Suicide by Self‐Administration of a Drug Mixture (Propofol,Midazolam, and Zolpidem) in an Anesthesiologist: The First Case Report in Italy

The authors report an unusual case of suicide of an anesthesiologist, in which the suicide manner and means depend upon the victim's occupation. This is the first case report published in Italy of a death involving propofol and other drugs. The anesthesiologist was found dead with an empty drip still inserted in the hand and another one near his body. Forensic and toxicological findings suggested that the cause of death was a respiratory depression due to a self‐administration of a rapidly infused lethal drug mixture. Analytical drug quantification was performed by gas chromatography‐mass spectrometry. Blood analysis revealed: zolpidem (0.86 μg/mL), propofol (0.30 μg/mL), midazolam (0.08 μg/mL), thiopental (0.03 μg/mL), and amitriptyline (0.07 μg/mL). Adipose tissue and hair analysis suggested a previous and repeated use of these drugs verifying the fact that in Italy recreational abuse of anesthetic and sedative agents in health care practitioners is becoming an increasing problem.     

Nitrous Oxide Determination in Postmortem Biological Samples: A Case of Serial Fatal Poisoning in a Public Hospital*

Abstract: In a public hospital, eight cases of fatal poisoning by nitrous oxide (N₂O) occurred under oxygen administration, due to an erroneous swapping of the lines in the gas system. The aim of the study was to clarify the factors involved in asphyxia by characterizing gases from different lines and measuring N₂O concentrations in postmortem biological samples from bodies exhumed. Analyses carried out on the gas system confirmed the erroneous substitution of O₂ line with N₂O and air line with O₂. Consequently, high N₂O amounts were revealed in several tissues and gaseous biological samples. All specimens were analyzed by headspace gas chromatography technique. A rigorous quantitative analysis was possible only in blood (11.29–2152.04 mg/L) and urine (95.11 mg/L) and in air samples from stomach and trachea (from 5.28 to 83.63 g/m³). This study demonstrates that N₂O can be detected in biological samples even 1 month after death.     

Determination of firing distance. Lead analysis on the target by atomic absorption spectroscopy (AAS)

This paper reports a method for the determination of the firing distance. Atomic absorption spectroscopy (AAS) was used to determine the lead (Pb) pattern around bullet holes produced by shots on test targets from the gun. Test shots were made with a Colt 38 Special at 5, 10, 20, 25, 30, 35, 40, 45, 50, 60, 80, and 100 cm target distance. The target was created with sheets of Whatman no. 1 paper on a polystyrene support. The target was subdivided into three carefully cut out rings (1, 2, and 3; with external diameters of 1.4 cm; 5 cm; 10.2 cm, respectively). Each sample was analyzed with graphite furnace AAS. Lead values analysis performed for each ring yielded a linear relation between the firing distance (cm) and the logarithm of lead amounts (microg/cm(2)) in definite target areas (areas 2 + 3): [ln dPb(2+3) = a(0) + a(1)l]; where dPb(2+3) = lead microg/cm(2) of area 2 + 3; a(0) and a(1) are experimentally calculated; l = distance in cm.