Clinical Effects and Lethal and Forensic Aspects of Propofol*

Abstract

Propofol is a potent intravenous anesthetic agent that rapidly induces sedation and unconsciousness. The potential for propofol dependency, recreational use and abuse has only recently been recognized and several cases of accidental overdose and suicide have emerged. In addition, the first documented case of murder using propofol was reported a few months ago and a high profile case of suspected homicide with propofol is currently under investigation. A number of analytical methods have been employed to detect and quantify propofol concentrations in biological specimens. The reported propofol related deaths and post-mortem blood and tissue levels are reviewed. Importantly, limitations of propofol detection are discussed and future considerations are presented. Because propofol has the potential for diversion with lethal consequences, the forensic scientist must have a basic understanding of its clinical indications and uses, pharmacologic properties, and detection methods. In addition, medical institutions should develop systems to prevent and detect diversion of this potential drug of abuse.

Safety Aspects of Deep Sedation during Catheter Ablation of Atrial Fibrillation

“…the United States) the use of propofol is restricted to specific departments. In many hospitals, propofol can only be administered by anesthesiologists 25 . The guideline for sedation and anesthesia in gastrointestinal endoscopy published in 2008 by the American Society for Gastrointestinal Endoscopy (ASGE) questions the restriction of propofol to anesthesiologists and supports the use of propofol by gastroenterologists, because propofol has been shown to be safe for endoscopic sedation 24 .…”

A murder disguised as a medical accident: A case report of homicidal poisoning of three anesthetics

“…A 24-year-old woman, who asked an acquaintance to release her headache, was injected with lethal dose of propofol. The lot numbers on the vials helped the police investigators to find the suspect, a male ICU (intensive care unit) nurse [12]. Similarly, the offender in our case was a person with anesthetic knowledge and access to anesthetics.…”

Determination of propofol glucuronide from hair sample by using mixed mode anion exchange cartridge and liquid chromatography tandem mass spectrometry

“…During 2000-2011, the National Forensic Service (NFS) of Korea reported 36 propofol related fatal cases in South Korea-20 cases of suicidal or accidental death of medical staffs and 16 cases of medical accident at normal therapeutic dosage. The report raises the level of precaution to be undertaken with the use of propofol [8,11]. Technically, it also alerts the need of highly sensitive analytical methods, for evaluating the metabolism of propofol and its forensic application.…”