USDTL Research

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

Joseph Salerno, Joseph Jones, Mary Jones, Charles Plate, Douglas Lewis

Received August 7, 2013; Revised September 9, 2013; Accepted September 21, 2013. DOI:10.4236/pp.2013.47076

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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 de-tected 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 follow-ing 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 lev-els of urinary PPFG of healthcare workers following operating room work shifts. The results presented here demon-strate that quantitation of PPFG in urinary samples is an efficient method of long-term screening for propofol misuse and abuse.

Keywords: Anesthetics; Drug Testing; Metabolism; Pharmacokinetics; Propofol; Propofol Glucuronide; Urine

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Introduction

Propofol (2,6-diisopropylphenol; Diprivan®, AstraZeneca Pharmaceuticals) is a fast-acting, short-duration, hypnotic agent that is administered intravenously for the induction and maintenance of general anesthesia. With a quick recovery time following induction and minimal side effects, propofol has become the most widely used compound for intravenously administered general anesthesia. Propofol rapidly enters the Central Nervous System, very smoothly induces unconsciousness, and undergoes

swift metabolic clearance. The highly lipophilic nature of propofol results in storage and slow release from deep tissue depots such as fat deposits and muscle tissues.

Although not traditionally seen as a drug of abuse, non-procedural misuse of propofol by anesthesiology and surgical healthcare professionals with direct access to the

compound has become a cause for concern. Propofol abuse among healthcare professionals increased five-fold from 1997 to 2011, and despite a low incidence of abuse among anesthesia-based providers (0.10%), the rate of fatality due to abuse is high (28%). The fatality hazard of propofol abuse owes in great part to the compound’s extremely narrow window of safety resulting from the rapid onset of unconsciousness during administration. The small difference between a therapeutic dose and a potentially hazardous dose that can cause acute respiratory depression creates a very real risk of fatal overdose if the drug is self-administered. Propofol is not scheduled with the US Drug Enforcement Administration and 71% of surveyed anesthesia programs have no control system in place to secure and account for propofol supplies.

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Published by: United States Drug Testing Laboratories on 01-Oct-2013
https://www.usdtl.com/media/articles/long-term-detection-of-propofol-glucuronide-in-urine-following-anesthetic-induction-and-maintenance-with-propofol

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