Authors: Zeng, Jiafa et al.
Anesthesiology 143(2): 345-356, August 2025. doi:10.1097/ALN.0000000000005531
This pilot study investigated whether pharmacometabolomic breath analysis could provide real-time monitoring of propofol exposure and associated metabolic changes in pediatric patients undergoing anesthesia. Ten children (median age 5.9 years) contributed 47 breath samples and 37 blood samples, which were analyzed using high-resolution mass spectrometry.
The results showed that propofol, its metabolites, and several endogenous compounds were detectable in exhaled breath, with strong correlations between exhaled markers and serum propofol concentrations. Differential metabolomic analysis revealed significant upregulation of fatty aldehydes after induction, consistent with lipid peroxidation and oxidative stress. Exogenous compounds linked to propofol metabolism were also identified.
The study demonstrates the feasibility of using exhaled-breath analysis to track anesthetic levels and detect surgery-related metabolic stress, though larger studies are needed before clinical application.
What you should know:
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Propofol and its metabolites can be reliably detected in exhaled breath.
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Breath-based measurements correlated strongly with serum propofol concentrations.
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Metabolomic shifts after induction indicated oxidative stress, including lipid peroxidation.
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This method may provide real-time, noninvasive monitoring of anesthetic depth and metabolic stress.
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Larger validation studies are required before integration into perioperative care.
Editor’s Perspective
What We Already Know about This Topic
- During total IV anesthesia with propofol, direct blood concentration measurement is not routinely achievable, and thus, clinicians rely on surrogate measures such as predicted effect-site concentrations or Bispectral Index
- Breath analysis by secondary electrospray ionization–high-resolution mass spectrometry is emerging as a noninvasive metabolomics technique that may be applicable to clinical contexts
What This Article Tells Us That Is New
- This pilot study in children having propofol-based anesthesia found that on-site secondary electrospray ionization–high-resolution mass spectrometry breath pharmacometabolomics can capture robust correlations between exhaled signals and serum propofol concentrations while revealing significant metabolic shifts likely linked to oxidative stress
Thank you to Anesthesiology for publishing this innovative study on breath-based monitoring of anesthetic pharmacology.