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

Electrochemical sensor for tricyclic antidepressants with low nanomolar detection limit: Quantitative Determination of Amitriptyline and Nortriptyline in blood

Amitriptyline and its metabolite, Nortriptyline are commonly used tricyclic antidepressant (TCA) drugs that are electrochemically active. In this work, the performance characteristics of a plasticized PVC membrane-coated glassy carbon (GC) electrode are described for the voltammetric quantification of Amitriptyline and Nortriptyline in whole blood. The highly lipophilic Amitriptyline and Nortriptyline preferentially partition into the plasticized PVC membrane where the free drug is oxidized on the GC electrode. The concentrations of the drugs in the membrane are orders of magnitude larger than in the sample solution, resulting in superb limit of detection (LOD) of the membrane-coated voltammetric sensor: 3 nmol/L for Amitriptyline and 20 nmol/L for Nortriptyline. Conversely, hydrophilic components of the sample solution, e.g., proteins, the protein-bound fraction of the drugs, and electrochemically active small molecules are blocked from entering the membrane, which provides exceptional selectivity for the membrane-coated sensor and feasibility for the measurements of Amitriptyline in whole blood. In this work, the concentrations of Amitriptyline and Nortriptyline were determined in whole blood using the sensor and the results of our analysis were compared to the results of the standard HPLC-MS method. Based on our experience, the one-step voltammetric methods with the membrane-coated sensor may become a real alternative to the significantly more complex HPLC-MS analysis.

Polymeric membrane-modified voltammetric sensors for lipophilic analytes with nanomolar detection limit: Key parameters influencing the response characteristics

Thin plasticized PVC membrane-coated glassy carbon working electrodes have been used for the voltammetric measurement of highly lipophilic, electroactive drugs. Compared to conventional working electrodes, these membrane-coated electrodes exhibit remarkable detection limit and selectivity and are less prone to electrode fouling. The unique performance characteristics of these sensors are related to the large partition coefficient of the analyte in the membrane coating where it is oxidized in a non-aqueous membrane phase. To analyze the influence of the key parameters of the response of membrane-coated sensors, we derived theoretical expressions on the voltammetric response of the sensors. In our analysis we considered 1) the partition coefficient (P_mw) of the analyte between the aqueous sample and the organic membrane, 2) the membrane volume to sample volume ratio (V_m/V_w), and 3) the binding constant of constituents in the sample that bind the analyte (K). The results of our theoretical analysis have been tested through voltammetric measurement of highly lipophilic analytes with logP_ow values (logarithm of the partition coefficient between octanol and water) ranging between 0.3 and 7.5. By understanding of the influence of the sensor design parameters on the overall sensor response, these parameters can be tuned for optimized response slope, detection limit, etc., for solving specific analytical tasks.

Propofol detection for monitoring of intravenous anaesthesia: a review

This paper presents a review of established and emerging methods for detecting and quantifying the intravenous anaesthetic propofol in solution. There is growing evidence of numerous advantages of total intravenous anaesthesia using propofol compared to conventional volatile-based anaesthesia, both in terms of patient outcomes and environmental impact. However, volatile-based anaesthesia still accounts for the vast majority of administered general anaesthetics, largely due to a lack of techniques for real-time monitoring of patient blood propofol concentration. Herein, propofol detection techniques that have been developed to date are reviewed alongside a discussion of remaining challenges.

Real-time continuous measurement of intraoperative trace exhaled propofol by planar differential mobility spectrometry

In order to study anesthetic pharmacokinetics and adequately adjust the anaesthesia depth of patients, real-time measurement of the intraoperative exhaled propofol concentration is of significant importance for anaesthetists. Although a series of analytical techniques and methods have been developed for the detection of exhaled propofol, differential mobility spectrometry (DMS) with the advantages of a much smaller instrument, faster response time and cheaper cost shows great potential for the point of care in the operating room. In this paper, a planar DMS was constructed for real-time continuous measurement of trace propofol in exhaled air. The effects of DMS parameters, such as the radio frequency voltage, the drift gas flow rate and the sampling flow rate of exhaled air on the propofol measurement under high humidity conditions were carefully investigated and discussed. Under the optimum experimental conditions, the limit of detection (LOD) for propofol was achieved in ppbv with a linear range of 0.5 to 25 ppbv, both of which meet clinical requirements. Finally, the planar DMS was performed on a patient undergoing thyroidectomy surgery to real-time monitor the intraoperative exhaled propofol, which demonstrated the capability of DMS for sensitive and breath-by-breath continuous measurement of intraoperative trace exhaled propofol.

A "Smart" Biosensor-Enabled Intravascular Catheter and Platform for Dynamic Delivery of Propofol to "Close the Loop" for Total Intravenous Anesthesia

BACKGROUND

Target-controlled infusion anesthesia is used worldwide to provide user-defined, stable, blood concentrations of propofol for sedation and anesthesia. The drug infusion is controlled by a microprocessor that uses population-based pharmacokinetic data and patient biometrics to estimate the required infusion rate to replace losses from the blood compartment due to drug distribution and metabolism. The objective of the research was to develop and validate a method to detect and quantify propofol levels in the blood, to improve the safety of propofol use, and to demonstrate a pathway for regulatory approval for its use in the USA.

METHODS

We conceptualized and prototyped a novel "smart" biosensor-enabled intravenous catheter capable of quantifying propofol at physiologic levels in the blood, in real time. The clinical embodiment of the platform is comprised of a "smart" biosensor-enabled catheter prototype, a signal generation/detection readout display, and a driving electronics software. The biosensor was validated in vitro using a variety of electrochemical methods in both static and flow systems with biofluids, including blood.

RESULTS

We present data demonstrating the experimental detection and quantification of propofol at sub-micromolar concentrations using this biosensor and method. Detection of the drug is rapid and stable with negligible biofouling due to the sensor coating. It shows a linear correlation with mass spectroscopy methods. An intuitive graphical user interface was developed to: (1) detect and quantify the propofol sensor signal, (2) determine the difference between targeted and actual propofol concentration, (3) communicate the variance in real time, and (4) use the output of the controller to drive drug delivery from an in-line syringe pump. The automated delivery and maintenance of propofol levels was demonstrated in a modeled benchtop "patient" applying the known pharmacokinetics of the drug using published algorithms.

CONCLUSIONS

We present a proof-of-concept and in vitro validation of accurate electrochemical quantification of propofol directly from the blood and the design and prototyping of a "smart," indwelling, biosensor-enabled catheter and demonstrate feedback hardware and software architecture permitting accurate measurement of propofol in blood in real time. The controller platform is shown to permit autonomous, "closed-loop" delivery of the drug and maintenance of user-defined propofol levels in a dynamic flow model.

Continuous monitoring of propofol in human serum with fouling compensation by support vector classifier

We present a new method for electrochemical sensing, which compensates the fouling effect of propofol through machine learning (ML) model. Direct and continuous monitoring of propofol is crucial in the development of automatic systems for control of drug infusion in anaesthesiology. The fouling effect on electrodes discourages the possibility of continuous online monitoring of propofol since polymerization of the surface produces sensor drift. Several approaches have been proposed to limit the phenomenon at the biochemical interface; instead, here, we present a novel ML-based calibration procedure. In this paper, we analyse a dataset of 600 samples acquired through staircase cyclic voltammetry (SCV), resembling the scenario of continuous monitoring of propofol, both in PBS and in undiluted human serum, to demonstrate that ML-based model solves electrode fouling of anaesthetics. The proposed calibration approach is based on Gaussian radial basis function support vector classifier (RBF-SVC) that achieves classification accuracy of 98.9% in PBS, and 100% in undiluted human serum. The results prove the ability of the ML-based model to correctly classify propofol concentration in the therapeutic range between 1μM and 60μM with levels of 10μM, continuously up to ten minutes, with one sample every 30s.

Plasticized PVC Membrane Modified Electrodes: Voltammetry of Highly Hydrophobic Compounds

In the last 50 years, plasticized polyvinyl chloride (PVC) membranes have gained unique importance in chemical sensor development. Originally, these membranes separated two solutions in conventional ion-selective electrodes. Later, the same membranes were applied over a variety of supporting electrodes and used in both potentiometric and voltammetric measurements of ions and electrically charged molecules. The focus of this paper is to demonstrate the utility of the plasticized PVC membrane modified working electrode for the voltammetric measurement of highly lipophilic molecules. The plasticized PVC membrane prevents electrode fouling, extends the detection limit of the voltammetric methods to sub-micromolar concentrations, and minimizes interference by electrochemically active hydrophilic analytes.

Reference Electrodes with Ionic Liquid Salt Bridge: When Will These Innovative Novel Reference Electrodes Gain Broad Acceptance?

In this paper, we raise questions that researchers have to ask if they intend to replace a conventional reference electrode with an ionic liquid-based reference electrode and try to answer these questions based on our experiences and literature data. Among these questions, the most important is which ionic liquid should be used. However, beyond the chemical composition of the ionic liquid, to realize all the potential benefits of ionic-liquid based reference electrodes, there are additional, equally important considerations. Through examples we will show the importance of the (i) purity of the ionic liquid and the consequences of deviations from its stoichiometric salt composition, (ii) form of implementation of the ionic liquid-based reference electrode membrane (free-flowing salt bridge, or ionic liquid embedded in a membrane), (iii) membrane/gelling agent material and its composition, and (iv) experimental conditions (steady state or flowing conditions) under which it will be used. Finally, we recommend methods to test the performance criteria of the ionic liquid-based reference electrodes.

Graphene quantum dots as nanoprobes for fluorescent detection of propofol in emulsions

We report a new fluorescent detection method for propofol based on graphene quantum dots (GQDs). Citric acid (CA) was selected as the carbon precursor, and fluorescent GQDs were prepared by carbonizing CA. The product, which efficiently quenched the fluorescence of GQDs, could be obtained through the oxidation of propofol in the presence of horseradish peroxidase and hydrogen peroxide. The fluorescence intensity ratio of GQDs (F/F ₀) was positively correlated with the concentration of propofol, which ranged within 5.34-89.07 mg l^-1, the limit of detection was 0.5 mg l^-1 and the limit of quantity was 5.34 mg l^-1. The developed fluorescence method reported in the present study is simple, sensitive, reproducible, and can serve in determining propofol contents in emulsions.

An IoT Solution for Online Monitoring of Anesthetics in Human Serum Based on an Integrated Fluidic Bioelectronic System

In this paper, we present the design, the implementation and the validation of a novel Internet of Things (IoT) drug monitoring system for the online continuous and simultaneous detection of two main anesthetics, e.g., propofol and paracetamol, in undiluted human serum. The described full system consists of a custom-built electronic Raspberry Pi (RPi) based Printed Circuit Board (PCB) that drives and reads out the signal from an electrochemical sensing platform integrated into a fluidic system. Thanks to the Polydimethylsiloxane (PDMS) fluidic device, the analyzed sample is automatically fluxed on the sensing site. The IoT network is supported by a Cloud system, which allows the doctor to control and share all the patient's data through a dedicated Android application and a smart watch. The validation closes with the first ever demonstration that our system successfully works for the simultaneous monitoring of propofol and paracetamol in undiluted human serum by measuring the concentration trends of these two drugs in fluxing conditions over time.

Generation, clearance, toxicity, and monitoring possibilities of unaccounted uremic toxins for improved dialysis prescriptions

Current dialysis-dosing calculations provide an incomplete assessment of blood purification. They exclude clearances of protein-bound uremic toxins (PB-UTs), such as polyamines, p-cresol sulfate, and indoxyl sulfate, relying solely on the clearance of urea as a surrogate for all molecules accumulating in patients with end-stage renal disease (ESRD). PB-UTs clear differently in dialysis but also during normal renal function. The kidney clears PB toxins via the process of secretion, whereas it clears urea through filtration. Herein, we review the clearance, accumulation, and toxicity of various UTs. We also suggest possible methods for their monitoring toward the ultimate goal of a more comprehensive dialysis prescription. A more inclusive dialysis prescription would retain the kidney-filtration surrogate, urea, and consider at least one PB toxin as a surrogate for UTs cleared through cellular secretion. A more comprehensive assessment of UTs that includes both secretion and filtration is expected to result in a better understanding of ESRD toxicity and consequently, to reduce ESRD mortality.

Voltammetric determination of diffusion coefficients in polymer membranes

The diffusion-controlled transport of ions and molecules through polymer membranes utilized in chemical and biosensors is often the key factor determining the response characteristics of these sensors. A simple voltammetric method utilizing a planar electrochemical cell allows the rapid determination of diffusion coefficients in resistive polymer membranes.

Handheld analyzer with on-chip molecularly-imprinted biosensors for electrical detection of propofol in plasma samples

This paper proposes a novel handheld analyzer with disposable lab-on-a-chip technology for the electrical detection of the anesthetic propofol in human plasma samples for clinical diagnoses. The developed on-chip biosensors are based on the conduction of molecularly imprinted polymers (MIPs) that employ label-free electrical detection techniques. Propofol in total intravenous anesthesia is widely used with a target-controlled infusion system. At present, the methods employed for detecting blood propofol concentrations in hospitals comprise high-performance liquid chromatography and ion mobility spectrometry. These conventional instruments are bulky, expensive, and difficult to access. In this study, we developed a novel plastic microfluidic biochip with an on-chip anesthetic biosensor that was characterized for the rapid detection of propofol concentrations. The experimental results revealed that the response time of the developed propofol biosensors was 25s. The specific binding of an MIP to a nonimprinted polymer (NIP) reached up to 560%. Moreover, the detection limit of the biosensors was 0.1μg/mL, with a linear detection range of 0.1-30μg/mL. The proposed disposable microfluidic biochip with an on-chip anesthetic biosensor using MIPs exhibited excellent performance in the separation and sensing of propofol molecules in the human plasma samples. Compared with large-scale conventional instruments, the developed microfluidic biochips with on-chip MIP biosensors present the advantages of a compact size, high selectivity, low cost, rapid response, and single-step detection.