Related Experiment Video
Updated: Jul 19, 2026

Non-Intubated Video-Assisted Thoracoscopic Surgery
Published on: May 26, 2023
Suicide with remifentanil and midazolam: a case report
G Asselborn1, M Yegles, R Wennig
1Laboratoire National de Santé-Toxicologie CRP-Santé, Centre Universitaire, 162a, av de la Faïencerie, L-1511 Luxembourg.
Background:
Remifentanil (Ultiva) is a recently introduced esterase-metabolized potent opioid (EMO) mu-receptor agonist with a rapid onset and offset of action for use as part of general anaesthesia in association with isoflurane or propofol or with midazolam (Dormicum) and in combination with mivacurium.
Case Report:
A nurse from the anaesthesiology department of a hospital was found dead at home with a syringe and empty vials of Ultiva (2 mg) and of Dormicum (1 mg/mL). At autopsy several injection sites were found on her body. Usual toxicology screening operated in our laboratory revealed only the presence of benzodiazepines in blood. Regarding the case history, we decided to adapt a method specially designed for remifentanil and its inactive metabolite testing. The analytes were isolated by SPE on a Clean-Screen column. After silylation with BSTFA with 1% TMCS, the analytes were detected by GC/MS-EI operating in the SIM mode. No Remifentanil could be detected, whereas the metabolite of remifentanil GR90291 was determined in femoral blood, liver, kidney and lung. Furthermore, midazolam could be detected in femoral and cardiac blood. Hair analysis of a segment of 5 cm revealed the presence of diazepam and midazolam, whereas neither remifentanil nor its metabolite could be detected.
Related Concept Videos
CNS Depressants: Barbiturates and Benzodiazepines
Opioid Analgesics: Synthetic and Semisynthetic Opioids
Parenteral Anesthetics: Overview
Inhalational Anesthetics: Overview
Sedatives and Hypnotics Drugs: Barbiturates
Sedatives and Hypnotics Drugs: Miscellaneous Agents
Melatonin congeners like ramelteon (Rozerem) and tasimelteon (Hetlioz) selectively bind to melatonin receptors (MT1 and MT2) and thus mimic the actions of melatonin, a hormone that regulates sleep-wake cycles. Tasimelteon is primarily used for non-24-hour sleep-wake disorder, common in blind patients. They are also used to treat conditions like insomnia...

