Correlations between Propofol Concentration in Exhaled Breath and BIS in Patients undergoing Thyroid Surgery.

IF 3.7 4区医学 Q1 BIOCHEMICAL RESEARCH METHODS Journal of breath research Pub Date : 2024-11-19 DOI:10.1088/1752-7163/ad9496

Xiaoxiao Li, Pan Chang, Xing Liu, Zhongjun Zhao, Yixiang Duan, Wensheng Zhang

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Abstract

Several clinical studies have reported promising correlations between propofol concentration in exhaled breath (Ce-pro) and the bispectral index (BIS) in patients, suggesting the potential of exhaled propofol measurement as a non-invasive method for adjusting anesthesia depth. However, these studies are still in the validation phase of instrument effectiveness, often limited by small sample sizes or inappropriate instrument selection, and thus lack convincing results regarding these correlations. In this study, one hundred patients aged 18-65, undergoing elective thyroid surgery under general anesthesia were included. The vacuum ultraviolet (VUV) photoionization and time-of-flight mass spectrometry (TOF MS) was employed to monitor Ce-pro at 20-second intervals, alongside continuous BIS measurement. The association between Ce-pro and BIS was analyzed using linear mixed-effects models, with marginal R² used to assess the correlation. The threshold of Ce-pro at awakening was also explored. Additionally, the univariate and multifactorial diagnostic model, including end-of-surgery Ce-pro, were employed to assess the accuracy of predicting delayed recovery. A weak correlation was observed between intraoperative Ce-pro and BIS (marginal R2 = 0.348). Predictive models utilising end-of-surgery Ce-pro levels showed good accuracy (AUC = 0.75, 95% CI: 0.62 to 0.89, P = 0.003) in predicting delayed recovery, while the model using end-of-surgery Ce-pro combined with gender, sufentanil dosage, the time from the last administration of sufentanil to the end of surgery, and anesthesia duration demonstrated stronger predicting accuracy (AUC = 0.91, 95% CI: 0.85 to 0.98, P < 0.001). This study suggests that Ce-pro alone may not reliably predict the depth of anesthesia in clinical practice, but shows promising accuracy in predicting delayed recovery from anesthesia. Clinical trial number: ChiCTR2300074605 Keywords: Propofol; Exhaled Breath; BIS; Correlation.

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甲状腺手术患者呼出气体中丙泊酚浓度与 BIS 之间的相关性

有几项临床研究报告称，患者呼出气体中的异丙酚浓度（Ce-pro）与双频谱指数（BIS）之间存在良好的相关性，这表明呼出异丙酚测量作为调整麻醉深度的无创方法具有潜力。然而，这些研究仍处于仪器有效性的验证阶段，往往受到样本量小或仪器选择不当的限制，因此在这些相关性方面缺乏令人信服的结果。本研究纳入了 100 名年龄在 18-65 岁之间、在全身麻醉下接受择期甲状腺手术的患者。研究人员采用真空紫外（VUV）光离子化和飞行时间质谱（TOF MS）技术，以 20 秒为间隔监测 Ce-pro，同时连续测量 BIS。使用线性混合效应模型分析了 Ce-pro 与 BIS 之间的关联，并使用边际 R² 评估了相关性。同时还探讨了唤醒时 Ce-pro 的阈值。此外，还采用了单变量和多因素诊断模型（包括手术结束时的 Ce-pro）来评估预测延迟恢复的准确性。术中 Ce-pro 与 BIS 之间存在微弱的相关性（边际 R2 = 0.348）。利用手术结束时 Ce-pro 水平的预测模型在预测延迟恢复方面显示出良好的准确性（AUC = 0.75，95% CI：0.62 至 0.89，P = 0.003），而利用手术结束时 Ce-pro 与性别、舒芬太尼剂量、最后一次使用舒芬太尼到手术结束的时间以及麻醉持续时间相结合的模型则显示出更高的预测准确性（AUC = 0.91，95% CI：0.85 至 0.98，P < 0.001）。这项研究表明，在临床实践中，单独使用Ce-pro可能无法可靠地预测麻醉深度，但在预测麻醉延迟恢复方面却显示出了良好的准确性：ChiCTR2300074605 Keywords:丙泊酚呼气 BIS 相关性

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来源期刊

Journal of breath research BIOCHEMICAL RESEARCH METHODS-RESPIRATORY SYSTEM

CiteScore

7.60

自引率

21.10%

发文量

审稿时长

>12 weeks

期刊介绍： Journal of Breath Research is dedicated to all aspects of scientific breath research. The traditional focus is on analysis of volatile compounds and aerosols in exhaled breath for the investigation of exogenous exposures, metabolism, toxicology, health status and the diagnosis of disease and breath odours. The journal also welcomes other breath-related topics. Typical areas of interest include: Big laboratory instrumentation: describing new state-of-the-art analytical instrumentation capable of performing high-resolution discovery and targeted breath research; exploiting complex technologies drawn from other areas of biochemistry and genetics for breath research. Engineering solutions: developing new breath sampling technologies for condensate and aerosols, for chemical and optical sensors, for extraction and sample preparation methods, for automation and standardization, and for multiplex analyses to preserve the breath matrix and facilitating analytical throughput. Measure exhaled constituents (e.g. CO2, acetone, isoprene) as markers of human presence or mitigate such contaminants in enclosed environments. Human and animal in vivo studies: decoding the ''breath exposome'', implementing exposure and intervention studies, performing cross-sectional and case-control research, assaying immune and inflammatory response, and testing mammalian host response to infections and exogenous exposures to develop information directly applicable to systems biology. Studying inhalation toxicology; inhaled breath as a source of internal dose; resultant blood, breath and urinary biomarkers linked to inhalation pathway. Cellular and molecular level in vitro studies. Clinical, pharmacological and forensic applications. Mathematical, statistical and graphical data interpretation.