Online exhaled propofol monitoring in normal-weight and obese surgical patients

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.

Dynamic headspace solid-phase extraction at room temperature: a theoretical model, method, and application for propofol analysis

Herein, a simple dynamic headspace solid-phase extraction (DHS-SPE) process at room temperature was used for a material that is sensitive to increase in the temperature. A proposed method was implemented to rapidly extract propofol (PF) from a complex matrix before fluorescence spectroscopy analysis, within a short sampling time without involving a hot plate or stirrer. A mini diaphragm pump was used to circulate the headspace gas. As the headspace gas flows over the sample solution surface, bubbles form and release analytes from the liquid into the headspace. During the extraction process, the headspace gas passes through the coated metal foam as a sorbent that is placed in a homemade glass vessel and analytes are trapped from the gas phase. A theoretical model of DHS-SPE based on the consecutive first-order process is proposed in this study. A mathematical solution for the dynamic process of mass transfer was obtained by correlating the variation in analyte concentration in the headspace and adsorber with the pump speed and amount of analyte extracted to the solid phase. Using electrochemically Nafion-doped polypyrrole (PPy-Naf) film on nickel foam as the solid-phase coupled to fluorescence detection, a linear dynamic range over the concentration range of 100-500 nM with a detection limit of 15 nM was obtained. This method was applied successfully for PF determination in human serum sample matrices without the interference of co-administered drugs, such as cisatracurium, which have significant emission spectrum overlap. The developed method can lead to a new idea for sample pretreatment, which is compatible with many analytical techniques and has been successfully combined with fluorescence spectroscopy in this work. This format of sampling simplifies the transfer of analytes from complex matrices to the headspace for the extraction and preconcentration process, eliminating the heating step and the need for expensive equipment.