TY  - JOUR
PY  - 2016//
TI  - Suicide of a nurse in a hospital environment involving anesthetic drugs
JO  - Toxicologie analytique et clinique
A1  - Aknouche, Frédéric
A1  - Guibert, Emilie
A1  - Tessier, Alison
A1  - Larcher, Olivier
A1  - Kintz, Pascal
SP  - 134
EP  - 138
VL  - 28
IS  - 2
N2  - In a medical environment, a postmortem toxicological analysis can be difficult to achieve when the deceased is part of the medical staff. Numerous anesthetic drugs can be used to commit suicide and there is a need to implement a specific strategy, particularly when the amount of specimens is limited. After a nurse was found dead, a complete strategy devoted to the identification of medicinal agents used in anaesthesia was developed, taking into consideration her profession and potential access to various controlled substances, a complete strategy devoted to the identification of medicinal agents used in anesthesia was organized. A general screening of the blood was achieved by liquid chromatography on a column C18 ACQUITY HSS after alkaline extraction by a mixture of dichloromethane/isopropanol/n-heptane (25/10/65, v/v/v) and detection by a tandem mass spectrometry (UPLC-Quattro Micro WATERS). The identification and the quantification of propofol was made after introduction to a Head-Space technique followed by a separation on a DB-WAW column (30 m × 0.25 mm) and a detection by mass spectrometry on a FocusGC + DSQII (Thermo). After an initial screening of curare by LC-MS/MS (extraction by ions pairing), laudanosine was simultaneously identified by LC-DAD on a Symmetry® C8 column and quantified by gas chromatography coupled with mass spectrometry after separation on a HP5MS capillary column. The forensic investigations performed on postmortem peripheral blood identified the simultaneous presence of midazolam at 32.8 μg/mL, amiodarone at 238 μg/mL, propofol at 223 μg/mL, and finally laudanosine (the circulating form of atracurium or cisatracurium) at 915 ng/mL. Tests for other drugs and ethyl alcohol were negative. All the concentrations of the compounds found in the blood of Miss P. were well above the usual therapeutic concentrations. Each concentration can be considered as potentially fatal. This multi-drug intoxication has probably produced a coma, complicated by respiratory failure and cardiovascular collapse (hypotension, cardiogenic shock) leading to the death of Miss P. The discussion emerging from this case report focusses on the characteristics of the used molecules in anaesthesiology and emergency services, their availability, and regulation and finally on their consumption patterns.<p />  <p>Language: fr</p>
LA  - fr
SN  - 2352-0078
UR  - http://dx.doi.org/10.1016/j.toxac.2016.02.001
ID  - ref1
ER  -