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Xu Y, Xin X, Tao T. Decoding the neurotoxic effects of propofol: insights into the RARα-Snhg1-Bdnf regulatory cascade. Am J Physiol Cell Physiol 2024; 326:C1735-C1752. [PMID: 38618701 PMCID: PMC11371332 DOI: 10.1152/ajpcell.00547.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/26/2023] [Accepted: 01/27/2024] [Indexed: 04/16/2024]
Abstract
The potential neurotoxic effects of propofol, an extensively utilized anesthetic, underline the urgency to comprehend its influence on neuronal health. Insights into the role of the retinoic acid receptor-α, small nucleolar RNA host gene 1, and brain-derived neurotrophic factor (RARα-Snhg1-Bdnf) network can offer significant advancements in minimizing these effects. The study targets the exploration of the RARα and Snhg1 regulatory network's influence on Bdnf expression in the realm of propofol-induced neurotoxicity. Harnessing the Gene Expression Omnibus (GEO) database and utilizing JASPAR and RNA-Protein Interaction Prediction (RPISeq) database for projections, the study embarks on an in-depth analysis employing both in vitro and in vivo models. The findings draw a clear link between propofol-induced neurotoxicity and the amplification of RAR signaling pathways, impacting hippocampal development and apoptosis and leading to increased RARα and Snhg1 and decreased Bdnf. Propofol is inferred to accentuate neurotoxicity by heightening RARα and Snhg1 interactions, culminating in Bdnf suppression.NEW & NOTEWORTHY This study aimed to decode propofol's neurotoxic effects on the regulatory cascade, provide insights into the RARα-Snhg1-Bdnf interaction, apply extensive validation techniques, provide a detailed analysis and exploration of propofol's neurotoxicity, and offer a comprehensive approach to understanding molecular interactions.
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Affiliation(s)
- Yuhai Xu
- Department of Anesthesiology, Air Force Medical Center, Beijing, People's Republic of China
| | - Xin Xin
- Department of Anesthesiology, Air Force Medical Center, Beijing, People's Republic of China
| | - Tianzhu Tao
- Department of Anesthesiology, Air Force Medical Center, Beijing, People's Republic of China
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Andersson SA, Dittrich A, Lauridsen H. Continuous anesthesia for 60 days in an isosmotic environment does not impair limb or cardiac regeneration in the axolotl. Sci Rep 2023; 13:14951. [PMID: 37697071 PMCID: PMC10495452 DOI: 10.1038/s41598-023-42339-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/08/2023] [Indexed: 09/13/2023] Open
Abstract
Longitudinal animal experiments in the field of regenerative biology often require repeated use of short-term anesthesia (minutes to a few hours). Regain of consciousness limits the level of acceptable invasiveness of procedures, and it makes it difficult to untangle behavioral changes caused by injury to physiological processes involved in the regenerative response. Therefore, a method to keep a regenerative research animal in a comatose state under continuous anesthesia during regenerative experiments often spanning months, would be ethically and experimentally desirable. Here we report on a method using propofol based anesthesia in an isosmotic environment that allows for continuous anesthesia of regenerating axolotls for 60 days with a 75% survival rate, thus spanning the majority of a full regenerative cycle following limb amputation or cryoinjury to the heart. No differences were detected in the axolotl's ability to regenerate amputated limbs and cardiac cryo-injury while anesthetized, however some regenerative failures in the limb were observed in both anesthetized and unanesthetized control groups, most likely caused by prolonged fasting. Sixty days of anesthesia may be approaching a level were kidney function is affected, but the 75% surviving anesthetized animals recovered well after anesthesia and showed a full behavioral recovery within 17 days.
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Affiliation(s)
- Sofie Amalie Andersson
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 11, 8200, Aarhus N, Denmark
| | - Anita Dittrich
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 11, 8200, Aarhus N, Denmark
| | - Henrik Lauridsen
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 11, 8200, Aarhus N, Denmark.
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Klonner ME, Rocchi A. Accidental 10‐fold propofol overdose in a cat undergoing general anaesthesia for diagnostic imaging. VETERINARY RECORD CASE REPORTS 2022. [DOI: 10.1002/vrc2.276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Moriz Ettore Klonner
- Clinical Unit for Anaesthesia and Perioperative Intensive‐Care Medicine University of Veterinary Medicine Vienna Austria
| | - Attilio Rocchi
- Clinical Unit for Anaesthesia and Perioperative Intensive‐Care Medicine University of Veterinary Medicine Vienna Austria
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Drevin G, Briet M, Ferec S, Rossi LH, Jousset N, Abbara C. Lethal self-administration of propofol and atracurium. J Forensic Sci 2021; 67:827-831. [PMID: 34586645 DOI: 10.1111/1556-4029.14903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/14/2021] [Accepted: 09/14/2021] [Indexed: 11/29/2022]
Abstract
Acute propofol intoxications appear rare and remain primarily related to the acquisition of the material from the hospital. In this study, two cases of suicide following self-administration of a propofol-atracurium combination are presented as well as other propofol-related fatalities, in order to investigate propofol postmortem blood concentrations and circumstances surrounding death. The two case studies involved a 48-years-old male and a 61-year-old female, both anesthesiologists, who were found unresponsive with drugs (propofol, atracurium for both, and cisatracurium for one of them) discovered at the scene. Toxicological analyses were performed using validated chromatographic methods and highlighted the presence of propofol (1.0 µg/ml), laudanosine (0.2 µg/ml), paroxetine (3.4 µg/ml), and ethanol (12 mg/dl) for the first case and propofol (1.9 µg/ml), laudanosine (1.2 µg/ml), and hydroxyzine (0.03 µg/ml) for the second case. In the literature, 14 publications describing 27 cases of propofol-related lethal intoxications were identified. Except for two cases, all these fatalities involved healthcare professionals. Accidental overdose was the most frequently reported manner of death and the reported propofol blood concentrations ranged from 0.026 to 223.8 µg/ml. These cases, in agreement with other reported cases, highlight the concerns related to the misuse of hospital-based medicines, especially by health-care professionals, and so, the need for a much more stringent internal control of such drugs.
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Affiliation(s)
- Guillaume Drevin
- Service de Pharmacologie-Toxicologie et Pharmacovigilance, Centre Hospitalo-Universitaire d'Angers, Angers, France.,Université d'Angers, Angers, France
| | - Marie Briet
- Service de Pharmacologie-Toxicologie et Pharmacovigilance, Centre Hospitalo-Universitaire d'Angers, Angers, France.,Université d'Angers, Angers, France.,Laboratoire MitoVasc, UMR CNRS 6215 INSERM 1083, Angers, France
| | - Séverine Ferec
- Service de Pharmacologie-Toxicologie et Pharmacovigilance, Centre Hospitalo-Universitaire d'Angers, Angers, France
| | - Lea-Helena Rossi
- Institut de Médecine légale, Centre Hospitalo-Universitaire d'Angers, Angers, France
| | - Nathalie Jousset
- Institut de Médecine légale, Centre Hospitalo-Universitaire d'Angers, Angers, France
| | - Chadi Abbara
- Service de Pharmacologie-Toxicologie et Pharmacovigilance, Centre Hospitalo-Universitaire d'Angers, Angers, France
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Gwiazda S, Dixon E, Cronly M, Kavanagh Y, Cullinane M, Mulligan LM. Propofol misuse in Ireland - Two case reports and a review of the literature. Forensic Sci Int 2021; 326:110909. [PMID: 34311287 DOI: 10.1016/j.forsciint.2021.110909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/12/2021] [Accepted: 07/14/2021] [Indexed: 10/20/2022]
Abstract
Propofol is a rapidly acting sedative drug, which is usually administered intravenously. It is widely used in procedural sedation due to its rapid onset and easy reversibility. It has a good safety profile when used in combination with ventilation and monitoring. However, propofol can bring on feelings of euphoria, sexual disinhibition, tension relief and hallucinations, creating a potential for abuse. At an international level, recreational propofol use among medical staff is a growing, yet under reported problem. In order to highlight this issue in an Irish context, the case reports described are among the first recorded deaths in Ireland due to unmonitored self-administration of propofol. The difficulties facing forensic pathologists in detecting propofol and its metabolites in these cases are outlined. The potential for propofol abuse should influence healthcare facilities to make their staff aware of the risks associated with it. This in turn would promote vigilance and encourage those affected to seek treatment.
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Affiliation(s)
- Sara Gwiazda
- Office of the State Pathologist, Griffith Avenue, Whitehall, Dublin D09RDT8, Ireland
| | - Eleanor Dixon
- Human Toxicology, The State Laboratory, Backweston Campus, Co., Kildare, Ireland
| | - Mark Cronly
- Human Toxicology, The State Laboratory, Backweston Campus, Co., Kildare, Ireland
| | - Yvonne Kavanagh
- Human Toxicology, The State Laboratory, Backweston Campus, Co., Kildare, Ireland
| | - Myra Cullinane
- FRCPI, MFFLM, Barrister-at-Law, Senior Coroner for the Dublin District, Store Street, Dublin 1, Ireland
| | - Linda M Mulligan
- Office of the State Pathologist, Griffith Avenue, Whitehall, Dublin D09RDT8, Ireland.
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Ottaviano V, Tavone AM, Scipione C, Potenza S, Petroni G, Marella GL. Drug detection in decomposed cadavers confirms testimonial evidence in a case of serial homicides. Forensic Sci Int 2021; 325:110893. [PMID: 34273605 DOI: 10.1016/j.forsciint.2021.110893] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 06/21/2021] [Accepted: 06/29/2021] [Indexed: 11/30/2022]
Abstract
Toxicology investigation on human's buried dead bodies is a rare and challenging task in the forensic field. As requested by the Judicial Authority, this work aimed to verify testimonial evidence that emerged during a criminal investigation involving multiple murder cases. The statements indicated an improper medical administration of one or more alleged drugs (propofol, morphine, diazepam, and midazolam) which presumably caused the deaths. Since the supposed crimes took place several years before, the task of the present work was to obtain results to support the charges. The analyses involved 18 biological samples taken from four exhumed bodies, three of which were female and one male, each buried in a different date and mode. Each sample was treated with specific purification and extraction techniques (LLE - SPE) after the addition of the deuterated analogs of the searched analytes (propofol-d17, morphine-d3, diazepam-d5, midazolam-d4) as internal standards. Afterwards, the extracts were subjected to qualitative analysis by gas chromatography-mass spectrometry-Electron Impact (GC/MS - EI), both in full scan and SIM mode. Propofol, morphine, and diazepam were identified in the corpses. It supports testimonials that were administered just before the deaths occurred.
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Affiliation(s)
- Valeria Ottaviano
- University of Rome "Tor Vergata", Department of Biomedicine and Prevention, via Montpellier 1, 00166 Rome, Italy
| | - Alessandro Mauro Tavone
- University of Rome "Tor Vergata", Department of Biomedicine and Prevention, via Montpellier 1, 00166 Rome, Italy.
| | - Claudia Scipione
- University of Rome "Tor Vergata", Department of Biomedicine and Prevention, via Montpellier 1, 00166 Rome, Italy
| | - Saverio Potenza
- University of Rome "Tor Vergata", Department of Biomedicine and Prevention, via Montpellier 1, 00166 Rome, Italy
| | - Giulia Petroni
- University of Rome "Tor Vergata", Department of Biomedicine and Prevention, via Montpellier 1, 00166 Rome, Italy
| | - Gian Luca Marella
- University of Rome "Tor Vergata", Department of Surgical Sciences, via Montpellier 1, 00166 Rome, Italy
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Ferrari Júnior E, Dos Santos JBA, Caldas ED. Drugs, pesticides and metabolites in forensic post-mortem blood samples. MEDICINE, SCIENCE, AND THE LAW 2021; 61:97-104. [PMID: 33081562 DOI: 10.1177/0025802420965006] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Forensic post-mortem toxicological data provide valuable information for the elucidation of cause of death. However, this is still not routine practice in Brazilian laboratories. This study investigated the presence of illicit and prescription drugs, pesticides and metabolites in 111 post-mortem blood samples from cases investigated by the Forensic Medical Institute of the Federal District, Brazil. Quantitative analysis was performed for 14 analytes using a validated programmed temperature vaporisation-large volume injection-gas chromatography-mass spectrometry method, which was also used as screening (qualitative analysis) for an additional 19 substances of forensic interest. At least one analyte was found in 61.2% of the samples, of which 34 were related to homicide, 15 to accidental death and 10 to suicide cases. The victims were 14-72 years old. The benzodiazepines diazepam, midazolam and 7-aminoflunitrazepan were detected in 46% of the positive samples (0.02-1.12 µg/mL; midazolam only qualitative). Cocaine was found in 34% (0.02-4.07 µg/mL), associated with substances commonly used as cocaine adulterants (e.g. caffeine, lidocaine and phenacetin). Three suicide cases involved the illegal rodenticide chumbinho, residues of which were found in the gastric content, and blood samples showed the presence of terbufos (0.03 and 0.04 µg/mL) and carbofuran (27.3 µg/mL). These results are discussed, along with autopsy and crime-scene information.
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Affiliation(s)
- Ettore Ferrari Júnior
- Forensic Analysis Laboratory, Criminalistics Institute, Brazil
- Laboratory of Toxicology, Department of Pharmacy, University of Brasilia, Brazil
| | | | - Eloisa Dutra Caldas
- Laboratory of Toxicology, Department of Pharmacy, University of Brasilia, Brazil
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Zhang J, Chen X, Kårbø M, Zhao Y, An L, Wang R, Wang K, Huang Z. Anticonvulsant effect of dipropofol by enhancing native GABA currents in cortical neurons in mice. J Neurophysiol 2018; 120:1404-1414. [DOI: 10.1152/jn.00241.2018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Temporal lobe epilepsy (TLE), the most common pharmacoresistant focal epilepsy disorder, remains a major unmet medical need. Propofol is used as a short-acting medication for general anesthesia and refractory status epilepticus with issues of decreased consciousness and memory loss. Dipropofol, a derivative of propofol, has been reported to exert antioxidative and antibacterial activities. Here we report that dipropofol exerted anticonvulsant activity in a mouse model of kainic acid-induced seizures. Whole cell patch-clamp recordings of brain slices from the medial entorhinal cortex (mEC) revealed that dipropofol hyperpolarized the resting membrane potential and reduced the number of action potential firings, resulting in suppression of cortical neuronal excitability. Furthermore, dipropofol activated native tonic GABAA currents of mEC layer II stellate neurons in a dose-dependent manner with an EC50 value of 9.3 ± 1.6 μM (mean ± SE). Taken together, our findings show that dipropofol activated GABAA currents and exerted anticonvulsant activities in mice, thus possessing developmental potential for new anticonvulsant therapy. NEW & NOTEWORTHY The anticonvulsant effect of dipropofol was shown in a mouse model of kainic acid-induced seizures. Whole cell patch-clamp recordings of brain slices showed suppression of cortical neuronal excitability by dipropofol. Dipropofol activated the native tonic GABAA currents in a dose-dependent manner.
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Affiliation(s)
- Jingliang Zhang
- State Key Laboratory of Natural and Biomimetic Drugs, Department of Molecular and Cellular Pharmacology, School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China
| | - Xiaoling Chen
- State Key Laboratory of Natural and Biomimetic Drugs, Department of Molecular and Cellular Pharmacology, School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China
| | - Matti Kårbø
- State Key Laboratory of Natural and Biomimetic Drugs, Department of Molecular and Cellular Pharmacology, School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China
| | - Yi Zhao
- Tech-Development Department, Xi’an Libang Pharmaceutical Company, Xi’an, China
| | - Long An
- Tech-Development Department, Xi’an Libang Pharmaceutical Company, Xi’an, China
| | - Rutao Wang
- Tech-Development Department, Xi’an Libang Pharmaceutical Company, Xi’an, China
| | - KeWei Wang
- Department of Pharmacology, Qingdao University School of Pharmacy, Qingdao, China
| | - Zhuo Huang
- State Key Laboratory of Natural and Biomimetic Drugs, Department of Molecular and Cellular Pharmacology, School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China
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11
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Metabolic Profiles of Propofol and Fospropofol: Clinical and Forensic Interpretative Aspects. BIOMED RESEARCH INTERNATIONAL 2018; 2018:6852857. [PMID: 29992157 PMCID: PMC5994321 DOI: 10.1155/2018/6852857] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 03/27/2018] [Accepted: 04/15/2018] [Indexed: 02/08/2023]
Abstract
Propofol is an intravenous short-acting anesthetic widely used to induce and maintain general anesthesia and to provide procedural sedation. The potential for propofol dependency and abuse has been recognized, and several cases of accidental overdose and suicide have emerged, mostly among the health professionals. Different studies have demonstrated an unpredictable interindividual variability of propofol pharmacokinetics and pharmacodynamics with forensic and clinical adverse relevant outcomes (e.g., pronounced respiratory and cardiac depression), namely, due to polymorphisms in the UDP-glucuronosyltransferase and cytochrome P450 isoforms and drugs administered concurrently. In this work the pharmacokinetics of propofol and fospropofol with particular focus on metabolic pathways is fully reviewed. It is concluded that knowing the metabolism of propofol may lead to the development of new clues to help further toxicological and clinical interpretations and to reduce serious adverse reactions such as respiratory failure, metabolic acidosis, rhabdomyolysis, cardiac bradyarrhythmias, hypotension and myocardial failure, anaphylaxis, hypertriglyceridemia, renal failure, hepatomegaly, hepatic steatosis, acute pancreatitis, abuse, and death. Particularly, further studies aiming to characterize polymorphic enzymes involved in the metabolic pathway, the development of additional routine forensic toxicological analysis, and the relatively new field of ‘‘omics” technology, namely, metabolomics, can offer more in explaining the unpredictable interindividual variability.
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Maas A, Maier C, Iwersen-Bergmann S, Pilgrim JL, Di Rago M, Madea B, Hess C. Propofol and propofol glucuronide concentrations in hair following medical propofol administration and in forensic death cases. Forensic Toxicol 2018. [DOI: 10.1007/s11419-017-0399-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Jones AW. Postmortem toxicology findings from medicolegal investigations of drug-related deaths among the rich and famous. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2017. [DOI: 10.1016/j.toxac.2017.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Procaccianti P, Farè F, Argo A, Casagni E, Arnoldi S, Facheris S, Visconti GL, Roda G, Gambaro V. Determination of Propofol by GC/MS and Fast GC/MS-TOF in Two Cases of Poisoning. J Anal Toxicol 2017; 41:771-776. [DOI: 10.1093/jat/bkx056] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 06/27/2017] [Indexed: 11/14/2022] Open
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Akram R, Ghazal S, Tayebeh S, Ebrahim K. Hepatoprotective Effects of Propofol in Cisplatin Induced Rat Liver Oxidative Damage. ACTA ACUST UNITED AC 2016. [DOI: 10.5567/pharmacologia.2016.229.233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Hantson P, Bonbled F. Le propofol comme agent de suicide ou d’abus. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2016. [DOI: 10.1016/j.toxac.2015.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Kwak JH, Kim HK, Choe S, In S, Pyo JS. Determination of propofol glucuronide from hair sample by using mixed mode anion exchange cartridge and liquid chromatography tandem mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci 2016; 1015-1016:209-213. [DOI: 10.1016/j.jchromb.2016.01.061] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 01/26/2016] [Accepted: 01/30/2016] [Indexed: 11/25/2022]
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Pyo JS. Selective and Accurate Determination Method of Propofol in Human Plasma by Mixed-Mode Cation Exchange Cartridge and GC-MS. JOURNAL OF ANALYTICAL METHODS IN CHEMISTRY 2016; 2016:9531769. [PMID: 27597928 PMCID: PMC4997078 DOI: 10.1155/2016/9531769] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 07/14/2016] [Indexed: 05/08/2023]
Abstract
A gas chromatography-mass spectrometry (GC-MS) method for the determination of propofol in human plasma has been developed and validated. Propofol was extracted from human plasma by using mixed-mode cation exchange/reversed-phase (MCX) cartridges. As propofol easily volatilizes during concentration, 100% methanol was injected directly into GC-MS to elute propofol. Despite avoiding concentration process of the eluted solution, lower limit of quantization (LLOQ) of propofol was 25 ng/mL. The validated method exhibited good linearity (R (2) = 0.9989) with accuracy and precision -5.8%~11.7% and 3.7%~11.6%, respectively. The other validation parameters, recovery and matrix effect, ranged from 96.6% to 99.4% and 95.3% to 101.4%, respectively. Propofol standard was quantified to evaluate possible loss due to the concentration processes, nitrogen gas and centrifugal vacuum. These two concentration processes resulted in notable decrease in the quantity of propofol, signifying avoiding any concentration processes during propofol quantification. Also, to confirm suitability of the developed method, authentic human plasma samples were analyzed. The selective assay method using MCX cartridge and GC-MS facilitated quantification of propofol in plasma sample accurately by preventing any losses due to the concentration processes.
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Affiliation(s)
- Jae Sung Pyo
- College of Pharmacy, Kyungsung University, Busan 48434, Republic of Korea
- *Jae Sung Pyo:
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Affiliation(s)
- Brian Martin
- From the Department of Anesthesiology, Baystate Medical Center, Springfield, Massachusetts
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Vaiano F, Serpelloni G, Focardi M, Fioravanti A, Mari F, Bertol E. LC–MS/MS and GC–MS methods in propofol detection: Evaluation of the two analytical procedures. Forensic Sci Int 2015; 256:1-6. [DOI: 10.1016/j.forsciint.2015.07.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 05/28/2015] [Accepted: 07/07/2015] [Indexed: 10/23/2022]
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Park HJ, Shin JY, Kim MH, Park BJ. Increased use in propofol and reported patterns of adverse events among anesthetics in Korea. Regul Toxicol Pharmacol 2015; 71:478-83. [PMID: 25666110 DOI: 10.1016/j.yrtph.2015.02.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 01/20/2015] [Accepted: 02/02/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Propofol is an addictive drug, and the problem of its abuse and dependence has occurred. To compare the safety profiles of propofol and other similar anesthetics such as diazepam, lorazepam, and midazolam, we evaluated their uses and related adverse drug reactions (ADRs) using Korean Adverse Event Reporting System (KAERS) data. METHODS The domestic consumption data and the ADR reports of four anesthetics from 2008 to 2012 were retrieved. ADR proportions were calculated using defined daily dose/1000 inhabitants/day (DID) for the denominator. The patient's characteristics were compared among the four drugs statistically, and the types of ADRs were analyzed. RESULTS The consumption and ADR reports increased during the study period, particularly in the cases of propofol and midazolam. Lorazepam showed the highest overall and serious ADR proportions (220.81 reports/DID, 58.47 reports/DID, respectively); however, with respect to death proportion, propofol was the first (19.21 reports/DID). Also, ADRs related to drug addiction were mainly observed in the propofol group. CONCLUSIONS Four anesthetics were different with regard to the consumption and proportion or the type of ADRs. The use of propofol increased more than 2 times, and propofol showed the highest ADR proportions in death and drug addiction cases among the four anesthetics.
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Affiliation(s)
- Hyo-Ju Park
- Korea Institute of Drug Safety and Risk Management, Seoul 110-750, South Korea
| | - Ju-Young Shin
- Korea Institute of Drug Safety and Risk Management, Seoul 110-750, South Korea
| | - Mi-Hee Kim
- Korea Institute of Drug Safety and Risk Management, Seoul 110-750, South Korea
| | - Byung-Joo Park
- Korea Institute of Drug Safety and Risk Management, Seoul 110-750, South Korea; Department of Preventive Medicine, Seoul National University College of Medicine, Seoul 110-744, South Korea.
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Kim HS, Cheong JC, Lee JI, In MK. Rapid and sensitive determination of propofol glucuronide in hair by liquid chromatography and tandem mass spectrometry. J Pharm Biomed Anal 2013; 85:33-9. [DOI: 10.1016/j.jpba.2013.06.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 06/12/2013] [Accepted: 06/18/2013] [Indexed: 10/26/2022]
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Mannocchi G, Napoleoni F, Napoletano S, Pantano F, Santoni M, Tittarelli R, Arbarello P. Fatal self administration of tramadol and propofol: A case report. J Forensic Leg Med 2013; 20:715-9. [DOI: 10.1016/j.jflm.2013.04.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 03/27/2013] [Accepted: 04/09/2013] [Indexed: 10/26/2022]
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Kim J, In S, Park Y, Park M, Kim E, Lee S. Quantitative analysis of propofol-glucuronide in hair as a marker for propofol abuse. Anal Bioanal Chem 2013; 405:6807-14. [DOI: 10.1007/s00216-013-7105-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 05/27/2013] [Accepted: 05/29/2013] [Indexed: 01/08/2023]
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Circumstantial and toxicological features of deaths from self-administered intravenous anesthetic/narcotic agents. Forensic Sci Med Pathol 2012; 9:138-44. [DOI: 10.1007/s12024-012-9374-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2012] [Indexed: 11/27/2022]
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Comparison of GC/MS and LC/MS methods for the analysis of propofol and its metabolites in urine. J Chromatogr B Analyt Technol Biomed Life Sci 2012; 900:1-10. [DOI: 10.1016/j.jchromb.2012.05.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Revised: 05/03/2012] [Accepted: 05/07/2012] [Indexed: 11/20/2022]
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VANLANDER AV, JORENS PG, SMET J, DE PAEPE B, VERBRUGGHE W, VAN DEN EYNDEN GG, MEIRE F, PAUWELS P, VAN DER AA N, SENECA S, LISSENS W, OKUN JG, VAN COSTER R. Inborn oxidative phosphorylation defect as risk factor for propofol infusion syndrome. Acta Anaesthesiol Scand 2012; 56:520-5. [PMID: 22260353 DOI: 10.1111/j.1399-6576.2011.02628.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2011] [Indexed: 12/24/2022]
Abstract
Propofol is an anesthetic agent widely used for induction and maintenance of anesthesia, and sedation in children. Although generally considered as reliable and safe, administration of propofol can occasionally induce a potentially fatal complication known as propofol infusion syndrome (PRIS). Mitochondrial dysfunction has been implicated in the pathogenesis of PRIS. We report on an adult patient with Leber hereditary optic neuropathy (LHON) who developed PRIS. He was a carrier of the m.3460G>A mutation, one of the major three pathogenic point mutations associated with LHON. The propositus was blind and underwent propofol sedation after severe head injury. Five days after start of propofol infusion, the patient died. The activity of complex I of the oxidative phosphorylation (OXPHOS) system was severely deficient in skeletal muscle. Our observation indicates that fulminate PRIS can occur in an adult patient with an inborn OXPHOS defect and corroborates the hypothesis that PRIS is caused by inhibition of the OXPHOS system.
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Affiliation(s)
- A. V. VANLANDER
- Department of Pediatrics; Division of Pediatric Neurology and Metabolism; Ghent University Hospital; Ghent; Belgium
| | - P. G. JORENS
- Department of Critical Care Medicine; Antwerp University Hospital, Antwerp University; Edegem; Belgium
| | - J. SMET
- Department of Pediatrics; Division of Pediatric Neurology and Metabolism; Ghent University Hospital; Ghent; Belgium
| | - B. DE PAEPE
- Department of Pediatrics; Division of Pediatric Neurology and Metabolism; Ghent University Hospital; Ghent; Belgium
| | - W. VERBRUGGHE
- Department of Critical Care Medicine; Antwerp University Hospital, Antwerp University; Edegem; Belgium
| | | | - F. MEIRE
- Department of Pediatric Ophthalmology; Hôpital Universitaire des Enfants Reine Fabiola; Brussels; Belgium
| | - P. PAUWELS
- Department of Pathology; Antwerp University; Wilrijk; Belgium
| | - N. VAN DER AA
- Department of Medical Genetics; Antwerp University Hospital, Antwerp University; Edegem; Belgium
| | - S. SENECA
- Center for Medical Genetics; UZ Brussel and Reproduction and Genetics (REGE); Vrije Universiteit Brussel; Brussels; Belgium
| | - W. LISSENS
- Center for Medical Genetics; UZ Brussel and Reproduction and Genetics (REGE); Vrije Universiteit Brussel; Brussels; Belgium
| | - J. G. OKUN
- Department of General Pediatrics; Division of Inborn Metabolic Diseases; University Children's Hospital; Heidelberg; Germany
| | - R. VAN COSTER
- Department of Pediatrics; Division of Pediatric Neurology and Metabolism; Ghent University Hospital; Ghent; Belgium
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WUTZLER ALEXANDER, ROLF SASCHA, HUEMER MARTIN, PARWANI ABDULSHOKOR, BOLDT LEIFHENDRIK, HERBERGER ERIK, HOHENBICHLER KATHARINA, DIETZ RAINER, HAVERKAMP WILHELM. Safety Aspects of Deep Sedation during Catheter Ablation of Atrial Fibrillation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2011; 35:38-43. [DOI: 10.1111/j.1540-8159.2011.03260.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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