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Metabolites

Title:		Non-Invasive O-Toluidine Monitoring during Regional Anaesthesia with Prilocaine and Detection of Accidental Intravenous Injection in an Animal Model
Author(s):		Brock B; Fuchs P; Kamysek S; Walther U; Traxler S; Pugliese G; Miekisch W; Schubert JK; Trefz P;
Address:		"Rostock Medical Breath Research Analytics and Technologies (ROMBAT), Department of Anaesthesiology and Intensive Care Medicine, Rostock University Medical Centre, 18057 Rostock, Germany. Ambulance and Rescue Service, Rostock District Administration, Mecklenburg-Vorpommern, 18209 Bad Doberan, Germany. Institute of Pharmacology and Toxicology, Rostock University Medical Centre, 18057 Rostock, Germany. Max Planck Institute for Chemistry, 55128 Mainz, Germany"
Journal Title:		Metabolites
Year:		2022
Volume:		20220531
Issue:		6
Page Number:		-
DOI:		10.3390/metabo12060502
ISSN/ISBN:		2218-1989 (Print) 2218-1989 (Electronic) 2218-1989 (Linking)
Abstract:		"Regional anaesthesia is well established as a standard method in clinical practice. Currently, the local anaesthetics of amino-amide types such as prilocaine are frequently used. Despite routine use, complications due to overdose or accidental intravenous injection can arise. A non-invasive method that can indicate such complications early would be desirable. Breath gas analysis offers great potential for the non-invasive monitoring of drugs and their volatile metabolites. The physicochemical properties of o-toluidine, the main metabolite of prilocaine, allow its detection in breath gas. Within this study, we investigated whether o-toluidine can be monitored in exhaled breath during regional anaesthesia in an animal model, if correlations between o-toluidine and prilocaine blood levels exist and if accidental intravenous injections are detectable by o-toluidine breath monitoring. Continuous o-toluidine monitoring was possible during regional anaesthesia of the cervical plexus and during simulated accidental intravenous injection of prilocaine. The time course of exhaled o-toluidine concentrations considerably differed depending on the injection site. Intravenous injection led to an immediate increase in exhaled o-toluidine concentrations within 2 min, earlier peak and higher maximum concentrations, followed by a faster decay compared to regional anaesthesia. The strength of correlation of blood and breath parameters depended on the injection site. In conclusion, real time monitoring of o-toluidine in breath gas is possible by means of PTR-ToF-MS. Since simulated accidental intravenous injection led to an immediate increase in exhaled o-toluidine concentrations within 2 min and higher maximum concentrations, monitoring exhaled o-toluidine may potentially be applied for the non-invasive real-time detection of accidental intravenous injection of prilocaine"
Keywords:		PTR-ToF-MS breath gas analysis drug monitoring o-toluidine prilocaine regional anaesthesia toxicology volatile organic compounds (VOC);
Notes:		"PubMed-not-MEDLINEBrock, Beate Fuchs, Patricia Kamysek, Svend Walther, Udo Traxler, Selina Pugliese, Giovanni Miekisch, Wolfram Schubert, Jochen K Trefz, Phillip eng Switzerland 2022/06/24 Metabolites. 2022 May 31; 12(6):502. doi: 10.3390/metabo12060502"