other medications to share with other patients for the sake of efficiency.
Objectives: This study aims to know the stability of anesthetic agents and the compatibility with co-simultaneous drugs used.
Methods: This review was conducted by searching literature through the following databases: PubMed, Science Direct, and Google Scholar. The keywords used in the search for articles were "stability," "beyond use date," "anesthetic drug," and "intravenous."
Results: The data showed that mixing fentanyl with levo-bupivakain or epinefrin is relatively stable up to one month, but it decreases only for 72 hours in dextrose 5% or normal saline (NS). Pethidin can be mixed with acetaminophen and metoclopramide using dextrose, NS, or water and stored up to 24 hours. Midazolam diluted in dextrose 5% (D5) or mixed with other medications maintains stability for up to 14 days or more. Stability of ketamine is 24 hours longer whether it is mixed in solvent or acetaminophen. Mixing with propofol induces instability because of the emulsion form of propofol.
Conclusion: In general, the anesthetic drugs of fentanyl, pethidine, midazolam, and ketamine are stable and safe for preparation and administration in more than 24 hours. These four medications are compatible with NS and D5 and all tested medications during 24 hours.
Keywords
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References
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- Bateman, D. N., Dear, J. W., Thanacoody, H. K. R., Thomas, S. H. L., Eddleston, M., Sandilands, E. A., Coyle, J., Cooper, J. G., Rodriguez, A., Butcher, I., Lewis, S. C., Vliegenthart, A. D. B., Veiraiah, A., Webb, D. J., & Gray, A. (2014). Reduction of adverse effects from intravenous acetylcysteine treatment for paracetamol poisoning: a randomised controlled trial. The Lancet, 383(9918), 697–704. https://doi.org/10.1016/S0140-6736(13)62062-0
- Bedocs, P., Evers, D. L., & Buckenmaier, C. C. (2019). Predosing Chemical Stability of Admixtures of Propofol, Ketamine, Fentanyl, and Remifentanil. Anesthesia & Analgesia, 129(1), e13–e15. https://doi.org/10.1213/ANE.0000000000003772
- Beiler, B., Barraud, D., Vigneron, J., & Demoré, B. (2020). Physicochemical stability of an admixture of lidocaine and ketamine in polypropylene syringe used in opioid-free anaesthesia. European Journal of Hospital Pharmacy, 27(e1), e79–e83. https://doi.org/10.1136/ejhpharm-2019-001976
- Ben-Shlomo, I., Abd-El-Khalim, H., Ezry, J., Zohar, S., & Tverskoy, M. (1990). Midazolam Acts Synergistically with Fentanyl For Induction Of Anaesthesia. British Journal of Anaesthesia, 64(1), 45–47. https://doi.org/10.1093/bja/64.1.45
- Brown, E. N., Lydic, R., & Schiff, N. D. (2010). General Anesthesia, Sleep, and Coma. New England Journal of Medicine, 363(27), 2638–2650. https://doi.org/10.1056/NEJMra0808281
- Chen, P., Chen, F., Lei, J., & Zhou, B. (2020).
Physical Compatibility and Chemical Stability of Fentanyl and Naloxone Hydrochloride in 0.9% Sodium Chloride Injection Solution for Patient-Controlled Analgesia Administration
. Drug Design, Development and Therapy, Volume 14, 4179–4187. https://doi.org/10.2147/DDDT.S248209 - Comer, S. D., & Cahill, C. M. (2019a). Fentanyl: Receptor pharmacology, abuse potential, and implications for treatment. Neuroscience & Biobehavioral Reviews, 106, 49–57. https://doi.org/10.1016/j.neubiorev.2018.12.005
- Comer, S. D., & Cahill, C. M. (2019b). Fentanyl: Receptor pharmacology, abuse potential, and implications for treatment. Neuroscience & Biobehavioral Reviews, 106, 49–57. https://doi.org/10.1016/j.neubiorev.2018.12.005
- Conway, A., Chang, K., Mafeld, S., & Sutherland, J. (2021). Midazolam for sedation before procedures in adults and children: a systematic review update. Systematic Reviews, 10(1), 69. https://doi.org/10.1186/s13643-021-01617-5
- Edinoff, A. N., Fitz-Gerald, J. S., Holland, K. A. A., Reed, J. G., Murnane, S. E., Minter, S. G., Kaye, A. J., Cornett, E. M., Imani, F., Khademi, S.-H., Kaye, A. M., Urman, R. D., & Kaye, A. D. (2021). Adjuvant Drugs for Peripheral Nerve Blocks: The Role of NMDA Antagonists, Neostigmine, Epinephrine, and Sodium Bicarbonate. Anesthesiology and Pain Medicine, 11(3). https://doi.org/10.5812/aapm.117146
- Emery N Brown, Kara J Pavone, & Marusa Naranjo. (2018). Multimodal General Anesthesia : Theory and Practice. Anesthesia And Analgesia, 1246–1258.
- Hanifah, S., Nugroho, B., & Chabib, L. (2020). Compatibility of acetaminophen with central nervous system medications during simulated Y-site injection. Anaesthesiology Intensive Therapy, 52(1), 23–27. https://doi.org/10.5114/ait.2020.92684
- Helin-Tanninen, M., Lehtonen, M., Naaranlahti, T., Venäläinen, T., Pentikäinen, J., Laatikainen, A., & Kokki, H. (2013). Stability of an epidural analgesic admixture of levobupivacaine, fentanyl and epinephrine. Journal of Clinical Pharmacy and Therapeutics, 38(2), 104–108. https://doi.org/10.1111/jcpt.12035
- Herawati, F. (2012). Beyond Use Date. Rasional, 10.
- Hor, M. M. S., Chan, S. Y., Yow, K. L., Lim, L. Y., Chan, E., & Ho, P. C. (1997). Stability of admixtures of pethidine and metoclopramide in aqueous solution, 5% dextrose and 0.9% sodium chloride. Journal of Clinical Pharmacy and Therapeutics, 22(5), 339–345. https://doi.org/10.1046/j.1365-2710.1997.00113.x
- Husna, M., Munawiroh, S. Z., Puji Ekawati, R., & Hanifah, S. (2021). Systematic review of the stability and compatibility of propofol injection. Anaesthesiology Intensive Therapy, 53(1), 79–88. https://doi.org/10.5114/ait.2021.103542
- Ilyas, M., Halimi, N. N., Waheed, R., & Salim, S. (2017). Efficacy Of ondansentron And Metoclopramide Againts Postoperative Nausea And Vomiting In Patients Udergoing Laparoscopic Cholecystectomy. J Med Sci, 25, 123–126.
- Jackson, E., & Kapp, N. (2011). Pain control in first-trimester and second-trimester medical termination of pregnancy: a systematic review. Contraception, 83(2), 116–126. https://doi.org/10.1016/j.contraception.2010.07.014
- Kee, W. D. N. (1998). Intrathecal Pethidine: Pharmacology and Clinical Applications. Anaesthesia and Intensive Care, 26(2), 137–146. https://doi.org/10.1177/0310057X9802600202
- Mortero, R. F., Clark, L. D., Tolan, M. M., Metz, R. J., Tsueda, K., & Sheppard, R. A. (2001). The Effects of Small-Dose Ketamine on Propofol Sedation: Respiration, Postoperative Mood, Perception, Cognition, and Pain. Anesthesia & Analgesia, 92(6), 1465–1469. https://doi.org/10.1097/00000539-200106000-00022
- Noviani, L., & Arrang, S. T. (2021). Stabilitas Dan Beyond Use Date Sediaan Farmasi Dalam Praktek Kefarmasian Sehari-Hari. Penerbit Universitas Atma Jaya.
- Park, K., Antoine, D. J., & Pirmohamed, M. (2014). Treatment of paracetamol overdose: room for improvement? The Lancet, 383(9918), 672–674. https://doi.org/10.1016/S0140-6736(13)62303-X
- Rahimzadeh, P., Imani, F., Alimian, M., Behzadi, B., Reza, F., & hamid, S. (2013). Comparasion between ketamine and acetaminophen administered at the end of anesthesia for pain management after hysterectomy. JAP, 4, 15–24.
- Reves JG, Fragen RJ, Vinik HR, & Greenblatt DJ. (1985). MIdazolam: pharmacology and uses. Europe PMC, 310–324.
- Riddell, J. M., Trummel, J. M., & Onakpoya, I. J. (2019). Low-dose ketamine in painful orthopaedic surgery: a systematic review and meta-analysis. British Journal of Anaesthesia, 123(3), 325–334. https://doi.org/10.1016/j.bja.2019.05.043
- Slavik, V. C., & Zed, P. J. (2007). Combination Ketamine and Propofol for Procedural Sedation and Analgesia. Pharmacotherapy, 27(11), 1588–1598. https://doi.org/10.1592/phco.27.11.1588
- Wilson, K. M., Schneider, J. J., & Ravenscroft, P. J. (1998). Stability of Midazolam and Fentanyl in Infusion Solutions. Journal of Pain and Symptom Management, 16(1), 52–58. https://doi.org/10.1016/S0885-3924(98)00024-4
- Xia, J., & Chen, P. (2020).
Stability and Compatibility of Ramosetron with Midazolam in 0.9% Sodium Chloride Injection for Postoperative Nausea and Vomiting Administration
. Drug Design, Development and Therapy, Volume 14, 1169–1176. https://doi.org/10.2147/DDDT.S244439
References
Arjumand, S., . F., Tariq, H., Zahid, W., Irum, Z., & Fatima, S. (2022). Immediate Postoperative Complications and Recovery Profile Following Spinal Anaesthesia: A Comparison Between Pethidine and Bupivacaine. Pakistan Journal of Medical and Health Sciences, 16(10), 978–981. https://doi.org/10.53350/pjmhs221610978
Attri, J., Kaur, G., Kaur, S., Kaur, R., Mohan, B., & Kashyap, K. (2015). Comparison of levobupivacaine and levobupivacaine with fentanyl in infraumbilical surgeries under spinal anaesthesia. Anesthesia: Essays and Researches, 9(2), 178. https://doi.org/10.4103/0259-1162.152148
Bateman, D. N., Dear, J. W., Thanacoody, H. K. R., Thomas, S. H. L., Eddleston, M., Sandilands, E. A., Coyle, J., Cooper, J. G., Rodriguez, A., Butcher, I., Lewis, S. C., Vliegenthart, A. D. B., Veiraiah, A., Webb, D. J., & Gray, A. (2014). Reduction of adverse effects from intravenous acetylcysteine treatment for paracetamol poisoning: a randomised controlled trial. The Lancet, 383(9918), 697–704. https://doi.org/10.1016/S0140-6736(13)62062-0
Bedocs, P., Evers, D. L., & Buckenmaier, C. C. (2019). Predosing Chemical Stability of Admixtures of Propofol, Ketamine, Fentanyl, and Remifentanil. Anesthesia & Analgesia, 129(1), e13–e15. https://doi.org/10.1213/ANE.0000000000003772
Beiler, B., Barraud, D., Vigneron, J., & Demoré, B. (2020). Physicochemical stability of an admixture of lidocaine and ketamine in polypropylene syringe used in opioid-free anaesthesia. European Journal of Hospital Pharmacy, 27(e1), e79–e83. https://doi.org/10.1136/ejhpharm-2019-001976
Ben-Shlomo, I., Abd-El-Khalim, H., Ezry, J., Zohar, S., & Tverskoy, M. (1990). Midazolam Acts Synergistically with Fentanyl For Induction Of Anaesthesia. British Journal of Anaesthesia, 64(1), 45–47. https://doi.org/10.1093/bja/64.1.45
Brown, E. N., Lydic, R., & Schiff, N. D. (2010). General Anesthesia, Sleep, and Coma. New England Journal of Medicine, 363(27), 2638–2650. https://doi.org/10.1056/NEJMra0808281
Chen, P., Chen, F., Lei, J., & Zhou, B. (2020).
Physical Compatibility and Chemical Stability of Fentanyl and Naloxone Hydrochloride in 0.9% Sodium Chloride Injection Solution for Patient-Controlled Analgesia Administration
. Drug Design, Development and Therapy, Volume 14, 4179–4187. https://doi.org/10.2147/DDDT.S248209Comer, S. D., & Cahill, C. M. (2019a). Fentanyl: Receptor pharmacology, abuse potential, and implications for treatment. Neuroscience & Biobehavioral Reviews, 106, 49–57. https://doi.org/10.1016/j.neubiorev.2018.12.005
Comer, S. D., & Cahill, C. M. (2019b). Fentanyl: Receptor pharmacology, abuse potential, and implications for treatment. Neuroscience & Biobehavioral Reviews, 106, 49–57. https://doi.org/10.1016/j.neubiorev.2018.12.005
Conway, A., Chang, K., Mafeld, S., & Sutherland, J. (2021). Midazolam for sedation before procedures in adults and children: a systematic review update. Systematic Reviews, 10(1), 69. https://doi.org/10.1186/s13643-021-01617-5
Edinoff, A. N., Fitz-Gerald, J. S., Holland, K. A. A., Reed, J. G., Murnane, S. E., Minter, S. G., Kaye, A. J., Cornett, E. M., Imani, F., Khademi, S.-H., Kaye, A. M., Urman, R. D., & Kaye, A. D. (2021). Adjuvant Drugs for Peripheral Nerve Blocks: The Role of NMDA Antagonists, Neostigmine, Epinephrine, and Sodium Bicarbonate. Anesthesiology and Pain Medicine, 11(3). https://doi.org/10.5812/aapm.117146
Emery N Brown, Kara J Pavone, & Marusa Naranjo. (2018). Multimodal General Anesthesia : Theory and Practice. Anesthesia And Analgesia, 1246–1258.
Hanifah, S., Nugroho, B., & Chabib, L. (2020). Compatibility of acetaminophen with central nervous system medications during simulated Y-site injection. Anaesthesiology Intensive Therapy, 52(1), 23–27. https://doi.org/10.5114/ait.2020.92684
Helin-Tanninen, M., Lehtonen, M., Naaranlahti, T., Venäläinen, T., Pentikäinen, J., Laatikainen, A., & Kokki, H. (2013). Stability of an epidural analgesic admixture of levobupivacaine, fentanyl and epinephrine. Journal of Clinical Pharmacy and Therapeutics, 38(2), 104–108. https://doi.org/10.1111/jcpt.12035
Herawati, F. (2012). Beyond Use Date. Rasional, 10.
Hor, M. M. S., Chan, S. Y., Yow, K. L., Lim, L. Y., Chan, E., & Ho, P. C. (1997). Stability of admixtures of pethidine and metoclopramide in aqueous solution, 5% dextrose and 0.9% sodium chloride. Journal of Clinical Pharmacy and Therapeutics, 22(5), 339–345. https://doi.org/10.1046/j.1365-2710.1997.00113.x
Husna, M., Munawiroh, S. Z., Puji Ekawati, R., & Hanifah, S. (2021). Systematic review of the stability and compatibility of propofol injection. Anaesthesiology Intensive Therapy, 53(1), 79–88. https://doi.org/10.5114/ait.2021.103542
Ilyas, M., Halimi, N. N., Waheed, R., & Salim, S. (2017). Efficacy Of ondansentron And Metoclopramide Againts Postoperative Nausea And Vomiting In Patients Udergoing Laparoscopic Cholecystectomy. J Med Sci, 25, 123–126.
Jackson, E., & Kapp, N. (2011). Pain control in first-trimester and second-trimester medical termination of pregnancy: a systematic review. Contraception, 83(2), 116–126. https://doi.org/10.1016/j.contraception.2010.07.014
Kee, W. D. N. (1998). Intrathecal Pethidine: Pharmacology and Clinical Applications. Anaesthesia and Intensive Care, 26(2), 137–146. https://doi.org/10.1177/0310057X9802600202
Mortero, R. F., Clark, L. D., Tolan, M. M., Metz, R. J., Tsueda, K., & Sheppard, R. A. (2001). The Effects of Small-Dose Ketamine on Propofol Sedation: Respiration, Postoperative Mood, Perception, Cognition, and Pain. Anesthesia & Analgesia, 92(6), 1465–1469. https://doi.org/10.1097/00000539-200106000-00022
Noviani, L., & Arrang, S. T. (2021). Stabilitas Dan Beyond Use Date Sediaan Farmasi Dalam Praktek Kefarmasian Sehari-Hari. Penerbit Universitas Atma Jaya.
Park, K., Antoine, D. J., & Pirmohamed, M. (2014). Treatment of paracetamol overdose: room for improvement? The Lancet, 383(9918), 672–674. https://doi.org/10.1016/S0140-6736(13)62303-X
Rahimzadeh, P., Imani, F., Alimian, M., Behzadi, B., Reza, F., & hamid, S. (2013). Comparasion between ketamine and acetaminophen administered at the end of anesthesia for pain management after hysterectomy. JAP, 4, 15–24.
Reves JG, Fragen RJ, Vinik HR, & Greenblatt DJ. (1985). MIdazolam: pharmacology and uses. Europe PMC, 310–324.
Riddell, J. M., Trummel, J. M., & Onakpoya, I. J. (2019). Low-dose ketamine in painful orthopaedic surgery: a systematic review and meta-analysis. British Journal of Anaesthesia, 123(3), 325–334. https://doi.org/10.1016/j.bja.2019.05.043
Slavik, V. C., & Zed, P. J. (2007). Combination Ketamine and Propofol for Procedural Sedation and Analgesia. Pharmacotherapy, 27(11), 1588–1598. https://doi.org/10.1592/phco.27.11.1588
Wilson, K. M., Schneider, J. J., & Ravenscroft, P. J. (1998). Stability of Midazolam and Fentanyl in Infusion Solutions. Journal of Pain and Symptom Management, 16(1), 52–58. https://doi.org/10.1016/S0885-3924(98)00024-4
Xia, J., & Chen, P. (2020).
Stability and Compatibility of Ramosetron with Midazolam in 0.9% Sodium Chloride Injection for Postoperative Nausea and Vomiting Administration
. Drug Design, Development and Therapy, Volume 14, 1169–1176. https://doi.org/10.2147/DDDT.S244439