Propofol and alfentanil mixture for outpatient surgery

Compatibility of propofol, fentanyl, and vecuronium mixtures designed for potential use in anesthesia and patient transport

STUDY OBJECTIVE

To determine whether propofol emulsion, fentanyl, and vecuronium remain compatible and stable when mixed in clinically appropriate concentrations.

DESIGN

Seven separate in vitro experiments. Two different propofol-fentanyl-vecuronium mixtures were formulated. Regular assays of propofol, fentanyl, and vecuronium were performed during a 90-minute infusion period and also during storage of one of the mixtures for 30 days at 4 degrees C, 22 degrees C, and 30 degrees C. Initial and storage pH were determined, and assays of the three drugs were performed when pH of the mixtures was varied between 1.4 and 12.7. Emulsion stability was assessed by measuring immediate and delayed alterations in droplet charge (zeta potential) and size. Finally, samples of the stored mixtures were incubated in culture medium for one week.

SETTING

Teaching hospital and university laboratories.

MEASUREMENTS AND MAIN RESULTS

Concentrations of the three drugs remained unchanged during infusion. During storage, concentrations of all three drugs were stable for two weeks at 4 degrees C or 22 degrees C, and for several days at 30 degrees C. Initial pH of the two mixtures was 5.1 and 5.3, and pH of the stored mixture increased slowly after 8 days. When the pH of mixtures was greater than or equal to 5.6, concentrations of fentanyl and vecuronium were unstable, but the concentration of propofol remained unchanged. Despite a reduction in zeta potential, immediate droplet size was essentially unchanged. No microbial growth was detected in stored mixtures.

CONCLUSION

The propofol, fentanyl, and vecuronium mixtures studied were compatible and stable immediately after mixing. Appropriate in vitro compatibility testing is recommended before clinical evaluation of propofol-opioid or propofol-opioid-muscle relaxant mixtures.