Clinical effects and lethal and forensic aspects of propofol.
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 postmortem 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.
Levy
Richard J
RJ
Children's National Medical Center, The George Washington University School of Medicine and Health Sciences, Washington, DC 20010. rlevy@cnmc.org
D000059:Accidents; D000138:Acidosis / Q000139:chemically induced; D058186:Acute Kidney Injury / Q000139:chemically induced; D016470:Bacteremia / Q000139:chemically induced; D001919:Bradycardia / Q000139:chemically induced; D062787:Drug Overdose; D050171:Dyslipidemias / Q000139:chemically induced; D053593:Forensic Toxicology; D006282:Health Personnel; D006323:Heart Arrest / Q000139:chemically induced; D006333:Heart Failure / Q000139:chemically induced; D006708:Homicide; D006801:Humans; D015228:Hypertriglyceridemia / Q000139:chemically induced; D006993:Hypnotics and Sedatives / Q000097:blood / Q000737:chemistry / Q000494:pharmacology*; D007022:Hypotension / Q000139:chemically induced; D015394:Molecular Structure; D010195:Pancreatitis / Q000139:chemically induced; D015742:Propofol / Q000097:blood / Q000737:chemistry / Q000494:pharmacology*; D012206:Rhabdomyolysis / Q000139:chemically induced; D018805:Sepsis / Q000139:chemically induced; D015813:Substance Abuse Detection / Q000379:methods; D019966:Substance-Related Disorders / Q000150:complications*; D013405:Suicide; D013577:Syndrome
D006993:Hypnotics and Sedatives; D015742:Propofol