Restraint-related asphyxia on the basis of a drug-induced excited delirium

Kunz, Sebastian; Þórðardóttir, S.; Rúnarsdóttir, R.

doi:10.1016/j.forsciint.2018.04.051

Cited by 9 publications

(2 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The EDS was first described as the sudden, unexpected death of people restrained by law enforcement officers [47] (in particular, positional holds are the restraints most frequently associated with sudden death in susceptible people with excited delirium) [48]. Frequently, the subjects tend to display signs of agitation, aggressiveness and hyperactivity prior to the exitus [49].…”

Section: Aggressionmentioning

confidence: 99%

Worsening of the Toxic Effects of (±)Cis-4,4′-DMAR Following Its Co-Administration with (±)Trans-4,4′-DMAR: Neuro-Behavioural, Physiological, Immunohistochemical and Metabolic Studies in Mice

Tirri

Frisoni

Bilel

et al. 2021

IJMS

View full text Add to dashboard Cite

4,4’-Dimethylaminorex (4,4’-DMAR) is a new synthetic stimulant, and only a little information has been made available so far regarding its pharmaco-toxicological effects. The aim of this study was to investigate the effects of the systemic administration of both the single (±)cis (0.1–60 mg/kg) and (±)trans (30 and 60 mg/kg) stereoisomers and their co-administration (e.g., (±)cis at 1, 10 or 60 mg/kg + (±)trans at 30 mg/kg) in mice. Moreover, we investigated the effect of 4,4′-DMAR on the expression of markers of oxidative/nitrosative stress (8-OHdG, iNOS, NT and NOX2), apoptosis (Smac/DIABLO and NF-κB), and heat shock proteins (HSP27, HSP70, HSP90) in the cerebral cortex. Our study demonstrated that the (±)cis stereoisomer dose-dependently induced psychomotor agitation, sweating, salivation, hyperthermia, stimulated aggression, convulsions and death. Conversely, the (±)trans stereoisomer was ineffective whilst the stereoisomers’ co-administration resulted in a worsening of the toxic (±)cis stereoisomer effects. This trend of responses was confirmed by immunohistochemical analysis on the cortex. Finally, we investigated the potentially toxic effects of stereoisomer co-administration by studying urinary excretion. The excretion study showed that the (±)trans stereoisomer reduced the metabolism of the (±)cis form and increased its amount in the urine, possibly reflecting its increased plasma levels and, therefore, the worsening of its toxicity.

show abstract

Section: Aggressionmentioning

confidence: 99%

Worsening of the Toxic Effects of (±)Cis-4,4′-DMAR Following Its Co-Administration with (±)Trans-4,4′-DMAR: Neuro-Behavioural, Physiological, Immunohistochemical and Metabolic Studies in Mice

Tirri

Frisoni

Bilel

et al. 2021

IJMS

View full text Add to dashboard Cite

show abstract

“…Deaths have been reported during physical restraint of agitated individuals held in the prone (facedown) position, as detailed in case reports, case series, and inquests. 1–13 However, the actual physiologic cause of death in these circumstances remains uncertain. There is currently controversy regarding the role of positional asphyxia as the primary factor underlying restraint-associated mortality.…”

Section: Introductionmentioning

confidence: 99%

Prone restraint cardiac arrest: A comprehensive review of the scientific literature and an explanation of the physiology

Steinberg

2021

Med Sci Law

View full text Add to dashboard Cite

Deaths occurring among agitated or violent individuals subjected to physical restraint have been attributed to positional asphyxia. Restraint in the prone position has been shown to alter respiratory and cardiac physiology, although this is thought not to be to the degree that would cause asphyxia in a healthy, adult individual. This comprehensive review identifies and summarizes the current scientific literature on prone position and restraint, including experiments that assess physiology on individuals restrained in a prone position. Some of these experimental approaches have attempted to replicate situations in which prone restraint would be used. Overall, most findings revealed that individuals subjected to physical prone restraint experienced a decrease in ventilation and/or cardiac output (CO) in prone restraint. Metabolic acidosis is noted with increased physical activity, in restraint-associated cardiac arrest and simulated encounters. A decrease in ventilation and CO can significantly worsen acidosis and hemodynamics. Given these findings, deaths associated with prone physical restraint are not the direct result of asphyxia but are due to cardiac arrest secondary to metabolic acidosis compounded by inadequate ventilation and reduced CO. As such, the cause of death in these circumstances would be more aptly referred to as “prone restraint cardiac arrest” as opposed to “restraint asphyxia” or “positional asphyxia.”

show abstract