Excipients in Anesthesia Medication

Introduction

The drug used in forming medicine has many ingredients in it, including the main drug ingredient. The main ingredient of a drug is called the active ingredient. The other ingredients, excluding the active ingredients, are mostly the excipients in the medicine. All medicines have excipients in them. These excipients are used as a vehicle for the treatment so that the patient's body can accept medication dosages. As the raw drug is unsuitable for the patient, the excipients change the drug into the accepted form ideal for the patient's body.

What Are Excipients?

Excipients are the ingredients excluding active ingredients of the medicine. They are also called "bulking agents." They are usually inactive in form, hence inert ingredients. The primary purpose of the excipients is the long-term stabilization of a drug and condensing of the medicine into a solid formulation. However, it also has other uses, like facilitating drug absorption and increasing the solubility of a drug. In addition, it provides an extra advantage in forming the shelf lives of the drug used in medicines. The selection of the perfect excipient used in treatment depends upon the following:

• Route of administration.

• Dosage form.

• The active ingredient of the drug.

• Various other factors.

Practically, all the marketed medicines have excipients more than the drug's active ingredient.

Role Of Excipients in Anesthesia:

Anesthesia drugs or medicine also have inactive ingredients in them. The excipients present in anesthesia, excluding the active ingredients, are inert. The excipient in anesthesia works as follows:

• Antioxidants - These inhibit oxidation by the formed preparation.

• Acidifying Agents - It provides an acidic environment for product stability.

• Solvents - It is used to dissolve substances.

• Disinfectants - These destroy the bacteria.

• Binding Agents - It binds the ingredient.

• Antimicrobial Preservatives - These prevent any microbial growth.

• Stabilizing Agents - It stabilizes the preparation by avoiding any reaction.

• Surfactants - These reduce surface tension.

• Buffering Agents - These maintain the pH.

• Humectants - These prevent drying of practice.

• Alkalizing Agents - These provide an alkaline environment.

All these excipients have different functions in formulating different types of medicine and making them consumable for the patients.

What Are the Excipients Used in Anesthesia?

Many excipients are used in anesthesia. According to their function, different excipients are used in various anesthesia medicines. Some of the excipients in anesthesia with their function are mentioned below:

• Acetic Acid - Acidifying agent.

• Alcohol - Solvent, disinfectant, antimicrobial preservative.

• Ascorbic Acid - Antioxidant, acidifying agent.

• Anhydrous Lactose - Binding agent.

• Benzyl Alcohol - Antimicrobial preservative, disinfectant, solvent.

• Dextrose - Tonicity agent.

• Propylene Glycol - Solvent, extractant, antimicrobial preservative.

• Mannitol - Tonicity agent.

• Methylparaben - Antimicrobial preservative.

• Meta Cresol - Preservative.

• Sodium Iodide - Diagnostic fluorescent agents.

• Sodium Bisulfite - Antimicrobial preservative, antioxidant.

How Do Anesthesia Drugs and Excipients React?

Anesthesia drugs and excipients are formulated to facilitate the patient, but it has proven to cause some discomfort to patients. Some specific excipients note reactions after medicine intake; they are mentioned below. In addition, many anesthesia drugs and other drugs use similar excipients. The excipients, along with drugs, and the effects on the patient on their intake, are listed below:

• Benzyl Alcohol - Itis added to anesthesia medicine as an antimicrobial agent, disinfectant, and solvent. It is used in many drugs like Amiodarone, Clindamycin, Midazolam, Morphine, Diazepam, and Propofol. It has shown some allergic dermatitis (skin inflammation) and ill effects on premature babies called "gasping syndrome." Other adverse effects are renal failure, seizures, hepatic failure, and even death.

• Iodide in Indocyanine Green - It is used in liver function, intraoperative angiography (X-ray for blood vessels), and ophthalmic angiography. It can cause hypotension in patients.

• Sulfiting Agents - It is added in Bupivacaine, Epinephrine, Morphine, Dexamethasone, Hydromorphone, and Propofol. It can cause skin urticaria (a type of skin allergy), cardiovascular collapse, and even death of the patient.

• Parabens - It is used in Bupivacaine, Lidocaine, Ondansetron, Heparin, Succinylcholine, Chloroprocaine, and Gentamicin. It expresses some localized skin reactions, pain, and dizziness.

• Propylene Glycol - It is used in Diazepam, Etomidate, Hydralazine, Nitroglycerin, and Lorazepam. It shows an effect on the patient's mental status, heart showing cardiac arrhythmias (heart beats with irregular rhythm) and causing seizures.

• Mannitol - It is used in Acetaminophen, Dantrolene, and Vecuronium. It shows ill effects on the skin, causing swelling, bullous eruptions formed by catheters, and sometimes severe hypersensitivity reactions.

• Meta Cresol - The medicines that use it are Insulin and Meperidine. Skin erythema and skin breakdown at injection sites are commonly seen with malaise (feeling ill), tremors, dizziness, and difficulty breathing.

• Dextrose - It is added along with Ceftriaxone, Heparin, Lidocaine, and Clindamycin drugs. It shows some hypersensitivity reactions, which can even be life-threatening.

• Oil - It is added along with Propofol and Etomidate. It also shows life-threatening severity reactions in patients.

How Are the Excipient Adverse Reactions Managed?

Although the inert ingredient excipients are due to the stabilization of the medicine, its formulation can show various reactions in patients. To manage these reactions, here are a few points:

• In benzyl alcohol, we need to discontinue the medication forming the reactions. Intravenous fluids are given, and liver, renal and cardiac activity is maintained by monitoring them.

• Iodide used in Indocyanine green requires supportive care with vasopressors (drugs used to constrict the blood vessels).

• Sulfiting agents on reacting require supportive care (treatment for relieving complications).

• If the use of parabens causes any harm, discontinue the medicine as soon as possible and supportive care is given on requirement.

• Propylene glycol shows any ill effects; medicine containing it needs to discontinue, and resuscitation (reviving the patient from dying) is done with fluid management.

• Mannitol in medicine, if it shows any effects, medicine needs to be discontinued resuscitation with steroids.

• Medicine containing Dextrose on reaction requires resuscitation.

• If the ethylenediaminetetraacetic acid drug shows any reaction, it is managed by injecting fluids and steroids.

Conclusion

The excipients are the inactive ingredients added to the drug for drug stabilization. It is done to formulate the main active ingredient for better shelf life and drug acceptance by the patient. The excipients used in anesthesia drugs are Benzyl alcohol, sulfating agents, Parabens, Propylene glycol, Mannitol, Dextrose, oil, and many more. Each excipient has different roles: preservation, stabilization, oxidation, acidifying, buffering, antiseptic, etc. These excipients and the benefit of formulation also discomfort the patient, sometimes showing ill effects. On its ill effects, the patient should initially discontinue the medicine containing excipients following the patient's resuscitation.