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Related Experiment Videos

Anesthesiologist suicide with atracurium.

María A Martínez1, Salomé Ballesteros, Elena Almarza

  • 1Chemistry Department, National Institute of Toxicology and Forensic Sciences, Ministry of Justice, C/ Luis Cabrera 9, 28002 Madrid, Spain. mariamart@terra.es

Journal of Analytical Toxicology
|April 20, 2006
PubMed
Summary

A fatal overdose of atracurium, a muscle relaxant, was confirmed in a depressed anesthesiologist. Toxicology revealed laudanosine, a metabolite, and venlafaxine in the victim, indicating suicide.

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Area of Science:

  • Forensic Toxicology
  • Pharmacology

Background:

  • Atracurium is a nondepolarizing muscle relaxant used in anesthesia.
  • It undergoes non-enzymatic degradation to laudanosine and an acrylate moiety.
  • Laudanosine is a known metabolite with potential central nervous system effects.

Observation:

  • A case of a 45-year-old anesthesiologist found deceased at their workplace.
  • The victim had a history of depression and was treated with venlafaxine.
  • An empty syringe was found near the body, prompting toxicological investigation.

Findings:

  • Toxicology confirmed the presence of laudanosine in the syringe, blood, urine, and vitreous humor.
  • Significant levels of venlafaxine and its active metabolite, O-desmethyl-venlafaxine, were also detected.

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  • Gas chromatography and mass spectrometry were used for sensitive and specific drug detection and quantification.

    • Implications:

    • The forensic pathologists concluded the cause of death was an atracurium overdose, with suicide as the manner of death.
    • This case highlights the potential toxicity of atracurium metabolites in overdose scenarios.
    • It underscores the importance of comprehensive toxicological analysis in post-mortem investigations, especially in cases involving healthcare professionals.