LC-MS/MS and GC-MS methods in propofol detection: Evaluation of the two analytical procedures.

Propofol is a short-acting hypnotic agent that is commonly used to induce and maintain anesthesia. Propofol abuse and its involvement in suicide deaths have increased in recent years, especially among healthcare personnel. An example is the suicide of a 61-year-old nurse found with a propofol drip in his left arm. We describe the postmortem concentration of propofol in various tissues (femoral and cardiac blood, bile, urine, brain, and liver) and in the drip. The toxicological analyses were performed through two analytical methods, differing in derivatization reaction and in instrumentation: silylation for gas chromatograph-mass spectrometer (GC-MS), as routinely performed in our laboratory for this kind of analyses (lower limits of quantification-LLOQ-in urine and blood: 0.3 and 5ng/ml); for liquid chromatograph-tandem mass spectrometer (LC-MS/MS) an innovative azo-coupling derivatization (LLOQ: 0.0004 and 0.1ng/ml). This latter produces an azo-derivative (molecular composition: C18H22ON2; molecular weight: 282Da) highly ionizable in electro-spray ion source, both in negative and positive ionizations. These two methods were compared to evaluate the effectiveness of this new LC-MS/MS analysis. An acidic hydrolysis (HCl 6N, 100°C, and 1h) was performed for the biological samples (1ml or 1g) irrespective of the analytical method applied. The drip content was extracted adding phosphate buffer (pH 8) and a dichloromethane/ethylacetate 8:2 (v:v) mixture. Derivatization steps were: silylation with N,O-bis(trimethylsilyl)trifluoroacetamide (BSTFA)+tetramethylammonium hydroxide (TMAH) for GC-MS; regarding LC-MS/MS, azo-coupling reaction with the aryl-diazonium salt (0-5°C, and 30min). The analyses were achieved in selected-ion monitoring for GC-MS (m/z, 235,250,73 propofol"; m/z, 252,267,27 propofol-d17) and in multiple reaction monitoring ([M-H](-): m/z 283→241,77, azo-propofol; m/z 299→251,77, azo-propofol-d17) for LC-MS/MS. Autopsy showed no significant findings. Propofol concentrations were (LC-MS/MS vs GC-MS, respectively): 15.1 vs 14.5mg/ml, drip content; 7.11 vs 6.07µg/ml, cardiac blood; 9.50 vs 7.19µg/ml, femoral blood; 0.64 vs 1.07µg/ml, bile; 0.042 vs 0.051µg/ml urine; 4.93 vs 5.89µg/g, brain; and 7.88 vs 6.80µg/g, liver. These values are comparable with the ones described in literature for death by acute propofol intoxication; the drip content is compatible with a diluted formulation of propofol available in Italy (20mg/ml injectable emulsion). The comparison shows an excellent fitting of the data (R(2): 0.9362). Toxicological results proved the cause of death as acute propofol intoxication. Furthermore, the new LC-MS/MS method showed an excellent effectiveness and reliability when compared to the routinely used GC-MS method.

Social [and health] relevance of psychotropic substances monitoring in air.

Drug abuse assessment methods based on measuring illicit substances in waste waters are consolidated. The approach of ambient air monitoring looks questionable, nonetheless it can be explored if the variables determining the drug burdens are accounted for, or suitable co-contaminants are adopted to normalize concentrations to environmental and human contours. The general approach linking the airborne drug concentrations to consumption is presented and the case of cocaine is discussed according to measurements conducted in Italy. The cocaine/nicotine concentration ratio, identified as the most suitable tool, fitted well with anti-drug Police operations and people noticed for drug-related crimes, and with the abuse prevalence estimated in the cities investigated. According to that, the conversion factors of drug concentrations into prevalence estimates seem assessable, provided sufficient databases over space and time are collected. Further investigations are necessary to understand if airborne drugs cause adverse sanitary effects.

UHPLC-ESI-MS/MS method for direct analysis of drugs of abuse in oral fluid for DUID assessment.

An ultra-high-performance liquid chromatography-electrospray ionization-tandem mass spectrometry method for the direct analysis in oral fluid (OF) of several abused drugs and metabolites in a single chromatographic run was set up and validated. Amphetamine, methamphetamine, morphine, O-6-monoacetylmorphine, cocaine, codeine, methylenedioxymethamphetamine (MDMA), methylenedioxyethylamphetamine, methylenedioxyamphetamine, methadone, benzoylecgonine (BEG), Δ9-tetrahydrocannabinol (THC), ketamine, and cocaethylene were determined in a single chromatographic run with no sample pretreatment, after addition of the respective deuterated internal standards. The method was designed to perform a confirmation analysis on the residual OF samples after the preliminary on-site screening test, and it was applied on preservative buffers from different devices (Mavand Rapidstat, Concateno DDS, and Greiner Bio-One) or on neat OF samples. The method was suitable to be applied to the small amounts of sample available for the confirmatory analysis after the preliminary on-site screening or on undiluted OF samples. Limits of detection varied from 5 (morphine) to 0.2 ng/mL (methamphetamine, MDMA, BEG, and cocaethylene). The method was linear for all the substances involved, giving quadratic correlation coefficients of >0.99 in all the different preservative buffers checked. In addition, repeatability and accuracy were satisfactory for the majority of the substances, except for a few cases. The developed method was subsequently applied to 466 residual samples from on-site screening performed by police officers. Of these samples, 74 showed the presence of cocaine and metabolites; THC was detected in 49 samples. Two samples showed codeine and morphine while MDMA was detected in 11 samples and ketamine in four samples.

Italian survey of organizational functioning and readiness for change: a cross-cultural transfer of treatment assessment strategies.

To better understand why some drug abuse treatment programs are more effective than others, USA research about organizational functioning and its role in the provision of treatment services was extended through a study of a delivery system in another country. The Texas Christian University (TCU) organizational functioning and readiness for change instrument (ORC) was translated into Italian and administered to 405 treatment program directors and staff from both public and private sectors in the Veneto Region of Northern Italy. Results indicated that the psychometric properties of the ORC in the USA and Italy are consistent. Some general differences in staff attributes were found between USA and Italian programs, but organizational climates were remarkably similar.