Lethal self-administration of propofol and atracurium.
anesthetics
atracurium
fatalities
intoxication
propofol
suicide
Journal
Journal of forensic sciences
ISSN: 1556-4029
Titre abrégé: J Forensic Sci
Pays: United States
ID NLM: 0375370
Informations de publication
Date de publication:
Mar 2022
Mar 2022
Historique:
revised:
14
09
2021
received:
02
06
2021
accepted:
14
09
2021
pubmed:
30
9
2021
medline:
7
4
2022
entrez:
29
9
2021
Statut:
ppublish
Résumé
Acute propofol intoxications appear rare and remain primarily related to the acquisition of the material from the hospital. In this study, two cases of suicide following self-administration of a propofol-atracurium combination are presented as well as other propofol-related fatalities, in order to investigate propofol postmortem blood concentrations and circumstances surrounding death. The two case studies involved a 48-years-old male and a 61-year-old female, both anesthesiologists, who were found unresponsive with drugs (propofol, atracurium for both, and cisatracurium for one of them) discovered at the scene. Toxicological analyses were performed using validated chromatographic methods and highlighted the presence of propofol (1.0 µg/ml), laudanosine (0.2 µg/ml), paroxetine (3.4 µg/ml), and ethanol (12 mg/dl) for the first case and propofol (1.9 µg/ml), laudanosine (1.2 µg/ml), and hydroxyzine (0.03 µg/ml) for the second case. In the literature, 14 publications describing 27 cases of propofol-related lethal intoxications were identified. Except for two cases, all these fatalities involved healthcare professionals. Accidental overdose was the most frequently reported manner of death and the reported propofol blood concentrations ranged from 0.026 to 223.8 µg/ml. These cases, in agreement with other reported cases, highlight the concerns related to the misuse of hospital-based medicines, especially by health-care professionals, and so, the need for a much more stringent internal control of such drugs.
Identifiants
pubmed: 34586645
doi: 10.1111/1556-4029.14903
doi:
Substances chimiques
Atracurium
2GQ1IRY63P
Propofol
YI7VU623SF
Types de publication
Case Reports
Langues
eng
Sous-ensembles de citation
IM
Pagination
827-831Informations de copyright
© 2021 American Academy of Forensic Sciences.
Références
Marik P. Propofol: therapeutic indications and side-effects. Curr Pharm Des. 2004;10(29):3639-49. https://doi.org/10.2174/1381612043382846.
Raoof AA, Augustijns PF, Verbeeck RK. In vivo assessment of intestinal, hepatic, and pulmonary first pass metabolism of propofol in the rat. Pharm Res. 1996;13(6):891-5. https://doi.org/10.1023/a:1016057229478.
Wilson C, Canning P, Caravati EM. The abuse potential of propofol. Clin Toxicol (Phila). 2010;48(3):165-70. https://doi.org/10.3109/15563651003757954.
Roussin A, Montastruc J-L, Lapeyre-Mestre M. Pharmacological and clinical evidences on the potential for abuse and dependence of propofol: a review of the literature. Fundam Clin Pharmacol. 2007;21(5):459-66. https://doi.org/10.1111/j.1472-8206.2007.00497.x.
Colin JN, Singlas E. Metabolism and pharmacokinetics of atracurium. Ann Fr Anesth Reanim. 1985;4(6):465-70. https://doi.org/10.1016/S0750-7658(85)80242-2.
Drevin G, Picard N, Jousset N, Briet M, Abbara C. Pitfalls and challenges associated with phenoconversion in forensic toxicology. Forensic Sci Int Genet. 2021;51:102433. https://doi.org/10.1016/j.fsigen.2020.102433.
U.S. Food and Drug Administration. Guidance for industry: bioanalytical method validation. 2018. https://www.fda.gov/files/drugs/published/Bioanalytical-Method-Validation-Guidance-for-Industry.pdf. Accessed 24 May 2018.
Kirby RR, Colaw JM, Douglas MM. Death from propofol: accident, suicide, or murder? Anesth Analg. 2009;108(4):1182-4. https://doi.org/10.1213/ane.0b013e318198d45e.
Cirimele V, Kintz P, Doray S, Ludes B. Determination of chronic abuse of the anaesthetic agents midazolam and propofol as demonstrated by hair analysis. Int J Legal Med. 2002;116(1):54-7. https://doi.org/10.1007/s0041401002400.
Iwersen-Bergmann S, Rosner P, Kuhnau HC, Junge M, Schmoldt A. Death after excessive propofol abuse. Int J Legal Med. 2001;114(4-5):248-51. https://doi.org/10.1007/s0041499001299.
Roussin A, Mirepoix M, Lassabe G, Dumestre-Toulet V, Gardette V, Montastruc J-L, et al. Death related to a recreational abuse of propofol at therapeutic dose range. Br J Anaesth. 2009;97(2):268. https://doi.org/10.1093/bja/ael168.
Strehler M, Preuss J, Wollersen H, Madea B. Lethal mixed intoxication with propofol in a medial layman. Arch Kriminol. 2006;217(5-6):153-60.
Kranioti EF, Mavroforou A, Mylonakis P, Michalodimitrakis M. Lethal self administration of propofol (Diprivan). Forensic Sci Int. 2007;167(1):56-8. https://doi.org/10.1016/j.forsciint.2005.12.027.
Drummer OH. A fatality due to propofol poisoning. J Forensic Sci. 1992;37(4):1186-9.
Chao TC, Lo DST, Chui PPS, Koh TH. The first fatal 2,6-di-isopropylphenol (propofol) poisoning in Singapore: a case report. Forensic Sci Int. 1994;66(1):1-7. https://doi.org/10.1016/0379-0738(94)90314-x.
Klausz G, Róna K, Kristóf I, Törő K. Evaluation of a fatal propofol intoxication due to self administration. J Forensic Leg Med. 2009;16(5):287-9. https://doi.org/10.1016/j.jflm.2008.12.010.
Aknouche F, Guibert E, Tessier A, Larcher O, Kintz P. Suicide of a nurse in a hospital environment involving anesthetic drugs. ToxAC. 2016;28(2):134-8. https://doi.org/10.1016/j.toxac.2015.03.042.
Hikiji W, Kudo K, Usumoto Y, Tsuji A, Ikeda N. A Simple and sensitive method for the determination of propofol in human solid tissues by gas chromatography-mass spectrometry. J Anal Toxicol. 2010;34(7):389-93. https://doi.org/10.1093/jat/34.7.389.
Procaccianti P, Farè F, Argo A, Casagni E, Arnoldi S, Facheris S, et al. Determination of propofol by GC/MS and fast GC/MS-TOF in two cases of poisoning. J Anal Toxicol. 2017;41(9):771-6. https://doi.org/10.1093/jat/bkx056.
Mannocchi G, Napoleoni F, Napoletano S, Pantano F, Santoni M, Tittarelli R, et al. Fatal self administration of tramadol and propofol: a case report. J Forensic Leg Med. 2013;20(6):715-9. https://doi.org/10.1016/j.jflm.2013.04.003.
Han E, Jung S, Baeck S, Lee S, Chung H. Deaths from recreational use of propofol in Korea. Forensic Sci Int. 2013;233(1-3):333-7. https://doi.org/10.1016/j.forsciint.2013.10.008.
Levy RJ. Clinical effects and lethal and forensic aspects of propofol. J Forensic Sci. 2011;56(1):S142-47. https://doi.org/10.1111/j.1556-4029.2010.01583.x.
Kent EA, Bacon DR, Harrison P, Lema MJ. Sexual illusions and propofol sedation. Anesthesiology. 1992;77(5):1037-8. https://doi.org/10.1097/00000542-199211000-0003.
Schulz M, Schmoldt A, Andresen-Streichert H, Iwersen-Bergmann S. Revisited: therapeutic and toxic blood concentrations of more than 1100 drugs and other xenobiotics. Crit Care. 2020;24(1):195. https://doi.org/10.1186/s13054-020-02915-5.
George AA, Hargrove VM, Molina DK. Postmortem propofol levels: a case of residual detection long after administration. Am J Forensic Med Pathol. 2016;37(1):4-6. https://doi.org/10.1097/PAF.0000000000000209.