Time course of ethanol and propofol exhalation after bolus injection using ion molecule reaction–mass spectrometry

Exhaled breath is found to be better than blood samples for determining propofol concentrations in the brain tissues of rats

The correlation between propofol concentration in exhaled breath (CE) and plasma (CP) has been well-established, but its applicability for estimating the concentration in brain tissues (CB) remains unknown. Given the impracticality of directly sampling human brain tissues, rats are commonly used as a pharmacokinetic model due to their similar drug-metabolizing processes to humans. In this study, we measuredCE,CP, andCBin mechanically ventilated rats injected with propofol. Exhaled breath samples from the rats were collected every 20 s and analyzed using our team's developed vacuum ultraviolet time-of-flight mass spectrometry. Additionally, femoral artery blood samples and brain tissue samples at different time points were collected and measured using high-performance liquid chromatography mass spectrometry. The results demonstrated that propofol concentration in exhaled breath exhibited stronger correlations with that in brain tissues compared to plasma levels, suggesting its potential suitability for reflecting anesthetic action sites' concentrations and anesthesia titration. Our study provides valuable animal data supporting future clinical applications.

A preclinical study on online monitoring of exhaled ciprofol concentration by the ultraviolet time-of-flight spectrometer and prediction of anesthesia depth in beagles

BACKGROUND

Exhaled air has been demonstrated as a reliable medium for monitoring propofol concentration. However, online monitoring of exhaled ciprofol have not been reported.

METHODS

Thirty-six beagles undergoing mechanical ventilation were divided into 6 groups, including bolus injection of low (Group BL, n = 6), medium (Group BM, n = 6), and high dose of ciprofol (Group BH, n = 6) groups; as well as 1 h continuous infusion of low (Group IL, n = 6), medium (Group IM, n = 6), and high dose of ciprofol (Group IH, n = 6) groups. The ciprofol concentration in exhaled air (CE) was determined by the ultraviolet time-of-flight mass spectrometer (UV-TOFMS). The correlations of CE and plasma concentration (Cp), CE and the bispectral index (BIS) were explored. Additionally, the pharmacokinetics (PK) models of CE and Cp, the pharmacodynamics (PD) models of CE and BIS were also established.

RESULTS

Online monitoring of exhaled ciprofol can be achieved with the UV-TOFMS instrument. The CE of ciprofol in beagles was found at parts per billion by volume (ppbv) level. The linear correlation of CE and Cp was weak in bolus injection groups (R2 = 0.01) nonetheless moderate in continuous infusion groups (R2 = 0.53). The i.v. bolus PK model of CE and Cp can be fitted with the non-compartment models. Additionally, the the PD models of CE and BIS can be well fitted with the inhibitory sigmoid Emax model with the estimate values of IC50 = 0.05 ± 0.01 ppbv, γ = 4.74 ± 1.51, E0 = 81.40 ± 3.75, Imax = 16.35 ± 4.27 in bolus injection groups; and IC50 = 0.05 ± 0.01 ppbv, γ = 6.92 ± 1.30, E0 = 83.08 ± 1.62, Imax = 12.58 ± 1.65 in continuous infusion groups.

CONCLUSIONS

Online monitoring of exhaled ciprofol concentration in beagles can be achieved with the UV-TOFMS instrument. Good correlations can be observed between exhaled ciprofol concentration and its cerebral effects reflected by the BIS value, demonstrating the potential of exhaled ciprofol monitoring for titrating depth of anesthesia in future clinical setting.

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.

Humidity and measurement of volatile propofol using MCC-IMS (EDMON)

The bedside Exhaled Drug MONitor - EDMON measures exhaled propofol in ppbv every minute based on multi-capillary column - ion mobility spectrometry (MCC-IMS). The MCC pre-separates gas samples, thereby reducing the influence of the high humidity in human breath. However, preliminary analyses identified substantial measurement deviations between dry and humid calibration standards. We therefore performed an analytical validation of the EDMON to evaluate the influence of humidity on measurement performance. A calibration gas generator was used to generate gaseous propofol standards measured by an EDMON device to assess linearity, precision, carry-over, resolution, and the influence of different levels of humidity at 100% and 1.7% (without additional) relative humidity (reference temperature: 37°C). EDMON measurements were roughly half the actual concentration without additional humidity and roughly halved again at 100% relative humidity. Standard concentrations and EDMON values correlated linearly at 100% relative humidity (R²=0.97). The measured values were stable over 100min with a variance ≤ 10% in over 96% of the measurements. Carry-over effects were low with 5% at 100% relative humidity after 5min of equilibration. EDMON measurement resolution at 100% relative humidity was 0.4 and 0.6 ppbv for standard concentrations of 3 ppbv and 41 ppbv. The influence of humidity on measurement performance was best described by a second-order polynomial function (R²≥0.99) with influence reaching a maximum at about 70% relative humidity. We conclude that EDMON measurements are strongly influenced by humidity and should therefore be corrected for sample humidity to obtain accurate estimates of exhaled propofol concentrations.

Rapid quantitative determination of blood propofol concentration throughout perioperative period by negative photoionization ion mobility spectrometer with solvent-assisted neutral desorption

Rapid and quantitative determination of blood propofol concentration is important for anesthesiologists to accurately control intraoperative propofol dose, timely monitor physiological statuses of patients and greatly improve the safety of surgery. Herein, a dopant-assisted negative photoionization ion mobility spectrometer with the optimized ionization region structure and the three-way inlet design was developed, increasing the generation ratio of the reactant ions O₂^-, and improving the ionization efficiency of propofol molecules. Besides, the addition of methanol-anisole solution during injection promoted the neutral desorption of propofol in blood, further improving the detection sensitivity by an order of magnitude, eliminating any sample pretreatment and effectively reducing the single analysis time to less than 1 min compared to the previous article. The dual calibration quantitative method, i.e. the method of calibrating the O₂^- concentration and the sample concentration changes during the entire process of detecting propofol through the integral value of M·O₂^- and the maximum signal intensity of O₂^-, successfully achieved accurate quantification of blood propofol. And the linear calibration curve of propofol was obtained with the range of 0.1-15 ng μL^-1 and with the limit of detection of 0.03 ng μL^-1, which was fulfilled to conduct propofol determination throughout the perioperative period. Finally, this method was applied to clinically measure the blood propofol concentration in patients newly regained consciousness with concentrations ranging from 0.2 ng μL^-1 to 3 ng μL^-1, and it turned out that the older patient had the lower propofol concentration in blood.

Dopant-assisted photoionization positive ion mobility spectrometry coupled with time-resolved purge introduction for online quantitative monitoring of intraoperative end-tidal propofol

Online monitoring of end-tidal propofol provides important information of anesthesia deepness for anesthetists as propofol concentrations in plasma and breath are well correlated. In this work, a dopant-assisted photoionization positive ion mobility spectrometry (DAPI-PIMS) coupled with time-resolved purge introduction was developed for online quantitative monitoring end-tidal propofol. With optimized dopant, toluene, the selectivity and sensitivity of propofol was improved as interference from sevoflurane was eliminated. Using the time-resolved purge introduction, the response of propofol and moisture was separated due to their absorption differences on the inwall of the fluorinated ethylene propylene (FEP) sample loop, ensuring sensitive measurement of end-tidal propofol with a short response time of 4 s. The quantitative equation derived from the second order reaction kinetics model extended the quantitative range of propofol from 0.2 ppbv to 45 ppbv. Finally, the method was used to monitor the intraoperative end-tidal propofol of six patients, and the results nicely demonstrated its feasibility in practical clinical environment.

Validation of liquid and gaseous calibration techniques for quantification of propofol in breath with sorbent tube Thermal Desorption System GC-MS

Plasma concentrations of intravenous drugs cannot currently be evaluated in real time to guide clinical dosing. However, a system for estimating plasma concentration of the anesthetic propofol from exhaled breath may soon be available. Developing reliable calibration and analytical validation techniques is thus necessary. We therefore compared the established sorbent tube liquid injection technique with a gas injection procedure using a reference gas generator. We then quantified propofol with Tenax sorbent tubes in combination with gas-chromatography coupled mass spectrometry in the breath of 15 patients (101 measurements). Over the clinically relevant concentration range from 10 to 50 ppb_v, coefficient of determination was 0.995 for gas calibration; and over the range from 10 to 100ng, coefficient of determination was 0.996 for liquid calibration. A regression comparing gas to liquid calibration had a coefficient of determination of 0.89; slope 1.05±0.01 (standard deviation). The limit of detection was 0.74ng and the lower limit of quantification was 1.12ng for liquid; the limit of detection was 0.90 ppb_v and the lower limit of quantification was 1.36 ppb_v for gas. Loaded sorbent tubes were stable for at least 14days without significant propofol loss as determined with either method. Measurements from liquid or gas samples were comparably suitable for evaluation of patient breath samples.

Propofol detection and quantification in human blood: the promise of feedback controlled, closed-loop anesthesia

The performance of a membrane-coated voltammetric sensor for propofol (2,6-diisopropylphenol) has been characterized in long term monitoring experiments using an automated flow analytical system (AFAS) and by analyzing human serum and whole blood samples by standard addition. It is shown that the signal of the membrane-coated electrochemical sensor for propofol is not influenced by the components of the pharmaceutical formulation of propofol (propofol injectable emulsion). The current values recorded with the electrochemical propofol sensor in buffer solutions and human serum samples spiked with propofol injectable emulsion showed excellent correlation with the peak heights recorded with an UV-Vis detector during the HPLC analysis of these samples (R(2) = 0.997 in PBS and R(2) = 0.975 in human serum). However, the determination of propofol using the electrochemical method is simpler, faster and has a better detection limit (0.08 ± 0.05 μM) than the HPLC method (0.4 ± 0.2 μM). As a first step towards feedback controlled closed-loop anesthesia, the membrane-coated electrochemical sensor has been implemented onto surface of an intravenous catheter. The response characteristics of the membrane-coated carbon fiber electrode on the catheter surface were very similar to those seen using a macroelectrode.

Microextraction techniques in breath biomarker analysis

Breath volatile organic compound analysis may open a non-invasive window onto (patho)physiological and metabolic processes in the body. Breath tests require controlled sampling with respect to different breath phases and on-site and point-of-care applicability. Microextraction techniques such as solid phase microextraction (SPME) or needle-trap microextraction (NTME) meet these requirements. Small sample volumes and fast and controlled sample preparation combine on-site sampling and pre-concentration in one step. Detection limits in the low ppbV range and fast and simple processing facilitate the application of distribution-based SPME for screening and targeted analysis. Exhaustive NTME has shown further advantages such as fast and automated sampling, improved stability and reproducibility with improved detection limits. Combinations of different sorbents and thermal expansion desorption have shown most promising properties when applied to water saturated breath samples. This article addresses major challenges and advantages of microextraction techniques in breath analysis. Important progress, current applications and future trends are discussed.

Online breath analysis of propofol during anesthesia: clinical application of membrane inlet-ion mobility spectrometry

BACKGROUND

Breath analysis of propofol is a potential noninvasive method for approximating the plasma propofol concentration. There have been various reported techniques for measuring the exhaled propofol concentration at steady state; however, the propofol concentration undergoes marked changes during clinical anesthesia. Therefore, this study investigated the use of membrane inlet-ion mobility spectrometry (MI-IMS) to monitor exhaled propofol discontinuously and continuously during propofol anesthesia.

METHODS

The study included 19 patients of American Society of Anesthesiologists physical status I or II. In experiment I (discontinuous study), breath and blood samples were collected discontinuously, with stable target propofol concentrations of 2.8 μg/ml, 3.2 μg/ml, 3.5 μg/ml, and 3.8 μg/ml. In experiment II (continuous study), propofol concentration was maintained at 3.5 μg/ml after induction, and exhaled breath was collected continuously every 3 min during propofol infusion. Relationships of the exhaled propofol concentration with the plasma propofol concentration, measured by high-performance liquid chromatography and the continuously measured bispectral (BIS) index were investigated.

RESULTS

Comparison of the exhaled and plasma propofol concentrations revealed a bias ± precision of 2.1% ± 14.6% (95% limits of agreement: - 26.5-30.7%) in experiment I and - 10.4% ± 13.2 (- 36.3-15.4%) in experiment II. In both experiments, exhaled propofol concentrations measured by MI-IMS were consistent with, the propofol effect represented by the BIS index.

CONCLUSIONS

MI-IMS may be a suitable method to predict plasma propofol concentration online during propofol anesthesia. Monitoring exhaled propofol may improve the safety of propofol anesthesia.

Real-time monitoring of exhaled drugs by mass spectrometry

Future individualized patient treatment will need tools to monitor the dose and effects of administrated drugs. Mass spectrometry may become the method of choice to monitor drugs in real time by analyzing exhaled breath. This review describes the monitoring of exhaled drugs in real time by mass spectrometry. The biological background as well as the relevant physical properties of exhaled drugs are delineated. The feasibility of detecting and monitoring exhaled drugs is discussed in several examples. The mass spectrometric tools that are currently available to analyze breath in real time are reviewed. The technical needs and state of the art for on-site measurements by mass spectrometry are also discussed in detail. Off-line methods, which give support and are an important source of information for real-time measurements, are also discussed. Finally, some examples of drugs that have already been successfully detected in exhaled breath, including propofol, fentanyl, methadone, nicotine, and valproic acid are presented. Real-time monitoring of exhaled drugs by mass spectrometry is a relatively new field, which is still in the early stages of development. New technologies promise substantial benefit for future patient monitoring and treatment.

Time course of expiratory propofol after bolus injection as measured by ion molecule reaction mass spectrometry

Propofol in exhaled breath can be detected and monitored in real time by ion molecule reaction mass spectrometry (IMR-MS). In addition, propofol concentration in exhaled breath is tightly correlated with propofol concentration in plasma. Therefore, real-time monitoring of expiratory propofol could be useful for titrating intravenous anesthesia, but only if concentration changes in plasma can be determined in exhaled breath without significant delay. To evaluate the utility of IMR-MS during non-steady-state conditions, we measured the time course of both expiratory propofol concentration and the processed electroencephalography (EEG) as a surrogate outcome for propofol effect after an IV bolus induction of propofol. Twenty-one patients scheduled for routine surgery were observed after a bolus of 2.5 mg kg(-1) propofol for induction of anesthesia. Expiratory propofol was measured using IMR-MS and the cerebral propofol effect was estimated using the bispectral index (BIS). Primary endpoints were time to detection of expiratory propofol and time to onset of propofol's effect on BIS, and the secondary endpoint was time to peak effect (highest expiratory propofol or lowest BIS). Expiratory propofol and changes in BIS were first detected at 43 ± 21 and 49 ± 11 s after bolus injection, respectively (P = 0.29). Peak propofol concentrations (9.2 ± 2.4 parts-per-billion) and lowest BIS values (23 ± 4) were reached after 208 ± 57 and 219 ± 62 s, respectively (P = 0.57). Expiratory propofol concentrations measured by IMR-MS have similar times to detection and peak concentrations compared with propofol effect as measured by the processed EEG (BIS). This suggests that expiratory propofol concentrations may be useful for titrating intravenous anesthesia.