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

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Abstract

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.

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Funding sources

This work was funded by departmental funds of the Department of Anaesthesiology at the Ludwig-Maximilians-University, Munich, Germany. Additionally, V&F medical development supported the study by providing an ion molecule reaction mass spectrometry system during the study period. Siegfried Praun, Ph.D. is a scientist employed by the company that holds the patent on the ion molecule reaction mass spectrometry technology. Cyrill Hornuss, M.D. received an indirect research grant from V&F. V&F reimbursed the travel expenses of Cyrill Hornuss and Michael Dolch, M.D. to the ASA annual meetings and the German Anaesthesia Congress (DAC) 2006–2009. No other personal funding or other financial support was received by any author; this includes contracts, equity interest, stock option(s), direct or indirect salary support, consultant fee(s), or honoraria within a period of 5 years of the date of submission of this manuscript.

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Authors and Affiliations

  1. Department of Anaesthesiology, Klinikum der Universität, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany

    Cyrill Hornuss, Dirk Wiepcke, Michael E. Dolch & Gustav Schelling

  2. V&F medical development GmbH, Andreas-Hofer-Str. 15, 6067, Absam, Austria

    Siegfried Praun

  3. Perioperative Clinical Research Core, Department of Anesthesia and Perioperative Care, Department of Epidemiology and Biostatistics, UCSF Mount Zion Hospital, University of California San Francisco, 1600 Divisadero Street, C-447, San Francisco, CA, 94115, USA

    Christian C. Apfel

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  1. Cyrill Hornuss
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  2. Dirk Wiepcke
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  3. Siegfried Praun
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  4. Michael E. Dolch
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  5. Christian C. Apfel
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  6. Gustav Schelling
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Correspondence to Cyrill Hornuss.

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Hornuss, C., Wiepcke, D., Praun, S. et al. Time course of expiratory propofol after bolus injection as measured by ion molecule reaction mass spectrometry. Anal Bioanal Chem 403, 555–561 (2012). https://doi.org/10.1007/s00216-012-5856-3

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  • DOI: https://doi.org/10.1007/s00216-012-5856-3

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