Moderne Atemgasanalysen

Exhaled propofol monitoring for plasma drug prediction in rats

While propofol can be detected in exhaled breath in rats, robust evidence supporting its correlation with plasma concentrations or its use in predicting plasma levels remains lacking. In this study, eighteen mechanically ventilated rats were divided into three groups and injected with low (Group BL, n = 6), medium (Group BM, n = 6), or high (Group BH, n = 6) doses of propofol. The propofol concentration in exhaled breath (Ce-pro) was determined online using vacuum ultraviolet time-of-flight mass spectrometry (VUV-TOF MS), while the propofol concentration in plasma (Cp-pro) were measured using high-performance liquid chromatograph. The results indicated that after propofol injection, the peak Ce-pro was 5.87 ± 1.67 ppbv, 16.54 ± 7.22 ppbv, and 25.40 ± 3.68 ppbv, respectively. Across the different dose groups, Cmax of Ce-pro and Cp-pro were linearly correlated (P BL = 0.032, P BM = 0.031, P BH = 0.049). Tmax of Ce-pro was 1.22 ± 0.17 min, 1.28 ± 0.13 min, and 1.33 ± 0.01 min, respectively (P = 0.341), similar to the Tmax of Cp-pro (1.00 ± 0.00 min). After natural logarithm transformation, the correlation between LN(Ce-pro) and LN(Cp-pro) was well fitted by a linear model, withR B L 2 = 0.94,R B M 2 = 0.95,R B H 2 = 0.98, andR A L L 2 = 0.96. Using the obtained regression equation LN(Cp-pro) = 1.42*LN(Ce-pro)-1.70, the predicted Cp-pro values showed excellent agreement with the actual values within groups (ICCBL = 0.92; ICCBM = 0.97, ICCBH = 0.99, all P < 0.001). This study demonstrates a strong correlation between exhaled and plasma propofol concentrations in rats, indicating that exhaled concentrations can be effectively used to estimate plasma levels.

Online monitoring of propofol concentrations in exhaled breath

Propofol, a widely used intravenous anesthetic agent, requires accurate monitoring to ensure therapeutic efficacy and prevent oversedation. Recent developments in modern analytical instrumentation have led to significant breakthroughs in on-line analysis of exhaled breath. This review discusses several sophisticated analytical methods that have been explored for noninvasive, real-time monitoring of propofol concentrations, including proton transfer reaction mass spectrometry, selected ion flow tube mass spectrometry, ion mobility spectrometry, and gas chromatography coupled to surface acoustic wave sensors. These techniques have demonstrated good correlations between plasma and exhaled propofol concentrations and between exhaled propofol concentrations and its cerebral effects. Despite these advances, the use of these technologies in clinical settings is hampered by challenges such as equipment noise, bulkiness, and high cost, as well as limitations related to endotracheal intubation, strong adsorption of propofol to components of the respiratory circuit, variability in respiratory patterns, susceptibility to changes in pulmonary ventilation and blood flow, inconsistencies in calibration methods, and the influence of other drugs and temperature fluctuations on measurement accuracy. Overcoming these technical and procedural challenges is critical to advancing the clinical application of breath analysis for propofol monitoring. This article reviews published studies and summarizes the progress and ongoing challenges in the field.

Calibration and validation of ultraviolet time-of-flight mass spectrometry for online measurement of exhaled ciprofol

Ciprofol (HSK 3486, C14H20O), a novel 2,6-disubstituted phenol derivative similar to propofol, is a new type of intravenous general anaesthetic. We found that the exhaled ciprofol concentration could be measured online by ultraviolet time-of-flight mass spectrometry (UV-TOFMS), which could be used to predict the plasma concentration and anaesthetic effects of ciprofol. In this study, we present the calibration method and validation results of UV-TOFMS for the quantification of ciprofol gas. Using a self-developed gas generator to prepare different concentrations of ciprofol calibration gas, we found a linear correlation between the concentration and intensity of ciprofol from 0 parts per trillion by level (pptv) to 485.85 pptv (R2 = 0.9987). The limit of quantification was 48.59 pptv and the limit of detection was 7.83 pptv. The imprecision was 12.44% at 97.17 pptv and was 8.96% at 485.85 pptv. The carry-over duration was 120 seconds. In addition, we performed a continuous infusion of ciprofol in beagles, measured the exhaled concentration of ciprofol by UV-TOFMS, determined the plasma concentration by high-performance liquid chromatography, and monitored the anaesthetic effects as reflected by the bispectral index value. The results showed that the exhaled and plasma concentrations of ciprofol were linearly correlated. The exhaled ciprofol concentration correlated well with the anaesthetic effect. The study showed that we could use UV-TOFMS to provide a continuous measurement of gaseous ciprofol concentration at 20 second intervals.

Correlation of exhaled propofol with Narcotrend index and calculated propofol plasma levels in children undergoing surgery under total intravenous anesthesia - an observational study

BACKGROUND

Exhaled propofol concentrations correlate with propofol concentrations in adult human blood and the brain tissue of rats, as well as with electroencephalography (EEG) based indices of anesthetic depth. The pharmacokinetics of propofol are however different in children compared to adults. The value of exhaled propofol measurements in pediatric anesthesia has not yet been investigated. Breathing system filters and breathing circuits can also interfere with the measurements. In this study, we investigated correlations between exhaled propofol (exP) concentrations and the Narkotrend Index (NI) as well as calculated propofol plasma concentrations.

METHODS

A multi-capillary-column (MCC) combined with ion mobility spectrometry (IMS) was used to determine exP. Optimal positioning of breathing system filters (near-patient or patient-distant) and sample line (proximal or distal to filter) were investigated. Measurements were taken during induction (I), maintenance (M) and emergence (E) of children under total intravenous anesthesia (TIVA). Correlations between ExP concentrations and NI and predicted plasma propofol concentrations (using pediatric pharmacokinetic models Kataria and Paedfusor) were assessed using Pearson correlation and regression analysis.

RESULTS

Near-patient positioning of breathing system filters led to continuously rising exP values when exP was measured proximal to the filters, and lower concentrations when exP was measured distal to the filters. The breathing system filters were therefore subsequently attached between the breathing system tubes and the inspiratory and expiratory limbs of the anesthetic machine. ExP concentrations significantly correlated with NI and propofol concentrations predicted by pharmacokinetic models during induction and maintenance of anesthesia. During emergence, exP significantly correlated with predicted propofol concentrations, but not with NI.

CONCLUSION

In this study, we demonstrated that exP correlates with calculated propofol concentrations and NI during induction and maintenance in pediatric patients. However, the correlations are highly variable and there are substantial obstacles: Without patient proximal placement of filters, the breathing circuit tubing must be changed after each patient, and furthermore, during ventilation, a considerable additional loss of heat and moisture can occur. Adhesion of propofol to plastic parts (endotracheal tube, breathing circle) may especially be problematic during emergence.

TRIAL REGISTRATION

The study was registered in the German registry of clinical studies (DRKS-ID:  DRKS00015795 ).

Quantification of Volatile Aldehydes Deriving from In Vitro Lipid Peroxidation in the Breath of Ventilated Patients

Exhaled aliphatic aldehydes were proposed as non-invasive biomarkers to detect increased lipid peroxidation in various diseases. As a prelude to clinical application of the multicapillary column–ion mobility spectrometry for the evaluation of aldehyde exhalation, we, therefore: (1) identified the most abundant volatile aliphatic aldehydes originating from in vitro oxidation of various polyunsaturated fatty acids; (2) evaluated emittance of aldehydes from plastic parts of the breathing circuit; (3) conducted a pilot study for in vivo quantification of exhaled aldehydes in mechanically ventilated patients. Pentanal, hexanal, heptanal, and nonanal were quantifiable in the headspace of oxidizing polyunsaturated fatty acids, with pentanal and hexanal predominating. Plastic parts of the breathing circuit emitted hexanal, octanal, nonanal, and decanal, whereby nonanal and decanal were ubiquitous and pentanal or heptanal not being detected. Only pentanal was quantifiable in breath of mechanically ventilated surgical patients with a mean exhaled concentration of 13 ± 5 ppb. An explorative analysis suggested that pentanal exhalation is associated with mechanical power—a measure for the invasiveness of mechanical ventilation. In conclusion, exhaled pentanal is a promising non-invasive biomarker for lipid peroxidation inducing pathologies, and should be evaluated in future clinical studies, particularly for detection of lung injury.

Exhaled Propofol Concentrations Correlate With Plasma and Brain Tissue Concentrations in Rats

BACKGROUND

Propofol can be measured in exhaled gas. Exhaled and plasma propofol concentrations correlate well, but the relationship with tissue concentrations remains unknown. We thus evaluated the relationship between exhaled, plasma, and various tissue propofol concentrations. Because the drug acts in the brain, we focused on the relationship between exhaled and brain tissue propofol concentrations.

METHODS

Thirty-six male Sprague-Dawley rats were anesthetized with propofol, ketamine, and rocuronium for 6 hours. Animals were randomly assigned to propofol infusions at 20, 40, or 60 mg·kg·h (n = 12 per group). Exhaled propofol concentrations were measured at 15-minute intervals by multicapillary column-ion mobility spectrometry. Arterial blood samples, 110 µL each, were collected 15, 30, and 45 minutes, and 1, 2, 4, and 6 hours after the propofol infusion started. Propofol concentrations were measured in brain, lung, liver, kidney, muscle, and fat tissue after 6 hours. The last exhaled and plasma concentrations were used for linear regression analyses with tissue concentrations.

RESULTS

The correlation of exhaled versus plasma concentrations (R = 0.71) was comparable to the correlation of exhaled versus brain tissue concentrations (R = 0.75) at the end of the study. In contrast, correlations between plasma and lung and between lung and exhaled propofol concentrations were poor. Less than a part-per-thousand of propofol was exhaled over 6 hours.

CONCLUSIONS

Exhaled propofol concentrations correlate reasonably well with brain tissue and plasma concentrations in rats, and may thus be useful to estimate anesthetic drug effect. The equilibration between plasma propofol and exhaled gas is apparently independent of lung tissue concentration. Only a tiny fraction of administered propofol is eliminated via the lungs, and exhaled quantities thus have negligible influence on plasma concentrations.