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. 2025 May 24;25(1):265.
doi: 10.1186/s12871-025-03140-9.

Association of exhaled breath volatile organic compounds with surgical traumatic stress

Qifeng Wang #  1   2 , Yuyi Zhao #  1 , Shikuo Li  1   3 , Xuehan Li  1 , Haiyan Wang  1   4 , Yunxia Zuo  5   6
Affiliations

Association of exhaled breath volatile organic compounds with surgical traumatic stress

Qifeng Wang et al. BMC Anesthesiol. .

Abstract

Purpose: This study explored the association of surgical traumatic stress with volatile organic compounds (VOCs) in breath.

Methods: Exhaled breath and blood samples were collected from 105 patients under general anesthesia at three time points: prior to incision (Pre-op), 2 h after incision (Intra-op), and prior to extubation (End-op). Differential mass spectral features between these time points were screened. Traumatic stress-related biomarker detection and mixed-effects model analysis were performed to define correlations and significance between parameters. Subgroup analysis was conducted to test the ability of mass spectral features to distinguish different surgical routes (open vs. laparoscopic).

Results: The abundances of mass spectral features changed significantly between these time points. All stress-related biomarker increased dramatically in the Intra-op group and decreased significantly after operation. Mixed-effects model analysis revealed that several features were significantly correlated with stress biomarkers. Most importantly, subgroup analysis revealed that different surgical routes failed to be distinguished by mass spectral features.

Conclusion: Surgical traumatic stress may change the exhaled breath mass spectral features in perioperative patients, providing preliminary evidence for mass spectral features use in future monitoring of this stress response.

Keywords: Exhaled breath; General anesthesia; Surgical traumatic stress; Volatile organic compounds.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was performed per the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of West China Hospital of Sichuan University (Chengdu, China) on June 2, 2022. Informed consent was obtained from all individual participants included in the study. Consent for publication: Not applicable. Competing interests: A Chinese patent based on this study is under review. The authors have no other relevant financial or non-financial interests to disclose.

Figures

Fig. 1
Fig. 1
Flow chart of patient inclusion and analysis. VOCs, volatile organic compounds
Fig. 2
Fig. 2
The capability of exhaled breath mass spectral features to distinguish surgical traumatic stress levels at different time points. a, d OPLS-DA plots between the Pre-op and Intra-op groups (a), and between the Intra-op and End-op groups. n = 105 per group (d). b, e Plots of the permutation test for the above two models, respectively. c, f Volcano plots of altered features between the Pre-op and Intra-op comparison groups (c) and between the Intra-op and End-op comparison groups (f). g Relative abundance of the 25 commonly changed mass spectral features in breath between groups Pre-op, Intra-op, and End-op, Longitudinal axis represents feature abundance. Pre-op: preoperative, Intra-op: intraoperative, End-op: postoperative. m/z, mass to charge ratio
Fig. 3
Fig. 3
Changes of clinical signs and traumatic stress-related markers. a-h SpO2 (a), systolic blood pressure (b), diastolic blood pressure (c), mean arterial pressure (d), pulse rate (e), heart rate (f), patient status index (g), PETCO2 (h). i-k Plasma levels of norepinephrine (i), epinephrine (j), and cortisol (k) in patients subjected to surgical traumatic stress. ** P < 0.01, **** P < 0.0001, vs. Pre-op; ### P < 0.001, #### P < 0.0001, vs. Intra-op. n = 105 per group. Pre-op: preoperative, Intra-op: intraoperative, End-op: postoperative
Fig. 4
Fig. 4
Subgroup analysis between different surgery types. a OPLS-DA plot between open vs. laparoscopy-guided group. n = 45 for laparoscopy-guided group, n = 60 for open group. b Permutation test for OPLS-DA model
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