Elimination characteristics of post-operative isoflurane levels in alveolar exhaled breath via PTR-MS analysis

Isoflurane (1-chloro-2,2,2-trifluoroethyl difluoromethyl ether), C3H2ClF5O, is a commonly used
inhalation anaesthetic. Using a proton transfer reaction mass spectrometer (PTR-MS) we have
detected isoflurane in the breath of patients several weeks following major surgery. That isoflurane
is detected in the breath of patients so long after being anaesthetised raises questions about when
cognitive function has fully returned to a patient. Temporal profiles of isoflurane concentrations in
breath are presented for five patients (F/M 3/2, mean age 50 years, min–max 36–58 years) who had
undergone liver transplant surgery. In addition, results from a headspace analysis of isoflurane are
presented so that the product ions resulting from the reactions of H3O+ with isoflurane in PTRMS
could be easily identified in the absence of the complex chemical environment of breath. Six
product ions were identified. In order of increasing m/z (using the 35Cl isotope where appropriate)
these are CHF+2 (m/z 51), CHFCl+ (m/z 67), CF3CHCl+ (m/z 117), C3F4OCl+ (m/z 163),
C3H2F4OCl+ (m/z 165), and C3F4OCl+ H2O (m/z 183). No protonated parent was detected. For the
headspace study both clean air and CO2 enriched clean air (4% CO2) were used as buffer gases in
the drift tube of the PTR-MS. The CO2 enriched air was used to determine if exhaled breath would
affect the product ion branching ratios. Importantly no significant differences were observed, and
therefore for isoflurane the product ion distributions determined in a normal air mixture can be
used for breath analysis. Given that PTR-MS can be operated under different reduced electric fields
(E/N), the dependence of the product ion branching percentages for isoflurane on E/N (96–138 Td)
are reported.