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Gwiazda S, Dixon E, Cronly M, Kavanagh Y, Cullinane M, Mulligan LM. Propofol misuse in Ireland - Two case reports and a review of the literature. Forensic Sci Int 2021; 326:110909. [PMID: 34311287 DOI: 10.1016/j.forsciint.2021.110909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/12/2021] [Accepted: 07/14/2021] [Indexed: 10/20/2022]
Abstract
Propofol is a rapidly acting sedative drug, which is usually administered intravenously. It is widely used in procedural sedation due to its rapid onset and easy reversibility. It has a good safety profile when used in combination with ventilation and monitoring. However, propofol can bring on feelings of euphoria, sexual disinhibition, tension relief and hallucinations, creating a potential for abuse. At an international level, recreational propofol use among medical staff is a growing, yet under reported problem. In order to highlight this issue in an Irish context, the case reports described are among the first recorded deaths in Ireland due to unmonitored self-administration of propofol. The difficulties facing forensic pathologists in detecting propofol and its metabolites in these cases are outlined. The potential for propofol abuse should influence healthcare facilities to make their staff aware of the risks associated with it. This in turn would promote vigilance and encourage those affected to seek treatment.
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Affiliation(s)
- Sara Gwiazda
- Office of the State Pathologist, Griffith Avenue, Whitehall, Dublin D09RDT8, Ireland
| | - Eleanor Dixon
- Human Toxicology, The State Laboratory, Backweston Campus, Co., Kildare, Ireland
| | - Mark Cronly
- Human Toxicology, The State Laboratory, Backweston Campus, Co., Kildare, Ireland
| | - Yvonne Kavanagh
- Human Toxicology, The State Laboratory, Backweston Campus, Co., Kildare, Ireland
| | - Myra Cullinane
- FRCPI, MFFLM, Barrister-at-Law, Senior Coroner for the Dublin District, Store Street, Dublin 1, Ireland
| | - Linda M Mulligan
- Office of the State Pathologist, Griffith Avenue, Whitehall, Dublin D09RDT8, Ireland.
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Ottaviano V, Tavone AM, Scipione C, Potenza S, Petroni G, Marella GL. Drug detection in decomposed cadavers confirms testimonial evidence in a case of serial homicides. Forensic Sci Int 2021; 325:110893. [PMID: 34273605 DOI: 10.1016/j.forsciint.2021.110893] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 06/21/2021] [Accepted: 06/29/2021] [Indexed: 11/30/2022]
Abstract
Toxicology investigation on human's buried dead bodies is a rare and challenging task in the forensic field. As requested by the Judicial Authority, this work aimed to verify testimonial evidence that emerged during a criminal investigation involving multiple murder cases. The statements indicated an improper medical administration of one or more alleged drugs (propofol, morphine, diazepam, and midazolam) which presumably caused the deaths. Since the supposed crimes took place several years before, the task of the present work was to obtain results to support the charges. The analyses involved 18 biological samples taken from four exhumed bodies, three of which were female and one male, each buried in a different date and mode. Each sample was treated with specific purification and extraction techniques (LLE - SPE) after the addition of the deuterated analogs of the searched analytes (propofol-d17, morphine-d3, diazepam-d5, midazolam-d4) as internal standards. Afterwards, the extracts were subjected to qualitative analysis by gas chromatography-mass spectrometry-Electron Impact (GC/MS - EI), both in full scan and SIM mode. Propofol, morphine, and diazepam were identified in the corpses. It supports testimonials that were administered just before the deaths occurred.
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Affiliation(s)
- Valeria Ottaviano
- University of Rome "Tor Vergata", Department of Biomedicine and Prevention, via Montpellier 1, 00166 Rome, Italy
| | - Alessandro Mauro Tavone
- University of Rome "Tor Vergata", Department of Biomedicine and Prevention, via Montpellier 1, 00166 Rome, Italy.
| | - Claudia Scipione
- University of Rome "Tor Vergata", Department of Biomedicine and Prevention, via Montpellier 1, 00166 Rome, Italy
| | - Saverio Potenza
- University of Rome "Tor Vergata", Department of Biomedicine and Prevention, via Montpellier 1, 00166 Rome, Italy
| | - Giulia Petroni
- University of Rome "Tor Vergata", Department of Biomedicine and Prevention, via Montpellier 1, 00166 Rome, Italy
| | - Gian Luca Marella
- University of Rome "Tor Vergata", Department of Surgical Sciences, via Montpellier 1, 00166 Rome, Italy
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Qi B, Nicolaï J, Smits A, De Vocht T, Deferm N, Van Brantegem P, Allegaert K, Annaert P. A sensitive liquid chromatography method for analysis of propofol in small volumes of neonatal blood. J Clin Pharm Ther 2019; 45:128-133. [PMID: 31583723 DOI: 10.1111/jcpt.13038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 07/10/2019] [Accepted: 08/08/2019] [Indexed: 12/13/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Sampling volumes of blood from neonates is necessarily limited. However, most of the published propofol analysis assays require a relatively large blood sample volume (typically ≥0.5 mL). Therefore, the aim of the present study was to develop and validate a sensitive method requiring a smaller sample volume (0.2 mL) to fulfill clinically relevant research requirements. METHODS Following simple protein precipitation and centrifugation, the supernatant was injected into the HPLC-fluorescence system and separated with a reverse phase column. Propofol and the internal standard (thymol) were detected and quantified using fluorescence at excitation and emission wavelengths of 270 nm and 310 nm, respectively. The method was validated with reference to the Food and Drug Administration (FDA) guidance for industry. Accuracy (CV, %) and precision (RSD, %) were evaluated at three quality control concentration levels (0.05, 0.5 and 5 µg/mL). RESULTS AND DISCUSSION Calibration curves were linear in the range of 0.005-20 µg/mL. Intra- and interday accuracy (-4.4%-13.6%) and precision (0.2%-5.8%) for propofol were below 15%. The calculated LOD (limit of detection) and LLOQ (lower limit of quantification) were 0.0021 µg/mL and 0.0069 µg/mL, respectively. Propofol samples were stable for 4 months at -20°C after the sample preparation. This method was applied for analyzing blood samples from 41 neonates that received propofol, as part of a dose-finding study. The measured median (range) concentration was 0.14 (0.03-1.11) µg/mL, which was in the range of the calibration curve. The calculated median (range) propofol half-life of the gamma elimination phase was 10.4 (4.7-26.7) hours. WHAT IS NEW AND CONCLUSION A minimal volume (0.2 mL) of blood from neonates is required for the determination of propofol with this method. The method can be used to support the quantification of propofol drug concentrations for pharmacokinetic studies in the neonatal population.
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Affiliation(s)
- Bing Qi
- Drug Delivery and Disposition, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Johan Nicolaï
- Drug Delivery and Disposition, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Anne Smits
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium.,Neonatal Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium
| | - Tom De Vocht
- Drug Delivery and Disposition, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Neel Deferm
- Drug Delivery and Disposition, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Pieter Van Brantegem
- Drug Delivery and Disposition, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Karel Allegaert
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium.,Department of Pediatrics, Division of Neonatology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Pieter Annaert
- Drug Delivery and Disposition, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
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Jia J, Sun Y, Hu Z, Li Y, Ruan X. Propofol inhibits the release of interleukin-6, 8 and tumor necrosis factor-α correlating with high-mobility group box 1 expression in lipopolysaccharides-stimulated RAW 264.7 cells. BMC Anesthesiol 2017; 17:148. [PMID: 29073894 PMCID: PMC5658982 DOI: 10.1186/s12871-017-0441-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 10/19/2017] [Indexed: 12/05/2022] Open
Abstract
Background Studies have found that propofol can inhibit endotoxin-induced monocyte-macrophages to produce various inflammatory factors. This study is to disclose whether the propofol affects the expression of high-mobility group box 1 (HMGB1) in lipopolysaccharides (LPS)-stimulated RAW 264.7 cells and the release of interleukin-6 (IL-6), 8 (IL-8) and tumor necrosis factor-α (TNF-α). Methods RAW 264.7 cells were divided into four groups for intervention. After culturing for 16 h, the cells and culture supernatants were collected. The expression of HMGB1 in RAW 264.7 cells was detected by Western blot. The levels of IL-6, IL-8 and TNF-α in supernatants of cells were determined by enzyme-linked immunosorbent assay (ELISA). Results Stimulation of LPS increased the expression of HMGB1 and promoted the release of IL-6, IL-8 and TNF-α in supernatants of RAW 264.7 cells (p < 0.05); however, propofol down-regulated the expression of LPS-stimulated HMGB1 and reduced the LPS-stimulated releases of IL-6, IL-8 and TNF-α in supernatants of RAW 264.7 cells (p < 0.05). Moreover, the releases of IL-6, IL-8 and TNF-α intimately correlated with the expression of HMGB1 in this process (p < 0.05). Conclusion Propofol inhibited the releases of IL-6, IL-8 and TNF-α in LPS-stimulated RAW 264.7 cells, and the levels of IL-6, IL-8 and TNF-α intimately correlated with the expression of HMGB1, which indicating that propofol may prevent inflammatory responses through reducing the releases of these cytokines and inflammatory mediators.
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Affiliation(s)
- Jie Jia
- Department of Anesthesiology, The First Affiliated Hospital of Jinan University, Guangzhou, China.,Department of Anesthesiology, Guangdong Women and Children Hospital, Guangzhou, China
| | - Yijuan Sun
- Department of Anesthesiology, Guangdong Women and Children Hospital, Guangzhou, China
| | - Zurong Hu
- Department of Anesthesiology, Guangdong Women and Children Hospital, Guangzhou, China
| | - Yi Li
- Department of Gynecology, Guangdong Women and Children Hospital, Guangzhou, China
| | - Xiangcai Ruan
- Department of Anesthesiology, The First Affiliated Hospital of Jinan University, Guangzhou, China. .,Department of Anesthesiology, Guangzhou First People's Hospital, Affiliated Hospital of Guangzhou Medical University, No. 1 Panfu Road, Guangzhou, 510180, China.
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