title: [Brain death diagnosis after sedation with propofol or sufentanil. Recommendations for the usage of toxicological analytics].
abstract: BACKGROUND
  Before the clinical diagnosis of brain death is made, toxicological analyses are often performed for the exclusion of effective serum levels of previously applied sedating drugs. For propofol and sufentanil there are no uniform recommendations for the usage of toxicology test results.
  
  
  OBJECTIVE
  To develop a standard practice in the diagnosis of brain death after therapeutic application of one of these drugs.
  
  
  METHODS
  Based on the current literature and the available analytical assays, an ad hoc working group consisting of specialists in toxicology and intensive care medicine compiled recommendations for the usage of toxicological analytics in the diagnosis of brain death at the Rostock University Hospital.
  
  
  RESULTS
  For propofol, current analytical assays allow the quantification of serum concentrations of 0.2 μg/ml and lower; the execution of clinical brain death diagnostics is recommended by the ad hoc group only at propofol serum levels lower than  0.4 μg/ml. For sufentanil, the currently prevalent assays set lower determination limits of about 0.2 ng/ml in serum and 0.1 ng/ml in urine, which is above the cautiously adopted lower therapeutic serum concentration of 0.02 ng/ml. Therefore after negative determination of sufentanil (< 0.2 ng/ml) in blood serum, the following alternative procedures are recommended: (1) the execution of clinical brain death diagnostics under administration of naloxone; or (2) at intact renal function the additional negative determination of sufentanil in urine (< 0.1 ng/ml). If an assay allowing the detection of sufentanil at ≤ 0.01 ng/ml is available, brain death diagnostics should be carried out only at a serum level lower than  0.02 ng/ml.
  
  
  CONCLUSIONS
  These recommendations may serve as a proposal for similar standards in other hospitals.
authors.affiliation: Klinik und Poliklinik für Neurologie, Universitätsmedizin Rostock, Gehlsheimer Str. 20, 18147, Rostock, Deutschland, uwe.walter@med.uni-rostock.de.
authors.forename: U
authors.initials: U
authors.lastname: Walter
authors.forename: U
authors.initials: U
authors.lastname: Brüderlein
authors.forename: M
authors.initials: M
authors.lastname: Gloger
authors.forename: S
authors.initials: S
authors.lastname: Mann
authors.forename: U
authors.initials: U
authors.lastname: Walther
mesh_terms: D001926:Brain Death / Q000097:blood / Q000175:diagnosis*; D004305:Dose-Response Relationship, Drug; D019983:Guideline Adherence; D006801:Humans; D008657:Metabolic Clearance Rate / Q000502:physiology; D009270:Naloxone / Q000493:pharmacokinetics / Q000627:therapeutic use; D015742:Propofol / Q000493:pharmacokinetics* / Q000627:therapeutic use* / Q000633:toxicity; D012680:Sensitivity and Specificity; D017409:Sufentanil / Q000493:pharmacokinetics* / Q000627:therapeutic use* / Q000633:toxicity
chemical_list: D009270:Naloxone; D017409:Sufentanil; D015742:Propofol