A study on fentanyl concentration in exhaled breath of premature infants admitted to neonatal intensive care unit of Alzahra Hospital in Tabriz

Abstract

Introduction: The free (unbound) fentanyl is responsible for pharmacological effect; however, generally total concentrations are measured for therapeutic drug monitoring (TDM) purposes. Measurement of free concentration of fentanyl can lead to reduction of prescribed dose, reduce side effects and increase its efficiency. So, any attempt to predict free drug concentration in pharmaceutical research will be important. The drug excreted in the exhaled air, can indicate the free concentration of the drug, in this case the use of fentanyl exhalation concentration can be helpful in estimating the free plasma concentration of the drug.Objective: Measurement of fentanyl in Exhaled Breath Condensate and its association with starting rate and deterioration of clinical symptoms.Methods: This study was a pilot study that was conducted in 32 patients under mechanical ventilation in Alzahra Hospital, Tabriz, Iran. The EBC samples were collected by using a ventilator water trap system. then, EBC samples analyzed with LC-MS/MS. all patients’ demographic, clinical and para-clinical data were recorded in the designed checklist and the association between fentanyl concentration with starting rate and deterioration of clinical symptoms was performed.Results: In this work, the calibration graph in determination of fentanyl Under the planned method provided a good linearity in the range of 5–10000 ng L−1 and good repeatability with % RSD 4.1%. The results of comparison variables with fentanyl concentration showed that the correlation fentanyl concentration with mean dose (p = 0.257), cumulative dose (p = 0.314), RDS grade (p = 0.24), BPD (p = 0.965) and ROP (p=0.701). The results of analysis presented, the fentanyl concentration was not associated well with age, hospitalization and vital signs.Conclusion: Measured fentanyl concentration in EBC does not correlate well with the clinical signs. There was better correlation between mortality and gestational age (p = 0.01) and birth weight (p = 0.001).