Validation of an analytical method for nitrous oxide (N2O) laughing gas by headspace gas chromatography coupled to mass spectrometry (HS-GC–MS): Forensic application to a lethal intoxication

Giuliani, N.; Beyer, Jonny; Augsburger, Marc; Varlet, Vincent

doi:10.1016/j.jchromb.2014.12.034

Cited by 18 publications

(8 citation statements)

References 25 publications

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“…N2O does not cause major respiratory depression but will inhibit the normal physiological response to hypoxia at high concentrations (> 50%) due to oxygen depletion (Jay 2008;Wagner et al 1992;Winek et al 1995;Giuliani et al 2015).…”

Section: Discussionmentioning

confidence: 99%

“…The complications of acute nitrous oxide abuse are hypoxia, aspiration, cardiac arrhythmias, seizures, trauma, and pneumomediastinum (Randhawa and Bodenham 2016;Potocka-Banas et al 2016). There are also rare reports of accidental inhalation at work or incorrect administration to hospitalized patients during anesthesia (Poli et al 2010;Bonsu and Stead 1983) The toxicological studies conducted with head-space gas chromatography (Giuliani et al 2015) found abnormal amounts of N2O in all tissue (blood, urine, liver, bile, kidney, fat, and brain), highlighting that the presence of N2O could be revealed even 31 days after death.…”

Section: Discussionmentioning

confidence: 99%

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Nitrous oxide intoxication: systematic literature review and proposal of new diagnostic possibilities

Cipolloni

Stefania

2022

Egypt J Forensic Sci

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Background Nitrous oxide (N2O), also called “laughing gas,” is the most commonly used inhalation anesthetic in dentistry. The N2O is no longer used, because of the long-term neurologic and cardiovascular sequelae. Due to its sedative and euphoric properties, N2O is often used for recreational use or in some erotic activities. Accidental deaths are mainly associated with the uses of N2O: death can occur from sudden cardiac arrhythmia or, most commonly, acute asphyxiation due to hypoxia. This paper aims to study the literature concerning deaths due to N2O intoxication and highlight pathological findings useful for diagnosis when the crime scene investigation does not reveal any evidence. Materials and methods The authors conducted the literature search by PubMed and Scopus databases, searching for articles from 1 January 1970 to 1 March 2020 using the key terms: “Nitrous oxide,” “Laughing gas,” “Hypoxic damage,” “Nitrous oxide anesthesia,” and “Nitrous oxide death.” Results and discussion A total of 244 articles were collected. Only 26 articles were included in the systematic review. Most of the deaths from intoxication are due to asphyxiation; the diagnosis is often difficult and immunohistochemistry could be helpful. Nitrous oxide increases the intracellular adhesion molecule expression, E- and P-Selectin (markers of the early inflammatory response), and HIF-1 α (indicative of oxidative stress during ischemia-reperfusion). Conclusion The macroscopic and microscopic signs of N2O intoxication are non-specific, but N2O has been proven to cause hypoxic damage to the brain. The suspicion of the presence of the gas in the environment should guide the pathologist. Tissue analyzes provide important information; immunohistochemical stains can confirm hypoxic damage through the use of markers such as HIF-1 α, E-Selectin, and P-Selectin.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Nitrous oxide intoxication: systematic literature review and proposal of new diagnostic possibilities

Cipolloni

Stefania

2022

Egypt J Forensic Sci

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“…As anticipated, N 2 O, to be administered safely as an analgesic, must be mixed with an adequate percentage of O 2 and must not exceed 70%; higher doses are quickly asphyxiating [ 12 ]. Nitrous oxide at high concentrations inhibits the physiological response to hypoxia due to oxygen depletion [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Lethal nitrous oxide (N2O) intoxication during surgery: the contribution of immunohistochemistry in identifying the cause of death: a case report

Cioffi,

Cecannecchia,

Bosco

et al. 2023

J Med Case Reports

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Background Nitrous oxide (N2O) is a gas used in medicine for its analgesic, anxiolytic and amnesic properties. It is a drug considered safe if adequately administered. In the literature, accidental N2O-related deaths are rare. They are mostly related to inhalation of this substance for recreational and autoerotic purposes; rarely are reported deaths due to incorrect administration of medical gas in anesthesia. The diagnosis of death from acute N2O intoxication is complex and is generally an exclusion diagnosis: the macroscopic and microscopic post-mortem signs are entirely nonspecific. Furthermore, the circumstantial data are not always supportive and can even be confusing, mainly if the death occurred inside a hospital. Case presentation We describe a particular case of death from acute nitrous oxide poisoning in a hospital environment, of a Caucasian male of 72-years-old. The intoxication occurred during a minimally invasive vascular surgery due to an incorrect assembly of the supply lines of medical gases (O2 and N2O). The identification of the cause of death resulted from the analysis of circumstantial data, macroscopic and microscopic autoptic findings, and immunohistochemical investigations based on the search for antibodies anti E-selectin, P-selectin, and HIF 1-α. Conclusion Although not pathognomonic of asphyxiation by N2O, the latter molecules are a valid and early marker of hypoxic insult. Therefore, in concert with all other findings, it may constitute valid support for the forensic pathologist to ascertain the cause of death in case of suspected intoxication by N2O.

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“…For example, Maroufi et al (2011) used infrared‐absorption spectrometry to measure occupational N 2 O exposure in operating and recovery rooms. Giuliani et al (2015) mentioned a gas chromatography—mass spectrometry based approach to quantify gas phase N 2 O for forensic applications and Giglio et al (2018) used an advanced photoacoustic spectroscopy based sensing system for atmospheric nitrous oxide measurements. Due to their complexity, need for highly trained personnel and related costs, these technologies are not suitable for routine screening purposes by law enforcement professionals.…”

Section: Pharmacokinetics and The Detection Of Duinomentioning

confidence: 99%

The prevalence, risks, and detection of driving under the influence of nitrous oxide

Vinckenbosch,

Durán Jiménez,

Helmerhorst

et al. 2023

WIREs Forensic Science

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Nitrous oxide (N2O), colloquially known as laughing gas, is a common recreational drug of abuse. The gas is inhaled in its undiluted form from a party balloon. Its intoxicating effects are described as dissociative and euphoric, accompanied by ataxia, hypoxia, and attenuated consciousness. Therefore, the recreational use of N2O appears irreconcilable with operating a vehicle in road traffic. However, the Netherlands, one of the leading countries regarding prevalence of recreational N2O use, has seen a sharp increase in police reports of N2O‐related traffic incidents since 2016. Road traffic deaths associated with recreational N2O use have also been reported in the United Kingdom, as well as a recent increase in traffic incidents. Hence, driving under the influence of nitrous oxide (DUINO) is possibly an underreported threat to road traffic safety. Based on the limited information available at this time, the current review considers the prevalence of DUINO, its effects driving performance, and approaches to road‐side detection. It is concluded that DUINO is a potentially significant threat to road traffic safety. Although its prevalence is unclear, it is almost certain that DUINO is accompanied by severe driving impairment, based on its pharmacodynamics and documented cognitive and psychomotor effects in medical studies. The pharmacokinetic profile of N2O lends credibility to the notion that recent use can be demonstrated in breath, blood, and saliva. However, the analytical complexities of such measurements warrant elaborate research into N2O detection techniques.This article is categorized under: Toxicology > Drug‐Impaired Driving

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Validation of an analytical method for nitrous oxide (N2O) laughing gas by headspace gas chromatography coupled to mass spectrometry (HS-GC–MS): Forensic application to a lethal intoxication

Cited by 18 publications

References 25 publications

Nitrous oxide intoxication: systematic literature review and proposal of new diagnostic possibilities

Nitrous oxide intoxication: systematic literature review and proposal of new diagnostic possibilities

Lethal nitrous oxide (N2O) intoxication during surgery: the contribution of immunohistochemistry in identifying the cause of death: a case report

The prevalence, risks, and detection of driving under the influence of nitrous oxide

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