Long-Term Detection of Propofol Glucuronide in Urine Following Anesthetic Induction and Maintenance with Propofol

Abstract

Propofol is the most commonly used compound for the intravenous induction and maintenance of anesthesia. Propofol addiction and abuse have become causes for concern in the healthcare community, especially among anesthesia and surgical professionals. The US Drug Enforcement Administration does not list propofol on any Schedules and most hospitals do not have inventory controls in place to prevent its misuse. Propofol is detectable in blood plasma as the parent compound for as much as 15 hours post-anesthesia. The metabolite propofol glucuronide (PPFG) has been detected in blood and urine as far out as 60 hours. Here we report the long-term renal excretion of PPFG in specimens from A) four participants following a 14-day course of orally ingested propofol dosing, and B) a female patient following anesthetic induction and 15 minutes' maintenance with propofol. Urinary PPFG was measurable well above limits of quantitation up to 6 days following oral ingestion and 28 days post-anesthesia. We also present a third set of data evaluating the likelihood of passive exposure to aerosolized propofol in the surgical environment by analyzing the levels of urinary PPFG of healthcare workers following operating room work shifts. The results presented here demonstrate that quantitation of PPFG in urinary samples is an efficient method of long-term screening for propofol misuse and abuse.

Propofol detection and quantification in human blood: the promise of feedback controlled, closed-loop anesthesia

“…20 Propofol metabolites have also been measured in urine. 21 Our group has shown that the voltammetric determination of propofol is possible in complex biological solutions using an organic lm (plasticized PVC membrane) coated working electrode. Propofol can be oxidized electrochemically, 22 which permitted the development of voltammetric methods for its quantitative assessment.…”

Diagnosed by Reversibility: Unmasking Propofol-Related Infusion Syndrome in a Critically-Ill Elderly Male

“…Propofol is metabolized in the liver, and its water-soluble metabolites are excreted through the kidneys. Although it cannot eliminate the highly lipophilic parent drug, continuous hemofiltration can eliminate the toxic water-soluble propofol metabolites [ 5 ]. For those with severe forms of cardiovascular collapse, mechanical circulatory support, using ventricular assist devices (VADs) or extracorporeal membrane oxygenation (ECMO) can be deployed to temporarily support end-organ blood flow and oxygen delivery [ 6 ].…”

Propofol‐induced irreversible hair depigmentation: a case report

“…Propofol has several mechanisms of action: potentiation of GABA receptor activity, slow down the channel‐closing time, and sodium channel blockade . Propofol may cause green discoloration of the urine through phenolic metabolities, such as propofol glucuronide, which can be easily detected in urine up to 28 days post‐anesthesia . In case of suspected chronic abuse, propofol concentration in hair can be measured using liquid chromatography‐tandem mass spectrometry (LC‐MS/MS) with a wider time window of detection .…”