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Release of S(+) enantiomers in breath samples after anaesthesia with isoflurane racemate

Published online by Cambridge University Press:  23 December 2004

H. A. Haeberle ,
H. G. Wahl ,
G. Aigner ,
K. Unertl  and
H.-J. Dieterich
H. A. Haeberle
Affiliation:
Tuebingen University Hospital, Department of Anaesthesiology and Intensive Care Medicine, Tuebingen, Germany
H. G. Wahl
Affiliation:
Philipps University Marburg, Department of Clinical Chemistry and Molecular Diagnostics, Marburg, Germany
G. Aigner
Affiliation:
Tuebingen University Hospital, Department of Anaesthesiology and Intensive Care Medicine, Tuebingen, Germany
K. Unertl
Affiliation:
Tuebingen University Hospital, Department of Anaesthesiology and Intensive Care Medicine, Tuebingen, Germany
H.-J. Dieterich
Affiliation:
Tuebingen University Hospital, Department of Anaesthesiology and Intensive Care Medicine, Tuebingen, Germany
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Abstract

Summary

Background and objective: Isoflurane is a chiral volatile anaesthetic, routinely administered as racemate. It has a low metabolic rate and is mostly eliminated via respiration. In blood samples, S(+) enantiomers are found in greater proportion in the days immediately after administration of isoflurane racemate whereas the ratio in breath samples is unknown.

Methods: Breath and blood samples were drawn immediately after recovery and daily up to 19 days after operation from patients undergoing anaesthesia with isoflurane racemate. The percentage of isoflurane enantiomer was determined by gas chromatography mass spectrometry in blood and thermodesorption gas chromatography mass spectrometry in breath samples.

Results: In breath samples, there were significant differences in S(+) enantiomers at all time points compared to the racemate. During the early postoperative phase, the percentage of S(+) enantiomers were significantly enhanced whereas 5 days after surgery predominantly R(−) enantiomers (50.41%) were detected in the breath samples. Also in blood samples a statistical significant accumulation of the S(+) enantiomer was noted between days 1 and 5 compared to isoflurane racemate blood control. S(+) enantiomers were significantly higher in blood compared to breath samples and was most evident on the third day after surgery (51.43%).

Conclusions: During the first days after application of isoflurane racemate, the percentage of S(+) enantiomers are higher in breath and blood samples of patients. We suggest that resorbtion and/or redistribution of enantiomers are responsible for the different kinetics of isoflurane enantiomers.

Keywords

ANAESTHETICS, INHALATION, isofluraneISOMERISM, stereoisomerism
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 21 , Issue 2 , February 2004 , pp. 144 - 150
Copyright
2004 European Society of Anaesthesiology

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