Sevoflurane Intoxication: A Fatal Suicide
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Keywords

Sevoflurane
volatile anesthetic
suicide
toxicology
forensic medicine

Abstract

A 20-year-old female anesthesia technichian student was found dead lying on her back in dormitory room. The crime scene investigator reported that there was a 250 mL bottle labeled “sevorane liquid” on the table. During the autopsy, no traumatic injuries were found that could have caused the death. Histopathological evaluation of internal organs revealed focal areas of atelectasis and congestion in the lungs, autolysis and congestion in the pancreas, and congestion liver, heart, kidney, brain. Screening for drugs and their metabolites was conducted in blood, urine, and internal organs using enzyme immunoassays along with gas chromatography-mass spectrometry. Sevoflurane was identified and quantified using headspace gas chromatography, indicating a concentration of 41.0 µg/ mL in the blood. This substance was also confirmed in the gastric content through GC/MS analysis. It was reported that the death of the person occurred as a result of ingestion of sevoflurane and accompanying complications.

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References

Alanoglu Z, Güclü Yildirim C, Bermede AO, Alkis N. What is the Difference Between Different Sevoflurane Products?. Anestezi Journal 2012; 20(4): 189–95.

Seymour C, Shaner RL, Feyereisen MC, Wharton RE, Kaplan P, Hamelin EI, et al. Determination of fentanyl analog exposure using dried blood spots with LC-MS-MS. J Anal Toxicol. 2019; 43(4): 266–76. DOI: 10.1093/jat/bky096.

De Hert S, Moerman A. Sevoflurane. F1000Research 2015; 4:1–8. DOI: 10.12688/f1000research.6288.1.

Behne M, Wilke H, Harder S. Clinical pharmacokinetics of Sevoflurane. Clin Pharmacokinet 1999; 36(1): 13–26. DOI: 10.2165/00003088-199936010-00002.

Spencer JAE, Green NM. Suicide by Ingestion of Halothane. JAMA J Am Med Assoc 1968; 205(10): 702–3.

Spencer JD, Raasch FO, Trefny FA. Halothane Abuse in Hospital Personnel. Surv Anesthesiol 1976; 20(6): 573

Pavlic M, Haidekker A, Grubwieser P, Rabl W. Fatal accident caused by isoflurane abuse. Int J Legal Med 2002; 116 (6): 357–60. DOI: 10.1007/s00414-002-0340-9.

Levine B, Cox D, Jufer-Phipps RA, Li N, Jacobs A, Fowler D. A fatality from sevoflurane abuse. J Anal Toxicol 2007;31(8): 534–6. DOI: 10.1093/jat/31.8.534.

Burrows DL, Nicolaides A, Stephens GC, Ferslew KE (2004) The distribution of sevoflurane in a sevoflurane induced death. J Forensic Sci 2004; 49(2):394-7.

Pihlainen K, Ojanperä I. Analytical toxicology of fluorinated inhalation anaesthetics. Forensic Sci Int 1998; 97 (2–3): 117–33. DOI: 10.1016/s0379-0738(98)00148-0.

Rosales CM, Young T, Laster MJ, Eger EI, Garg U. Sevoflurane concentrations in blood, brain, and lung after sevoflurane-induced death. J Forensic Sci 2007; 52(6): 1408–10. DOI: 10.1111/j.1556-4029.2007.00556.x

Baselt RC. Disposition of Toxic Drugs and Chemicals in Man, 9th ed.,Biomedical Publications, Seal Beach, CA, USA, 2011.

Biricik E, Karacaer F, Güneş Y, Dağlıoğlu N, Efeoğlu P, Ilgınel M, et al. Effect of One-Lung Ventilation on Blood Sevoflurane and Desflurane Concentrations. J Cardiothorac Vasc Anesth 2019; .33(2): 442–9. DOI: 10.1053/j.jvca.2018.05.03

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