Changes of Exhaled Volatile Organic Compounds in Postoperative Patients Undergoing Analgesic Treatment: A Prospective Observational Study

Abstract

Assessment and treatment of postoperative pain can be challenging as objective examination techniques to detect and quantify pain are lacking. We aimed to investigate changes of exhaled volatile organic compounds (VOCs) in patients with postoperative pain before and after treatment with opioid analgesics. In an observational study in 20 postoperative patients, we monitored for postoperative pain, hemodynamic parameters, and catecholamines before and during treatment. VOCs in the patients were determined by direct real-time proton transfer reaction time-of-flight mass spectrometry prior (0 min) and after piritramide application (15 min as well as 30 min). Cardiovascular variables changed and norepinephrine levels decreased during treatment. The VOCs acetonitrile (<0.001), acetaldehyde (p = 0.002), benzopyran (p = 0.004), benzene (p < 0.001), hexenal (p = < 0.001), 1-butanethiol (p = 0.004), methanethiol (p < 0.001), ethanol (p = 0.003), and propanol (p = < 0.001) changed significantly over time. Patients with Numeric Rating Scale (NRS) < 4 showed a significantly lower concentration of hexenal compared to patients with NRS > 4 at the time points 15 min (45.0 vs. 385.3 ncps, p = 0.047) and 30 min (38.3 vs. 334.6 ncps, p = 0.039). Breath analysis can provide additional information for noninvasive monitoring for analgesic treatment in postoperative patients.

Physiological and metabolic effects of healthy female aging on exhaled breath biomarkers

“…Among hundreds of measured VOCs, here we considered compounds with expiratory abundances significantly above the inspiratory/room-air abundance. Out of those markers we selected 23 substances that are important breath biomarkers in clinical breathomics and reflect different origins, physico-chemical characters and dependencies on physiology, metabolism, pathology, therapy and lifestyle/habits( Löser et al., 2020 ; Sukul et al., 2017a , 2018 ; Trefz et al., 2013 , 2019 ).…”

“…High-resolution and real time mass spectrometry based noninvasive, rapid, and repeated evaluation of exhaled volatile metabolites offers immediate overview of various physio-metabolic ( Spacek et al., 2018 ; Sukul et al., 2014 , 2015 , 2017a ), biochemical ( Refat et al., 1991 ; Sukul et al., 2021 ; Weber et al., n.d. ) and pathological/therapeutic processes ( Löser et al., 2020 ; Paardekooper et al., 2017 ; Trefz et al., 2019 ) via breathomics. Previously we have demonstrated the effects of natural menstrual cycle and oral contraception on the exhaled volatile organic compounds (VOCs) profile from healthy adults ( Sukul et al., 2018 ).…”

ptairMS: real-time processing and analysis of PTR-TOF-MS data for biomarker discovery in exhaled breath

“…Altogether, these results demonstrate the value of the ptairMS software as a key resource in breathomics for real-time analysis at the point of care and in biomarker discovery studies, with a high clinical potential for the phenotyping of health and disease, therapeutic drug monitoring, toxicological studies and precision medicine ( Fernández del Río et al , 2015 ; Ibrahim et al , 2019 ; Jung et al , 2021 ; Löser et al , 2020 ; Zhou et al , 2017 ).…”

Exhaled-Breath Testing Using an Electronic Nose during Spinal Cord Stimulation in Patients with Failed Back Surgery Syndrome: An Experimental Pilot Study

“…Perhaps, only a discrimination between the absence or presence of pain is possible, without a further finetuning of the amount of pain. Finally, it might also be possible that exhaled breath is not altered by neuromodulation (i.e., absence of changes in VOCs) or that the device is not sensitive enough to detect small changes in VOCs, since a study with mass spectrometry revealed clear differences is several specific VOCs in patients with postoperative pain, before and after treatment with opioid analgesics [39], pointing at the potential to differentiate between pain states with mass spectrometry. This is the first study exploring the use of an electronic nose in the context of neuromodulation.…”