Estimation of ICI 35,868 (Diprivan R) in blood by high-performance liquid chromatography, following coupling with Gibbs' reagent

Quantitation of propofol metabolites by LC-MS/MS demonstrating long detection window for urine drug monitoring

Introduction

Chromatographic methods for analysis of propofol and its metabolites have been widely used in pharmacokinetic studies of propofol distribution, metabolism, and clearance. Application of chromatographic methods is also needed in clinical and forensic laboratories for detecting and monitoring propofol misuse.

Objective

We report a method for sensitive analysis of propofol, propofol 1-glucuronide (PG), 4-hydroxypropofol 1-glucuronide (1-QG), 4-hydroxypropofol 4-glucuronide (4-QG) and 4-hydroxypropofol 4-sulfate (4-QS) in urine by LC-MS/MS analysis. The method employs a simple dilute-and-analyze sample preparation with stable isotope internal standardization.

Results

Validation studies demonstrate a linear calibration model (100-10,000 ng/mL), with dilution integrity verified for the extended range of concentrations experienced in propofol use. Criteria-based validation was achieved, including an average coefficient of variation of 6.5 % and a percent bias of -4.2 ng/mL. The method was evaluated in 12 surgical patients, with monitoring periods lasting up to 30 days following intravenous propofol administrations of 100-3000 mg on the day of surgery. While the concentration ratio of PG to 4-hydroxy propofol metabolite decreased significantly in the days following surgery, PG maintained the highest concentration in all specimens. Both PG and 1-QG were detectable throughout the monitoring periods, including in a patient monitored for 30 days. Lower concentrations were determined for 4-QG and 4-QS, with evidence of detection up to 20 days. Propofol was not detectable in any urine specimens, thereby proving ineffective for identifying drug use.

Conclusion

The validated method for quantifying propofol metabolites demonstrates its applicability for the sensitive detection of propofol misuse over a long window of drug-use detection.

The influence of storage time and temperature on propofol concentrations in canine blood and plasma

Propofol is an intravenous anesthetic commonly used due to its favorable pharmacokinetic and pharmacodynamic profile. There are discrepancies in the literature about the most appropriate sample for determining propofol concentrations. Although plasma has been used for determining propofol concentrations, whole blood has been the preferred sample. There is also a lack of consistency in the literature on the effect of storage time and temperature on propofol concentrations and this may lead to errors in the design of pharmacokinetic/pharmacodynamics studies. The purpose of this study was to determine the difference in propofol concentrations in whole blood versus plasma and to evaluate the influence of storage time (56 days) and temperature (4 °C, −20 °C, −80 °C) on the stability of propofol concentrations in blood and plasma samples. Results from the study indicate that whole blood and plasma samples containing propofol stored at −80 °C have concentrations as high as or higher than those stored at 4 °C or −20 °C for 56 days; thus, −80 °C is an appropriate temperature for propofol sample storage. Plasma propofol concentrations were consistently higher than whole blood for all three storage temperatures. Consequently, plasma is the most appropriate sample for propofol analysis due to its consistent determinations.

Tissue/blood and tissue/water partition coefficients for propofol in sheep

The primary objective of this study was to determine in vivo tissue/blood partition coefficients of propofol for use in physiological modelling of its pharmacokinetics. The sheep was used as an animal model. In the main series of experiments, crossbred ewes received a bolus of propofol 1% (Diprivan) followed by an infusion during which blood concentrations were measured at intervals. After 2 h, the sheep were killed with an injection of potassium chloride, and tissue samples were taken for storage at -20 degrees C and subsequent analysis. Tissue/blood partition coefficients depend on the amount of triglyceride which accumulates in blood from the propofol vehicle; for blood, free of added triglyceride, the following coefficients were calculated: brain, 3.23; heart, 5.94; kidney, 2.46; spleen, 1.86; semimembranosus muscle, > or = 1.61; triceps muscle, > or = 1.47. Calculated tissue/water coefficients were 35 times greater. There was indirect evidence of extraction of propofol by the lungs.

The advantages of cell lysis before blood sample preparation by extraction for HPLC propofol analysis

Propofol (2,6-diisopropylphenol) is a short-acting drug with a large volume of distribution and high body clearance. It is suitable both for the induction of anaesthesia by bolus injection and the maintenance of anaesthesia by repeated injections or a continuous infusion. Examining the drug concentration its analysis in whole blood is recommended. This results from the fact that propofol molecules strongly bind with plasma proteins and cellular blood constituents and blood composition variations are observed between individuals or in different disease states or resulting from transfusion etc. In most cases the HPLC analysis follows the extraction of samples. The degree of propofol binding with blood cells can be different, depending on the blood type, and it can change in time, which may affect the results of the analysis. The paper discusses and shows the necessity of blood cell lysis before the extraction procedure. The cell lysis makes possible to determine the total amount of propofol in blood independently of the degree of propofol binding with cellular blood constituents and its changes.

Direct high-performance liquid chromatography determination of propofol and its metabolite quinol with their glucuronide conjugates and preliminary pharmacokinetics in plasma and urine of man

Propofol (P) is metabolized in humans by oxidation to 1,4-di-isopropylquinol (Q). P and Q are in turn conjugated with glucuronic acid to the respective glucuronides, propofol glucuronide (Pgluc), quinol-1-glucuronide (Q1G) and quinol-4-glucuronide (Q4G). Propofol and quinol with their glucuronide conjugates can be measured directly by gradient high-performance liquid chromatographic analysis without enzymic hydrolysis. The glucuronide conjugates were isolated by preparative HPLC from human urine samples. The glucuronides of P and Q were present in plasma and urine, P and Q were present in plasma, but not in urine. Quinol in plasma was present in the oxidised form, the quinone. Calibration curves of the respective glucuronides were constructed by enzymic deconjugation of isolated samples containing different concentrations of the glucuronides. The limit of quantitation of P and quinone in plasma are respectively 0.119 and 0.138 microg/ml. The limit of quantitation of the glucuronides in plasma are respectively: Pgluc 0.370 microg/ml, Q1G 1.02 microg/ml and Q4G 0.278 microg/ml. The corresponding values in urine are: Pgluc 0.264 microg/ml, Q1G 0.731 microg/ml and Q4G 0.199 microg/ml. A pharmacokinetic profile of P with its metabolites is shown, and some preliminary pharmacokinetic parameters of P and Q glucuronides are given.

The influence of age and administration rate on the brain sensitivity to propofol in rats

BACKGROUND

It is well established that the dose of propofol for induction of anaesthesia is influenced by patient age. This may be explained by differences in pharmacokinetics or pharmacodynamics. To evaluate the effect of age on propofol pharmacodynamics, the brain concentration of propofol at the time of an EEG end-point was used as a measure of CNS sensitivity.

METHODS

Ninety-five rats were assigned to 4 groups. Anaesthesia was induced by continuous propofol infusion at different rates. The dose of propofol and duration of anaesthesia were determined from 23 up to 776 days of age. The rats were killed at 23, 287 or 776 days of age at the EEG end-point and samples of cerebral cortex, midbrain, cerebellum, serum and fat tissue were submitted to HPLC analysis of propofol concentrations.

RESULTS

The induction dose of propofol varied with age and administration rate. Young animals needed a higher dose of propofol. Old animals had higher brain concentrations of propofol at the EEG end-point than young animals. However, propofol concentrations in serum were higher in young animals. The propofol concentration in the brain was influenced by the administration rate.

CONCLUSION

The dose of propofol for induction of anaesthesia in rats is influenced by animal age and administration rate. Young animals need a larger induction dose than old rats, but are more sensitive as measured by the brain concentration of propofol. The larger induction dose in young rats when compared with adults is explained by pharmacokinetic differences rather than by pharmacodynamic changes.

Determination of propofol in rat whole blood and plasma by high-performance liquid chromatography

A simple, accurate and sensitive high-performance liquid chromatographic method was developed for the determination of propofol, an intravenous anaesthetic agent, in rat whole blood or plasma samples. The method is based on precipitation of the protein in the biological fluid sample and direct injection of the supernatant into an HPLC system involving a C18 reversed-phase column using a methanol-water (70:30) mobile phase delivered at 1 ml/min. Propofol and the internal standard (4-tert.-octylphenol) were quantified using a fluorescence detector set at 276 nm (excitation) and 310 nm (emission). The analyte and internal standard had retention times of 6.3 and 10.5 min, respectively. The limit of quantification for propofol was 50 ng/ml using 100 microl of whole blood or plasma sample. Calibration curves were linear (r2=0.99) over a 1-10 microg/ml concentration range and intra- and inter-day precision were between 4-11%. The assay was applied to the determination of propofol whole blood pharmacokinetics and propofol whole blood to plasma distribution ratios in rats.

Determination of diprivan in urine by a supported liquid membrane technique and liquid chromatography-electrochemical detection

A supported liquid membrane technique was used for the extraction and enrichment of propofol in a spiked sample of urine. An acidic solution of propofol and thymol as an internal standard was passed over the membrane and after enrichment the acceptor solution was analyzed by LC with an electrochemical detector. The acceptor and donor pH, flow-rate, and volume of donor and different membrane solvents were varied to optimize the extraction efficiency. The detection limit for 100 ml of a spiked urine sample was 10 ppt of propofol.

High-performance liquid chromatographic assay of propofol in human and rat plasma and fourteen rat tissues using electrochemical detection

This paper describes a sensitive HPLC-electrochemical detection analytical method for determining the concentration of the intravenous anesthetic, propofol, in human or rat plasma or serum and a variety of rat tissues. Internal standard and drug are extracted from serum or plasma and other tissues with pentane. 2,6-tert.-Butylmethylphenol is used as internal standard. It includes a novel steam distillation procedure for separating the highly lipophilic propofol from skin and fat. The plasma/serum assay has a precision of 1-4% (C.V.) in the range 10 ng/ml to 1 microgram/ml and permits the assay of assay of 5 ng/ml from 0.1 ml of plasma/serum. The tissue procedure allows the estimation of 50 ng/g in 0.1 g of tissue for most of the major organs with less than 2% (C.V.) precision. This assay was used to measure propofol concentrations in plasma/serum and tissue samples in support of a project to develop a physiological pharmacokinetic model for propofol in the rat.

Measurement of propofol concentration in sheep blood and plasma: effect of storage at different temperatures

In planning a study of the pharmacokinetics of propofol in sheep, contradictions were noted in the literature with regard to loss of propofol during storage of blood samples. This prompted a study of such loss from samples of sheep blood and plasma during storage at room temperature, +4 degrees C and -20 degrees C, for up to 17 days, over a range of concentrations from 1 to 20 micrograms/mL. Samples were drawn from 22 different sheep. Analysis was by the method of Adam et al. (1981). The best estimate of the overall mean loss rate was 0.7% per day with 95% confidence limits of 0.3% to 1.2% per day. The loss rate increased nonsignificantly with storage temperature. There were very small nonsignificant differences of loss rate between plasma and blood, between different concentrations, and between genders. There were significant differences of loss rate between sheep--up to about 2% per day in blood or plasma from any one sheep.

Propofol concentration monitoring in plasma or whole blood by gas chromatography and high-performance liquid chromatography

We compared the measurement of propofol concentrations in plasma or whole blood by high-performance liquid chromatography (HPLC) to that of gas chromatography (GC). Blood samples were collected from patients who had received bolus injection or continuous infusion of propofol. The results showed that the two methods correlated well both in plasma and whole blood samples. However, significant biphasic differences of propofol concentrations between plasma and whole blood specimens were observed in the bolus injection group. Differences were larger in the infusion group. This discrepancy in concentrations resulted from the infusion or clearance of propofol, and the lag of redistribution across blood cell membranes. In conclusion, monitoring of propofol concentrations by the methods of GC and HPLC gives equivalent results. For propofol concentration monitoring, plasma samples are preferred, but immediate centrifugation is needed.

Anesthetic modulation of the cardiovascular response to microlaryngoscopy. A comparison of propofol and methohexital with special reference to leg blood flow, catecholamines and recovery

The modulating effects of propofol versus methohexital on the cardiovascular response to microlaryngoscopy were studied in 35 patients divided into four equal groups (one patient participated twice). Heart rate (HR), mean arterial blood pressure (MAP, cardiac output (CO; impedance cardiography), leg blood flow (LBF; occlusion plethysmography) and concentrations of arterial catecholamines were measured. After administration of atropine and fentanyl (2 micrograms.kg-1), anesthesia was induced by either an injection of propofol (2.0 mg.kg-1) followed by a low (6 mg.kg-1.h-1; n = 9) or a high (12 mg.kg-1.h-1; n = 9) dose propofol infusion or an injection of methohexital (1.5 mg.kg-1) followed by a low (5 mg.kg-1.h-1; n = 9) or a high (10 mg.kg-1.h-1; n = 9) dose methohexital infusion. The low methohexital infusion dose was insufficient to control MAP, which increased 41% during microlaryngoscopy compared to the awake state. The HR increased in all groups but the increase was most prominent in the low dose methohexital group. There were no statistically significant changes in CO in any group, whereas LBF increased consistently in all groups except in patients anesthetized with the low dose of methohexital. The increases of LBF in the propofol groups were intermediate and not dose dependent. The methohexital low dose group showed increases in norepinephrine levels compared to awake values and in epinephrine levels compared to the other groups. Propofol seems to differ from methohexital in modulation of peripheral vascular tone.(ABSTRACT TRUNCATED AT 250 WORDS)

Quantitation of propofol in plasma by capillary gas chromatography

A rapid, accurate and sensitive gas chromatographic method is described for measuring plasma concentrations of propofol. The technique required only 200 microliters of plasma and a single extraction process, using chloroform containing pentadecane (500 ng/ml) as an internal standard. Quantitation was achieved on an SGE BP-1 fused-silica capillary column (25 m x 0.33 mm I.D., 0.5 micron film thickness) with flame ionization detector. The peak response was linear over a wide concentration range (10-10,000 ng/ml) and the limit of quantitation was 10 ng/ml. The absolute recoveries were over 96% (n = 3). The method is applicable for both research and routine plasma level monitoring.

Rapid and sensitive pre-column extraction high-performance liquid chromatographic assay for propofol in biological fluids

A completely automated high-performance liquid chromatographic system is described for the determination of the phenolic anaesthetic propofol. The method is based on pre-column extraction in a closed system allowing direct injection of biological samples without any sample pretreatment. The assay is sensitive (limit of quantification is 5 ng/ml serum), reliable (the variability within a series is 2%) and rapid (results are available after 6 min).

The pharmacokinetics of propofol in laboratory animals

1. The pharmacokinetics of propofol in an emulsion formulation ('Diprivan') have been studied after single bolus doses to rats, dogs, rabbits and pigs, and after single and multiple infusions to dogs. Venous blood propofol concentrations were determined by h.p.l.c. with u.v. or fluorescence detection. Curve fitting was performed using ELSFIT. 2. The distribution of propofol in blood and its plasma protein binding have been studied in rat, dog, rabbit and man. Protein binding was high (96-98%), and in most species propofol showed appreciable association with the formed elements of blood. 3. Where an adequate sampling period was employed the pharmacokinetics of propofol were best described by a three-compartment open 'mammillary' model. Propofol was distributed into a large initial volume (1-21/kg) and extensively redistributed (Vss = 2-10 x body weight) in all species. Clearance of propofol by all species was rapid, ranging from about 30-80 ml/kg per min in rats, dogs and pigs to about 340 ml/kg per min in rabbits.

Species differences in blood profiles, metabolism and excretion of 14C-propofol after intravenous dosing to rat, dog and rabbit

1. Bolus i.v. doses of 14C-propofol (7-10 mg/kg) to rat, dog and rabbit, or an infusion dose (0.47 mg/kg per min for 6 h) to dog were eliminated primarily in urine (60-95% dose); faecal elimination (13-31%) occurred for rat and dog, but was minimal (less than 2%) for rabbit. 2. After bolus administration, blood 14C concentrations were maximal (8-30 micrograms equiv./ml) at 2-15 min; these declined rapidly during the 0-2 h period and thereafter more slowly. Propofol concentrations were maximal (4-16 micrograms/ml) at 2 min and the profiles were best fitted by a tri-exponential (rat and dog) or bi-exponential (rabbit) equation. Duration of sleep ranged from 5 to 8 min. 3. Infusion of 14C-propofol in dog gave a blood 14C concentration of 117 micrograms equiv./ml at the end of the 6 h infusion period; this declined at a similar rate to that after the bolus dose. Propofol concentration on termination of infusion was 13 micrograms/ml; thereafter, propofol concentrations declined less rapidly than after the bolus dose. Waking occurred about 44 min post-infusion. 4. Propofol was cleared by conjugation of the parent molecule or its quinol metabolite; hydroxylation of an isopropyl group also occurred in rat and rabbit. Biliary excretion leading to enterohepatic recirculation, and in turn increased sulphate conjugation, occurred in rat and dog, but not rabbit, resulting in a marked interspecies variation in drug clearance and metabolite profiles.

Comparison of the effects of fentanyl on respiratory mechanics under propofol or thiopental anaesthesia

Twenty patients were randomly anaesthetized with either thiopental 5 mg/kg followed by a 15 mg/kg/h continuous infusion, or propofol 2.5 mg/kg followed by a 9 mg/kg/h continuous infusion, paralysed with vecuronium 0.1 mg/kg, intubated and ventilated with nitrous oxide 50% in oxygen. Fifteen minutes after induction, fentanyl 5 micrograms/kg was injected. Inspiratory tracheal pressure (PT), gas flow (V) and volume (V) were continuously measured while the lungs were inflated with a constant inspiratory flow ventilator. Respiratory compliance (Crs) and resistance (Rrs) were calculated from the regression of PT on V. In both groups Crs decreased following anaesthesia. Fentanyl injection elicited an increase in Rrs (from 1.04 +/- 0.70 to 1.63 +/- 0.92 kPa x l-1 x s) and a further decrease in Crs (from 0.55 +/- 0.30 to 0.42 +/- 0.10 l x kPa-1) in the thiopental group but not in the propofol group (Rrs: 1.26 +/- 0.69 to 1.08 +/- 0.44 kPa x l-1 x s, Crs: 0.49 +/- 0.11 to 0.48 +/- 0.13 l x kPa-1). These results suggest that the dose of propofol administered in this study may prevent fentanyl-induced bronchoconstriction.

Pharmacokinetic implications for the clinical use of propofol

Propofol, the recently marketed intravenous induction agent for anaesthesia, is chemically unrelated to earlier anaesthetic drugs. This highly lipophilic agent has a fast onset and short, predictable duration of action due to its rapid penetration of the blood-brain barrier and distribution to the CNS, followed by redistribution to inactive tissue depots such as muscle and fat. On the basis of pharmacokinetic-pharmacodynamic modelling, a mean blood-brain equilibration half-life of only 2.9 minutes has been calculated. In most studies, the blood concentration curve of propofol has been best fitted to a 3-compartment open model, although in some patients only 2 exponential phases can be defined. The first exponential phase half-life of 2 to 3 minutes mirrors the rapid onset of action, the second (34 to 56 minutes) that of the high metabolic clearance, whereas the long third exponential phase half-life of 184 to 480 minutes describes the slow elimination of a small proportion of the drug remaining in poorly perfused tissues. Thus, after both a single intravenous injection and a continuous intravenous infusion, the blood concentrations rapidly decrease below those necessary to maintain sleep (around 1 mg/L), based on both the rapid distribution, redistribution and metabolism during the first and second exponential phases (more than 70% of the drug is eliminated during these 2 phases). During long term intravenous infusions cumulative drug concentrations and effects might be expected, but even then the recovery times do not appear to be much delayed. The liver is probably the main eliminating organ, and renal clearance appears to play little part in the total clearance of propofol. On the other hand, because the total body clearance may exceed liver blood flow, an extrahepatic metabolism or extrarenal elimination (e.g. via the lungs) has been suggested. Approximately 60% of a radiolabelled dose of propofol is excreted in the urine as 1- and 4-glucuronide and 4-sulphate conjugates of 2.6-diisopropyl 1,4-quinol, and the remainder consists of the propofol glucuronide. Thus for hepatic and renal diseases, co-medication, surgical procedure, gender and obesity do not appear to cause clinically significant changes in the pharmacokinetic profile of propofol, but the decrease in the clearance value in the elderly might produce higher concentrations during a long term infusion, with an increased drug effect. In addition, the lower induction dose observed in relation to increased age might be partly explained by a smaller central volume of distribution.(ABSTRACT TRUNCATED AT 400 WORDS)

Propofol: assay and regional mass balance in the sheep

1. Pharmacokinetic data for propofol, a new intravenous anaesthetic agent, indicate that there may be extensive extrahepatic clearance. This was investigated during intravenous infusions of propofol in adult merino ewes with chronic intravascular cannulae using a newly developed simple and rapid assay for propofol in blood and other biological samples. 2. The assay was based on organic solvent extraction of pH 4.5 buffered blood, urine or tissue homogenate, followed by reverse-phase h.p.l.c. with fluorescence detection. 3. A mean total body clearance of propofol of 3.15 l/min, (SD 0.87 l/min; n = 8) was found, consistent with a high hepatic extraction ratio (overall mean 0.87, SD 0.19; n = 8) and clearance (overall mean 1.12, SD 0.25 l/min; n = 7). The difference between total and hepatic clearances consisted principally of pulmonary clearance, but its extent was variable. 4. Other regional pharmacokinetic data were consistent with propofol distribution into muscle and brain tissues and propofol 'production' by the kidney, probably from a propofol metabolite formed elsewhere. 5. If these data are confirmed in humans then clinical pharmacokinetic data so far derived from peripheral venous blood sampling will require re-evaluation.

Intravenous infusion of midazolam, propofol and vecuronium in a patient with severe tetanus

An adult patient with severe tetanus was successfully treated with alternating long-term infusions of propofol (20-80 mg/h, 8 + 3 days) and midazolam (5-15 mg/h, 29 days) for sedation, and with vecuronium infusion (6-8 mg/h, 35 days) for muscle relaxation. In addition, continuous infusion of labetalol (10-20 mg/h, 39 days) was given to control arterial blood pressure. Blood samples were taken daily for assays of propofol, midazolam and vecuronium plasma concentrations. No accumulation of propofol and vecuronium could be detected. There was an increase in liver enzyme activity at the end of the first 8-day propofol infusion. During the 4-week midazolam infusion, there were two marked plasma concentration peaks at times when the infusion rate was fairly stable. These changes coincided with pulmonary infection (C-reactive protein elevated) and ciprofloxacin treatment. The patient awoke rapidly after the last propofol infusion. He was unable to recall anything about his stay in the intensive care unit.

Comparison of propofol and methohexitone anaesthesia for thermocoagulation therapy of trigeminal neuralgia

Propofol and methohexitone given in equipotent doses were compared for anaesthesia for thermocoagulation of trigeminal rootlets. Thirty-eight patients received two to six injections of the induction agents in one therapy session. The increase in arterial blood pressure during coagulation was significantly lower in the propofol group. Respiratory problems were encountered more often in those who received methohexitone (7/19 patients) than propofol (2/19 patients). There was a small but significant increase in blood propofol concentrations as well as in methohexitone plasma concentrations after repeated injections. Individual wake-up times increased to a statistically significant extent in relation to the number of doses of the induction agent but the increases were clinically unimportant (maximal mean change approximately 2 minutes). There were no differences in wake-up times between the two anaesthetic groups.

Blood disoprofol levels in anesthetised patients. Correlation of concentrations after single or repeated doses with hypnotic activity

The blood concentrations of disoprofol (Diprivan) after single intravenous doses of 1, 2 or 3 mg/kg have been examined in a subpopulation from previously reported clinical studies. The linear relationship between sleep time and dose could be explained by the linearity of the pharmacokinetics at these doses. After a single injection the awakening concentration was independent of dose, with a mean value of 1.04 micrograms/ml. No acute tolerance occurred with disoprofol. On repeated 1 mg/kg bolus injections the sleeping time rose initially but stabilised after four doses. The waking concentration was independent of the number of doses administered. The clinical findings fitted an agent with a very rapid distribution phase and a short elimination half-life.