Get access

Sevoflurane Concentrations in Blood, Brain, and Lung After Sevoflurane-Induced Death

Authors

  • Cecilia M. Rosales M.D.,

    1. Department of Pathology and Laboratory Medicine, Children’s Mercy Hospitals and Clinics, and University of Missouri Kansas City School of Medicine, Kansas City, MO 64108.
    Search for more papers by this author
  • Thomas Young M.D.,

    1. Jackson County Medical Examiner’s Office, Kansas City, MO 64108.
    Search for more papers by this author
  • Michael J. Laster D.V.M.,

    1. Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA 94143.
    Search for more papers by this author
  • Edmond I Eger II M.D.,

    1. Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA 94143.
    2. Baxter Healthcare Corp., Round Lake, IL 60073.
    Search for more papers by this author
  • Uttam Garg Ph.D.

    1. Department of Pathology and Laboratory Medicine, Children’s Mercy Hospitals and Clinics, and University of Missouri Kansas City School of Medicine, Kansas City, MO 64108.
    Search for more papers by this author

Additional information and reprint request:
Uttam Garg, Ph.D., DABFT
Director, Clinical Chemistry and Toxicology
Department of Pathology and Laboratory Medicine
Children’s Mercy Hospitals and Clinics
2401 Gillham Road
Kansas City, MO 64108
E-mail: ugarg@cmh.edu

Abstract

Abstract:  Sevoflurane concentrations in blood, brain, and lung were measured in an individual apparently dying from sevoflurane inhalation. Sevoflurane is a volatile nonflammable fluorinated methyl isopropyl ether inhaled anesthetic, chemically related to desflurane and isoflurane. The incidence of abuse of sevoflurane is lower than that of other drugs of abuse possibly due to its inaccessibility to the general public and less pleasurable and addicting effects. The dead subject was an anesthetist found prone in bed holding an empty bottle of sevoflurane (Ultane®). Serum, urine, and liver were screened for numerous drugs and metabolites using enzyme immunoassays and gas chromatography-mass spectrometry. Analysis did not reveal presence of any drug, including ethanol, other than sevoflurane. Sevoflurane was determined by headspace gas chromatography and revealed concentrations of 15 μg/mL in blood and 130 mg/kg in brain and lung. Autopsy revealed pulmonary edema and frothing in the lung, pathological findings associated with death by sevoflurane or hypoxia. The cause of death was ruled as sevoflurane toxicity and the manner of death as accident.

Ancillary