프로포폴 투여와 관련된 사망에 대한 법의학적 고찰 - 36 부검례에 대한 분석 -
Medicolegal Review of Deaths Related to Propofol Administration: Analysis of 36 Autopsied Cases
0
조회
0
다운로드
10
인용
0
참고문헌
키워드
초록
Propofol is a widely used anesthetic in anesthesia and sedation. Recent cases of propofol-induced death have been associated with adverse effects, abuse, or intoxication. However, there are few forensic reports of propofol-associated death. We reviewed and analyzed 36 cases of death related to propofol administration recorded by the National Forensic Service in 2000-2011. The number of women was 28(77.8%). Subjects in their 20s and 30s accounted for 61.1% of cases. Cause included medical accidents, 16 (44.4%); suicides, 2 (5.6%); and undetermined, 18 (50%; suicide/accident). Of the 16 medical accidents, 8 were internal medicine cases (conscious sedation endoscopy), 3 surgical cases, 3 plastic surgery cases, 1 urology case,and 1 obstetrics and gynecology case. In 20 cases of suicide or undetermined (suicide/accident), the victims were nurses (9 cases), doctors (4 cases), hospital administrators (2 cases), homemakers (2 cases), bar hostesses (2 cases) and an office worker (1 case). The doctor included 2 plastic surgeons, an internist, and a resident anesthesiologist. The autopsy findings were nonspecific; congested parenchymal organs (34 cases), pulmonary edema (8 cases), cerebral edema (2 cases), pulmonary and cerebral edema (2 cases), putrefaction (2 cases), mucosal petechiae in the interior of the larynx (1 case), and cerebral ischemic necrosis and pneumonia (1 case). The blood propofol concentrations ranged between 0.007 mg/L (cardiopulmonary resuscitation)or 0.23 mg/L (no cardiopulmonary resuscitation) and 4.38 mg/L in medical accident cases, and from 0.12 mg/L to 108.3 mg/L in suicide or undetermined (suicide/accident) cases. Other drugs were detected in 17 cases and alcohol was detected in only 2 cases. Blood concentrations in cases of medical accident were lower than in cases of undetermined cause.
Abstract
Propofol is a widely used anesthetic in anesthesia and sedation. Recent cases of propofol-induced death have been associated with adverse effects, abuse, or intoxication. However, there are few forensic reports of propofol-associated death. We reviewed and analyzed 36 cases of death related to propofol administration recorded by the National Forensic Service in 2000-2011. The number of women was 28(77.8%). Subjects in their 20s and 30s accounted for 61.1% of cases. Cause included medical accidents, 16 (44.4%); suicides, 2 (5.6%); and undetermined, 18 (50%; suicide/accident). Of the 16 medical accidents, 8 were internal medicine cases (conscious sedation endoscopy), 3 surgical cases, 3 plastic surgery cases, 1 urology case,and 1 obstetrics and gynecology case. In 20 cases of suicide or undetermined (suicide/accident), the victims were nurses (9 cases), doctors (4 cases), hospital administrators (2 cases), homemakers (2 cases), bar hostesses (2 cases) and an office worker (1 case). The doctor included 2 plastic surgeons, an internist, and a resident anesthesiologist. The autopsy findings were nonspecific; congested parenchymal organs (34 cases), pulmonary edema (8 cases), cerebral edema (2 cases), pulmonary and cerebral edema (2 cases), putrefaction (2 cases), mucosal petechiae in the interior of the larynx (1 case), and cerebral ischemic necrosis and pneumonia (1 case). The blood propofol concentrations ranged between 0.007 mg/L (cardiopulmonary resuscitation)or 0.23 mg/L (no cardiopulmonary resuscitation) and 4.38 mg/L in medical accident cases, and from 0.12 mg/L to 108.3 mg/L in suicide or undetermined (suicide/accident) cases. Other drugs were detected in 17 cases and alcohol was detected in only 2 cases. Blood concentrations in cases of medical accident were lower than in cases of undetermined cause.
참고문헌 (21)
- 이종화, "개원가에서의 안전한 진정", 대한의사협회지, 54(11), pp.1179~1188 (2011), 대한의사협회
- 이순애, "수술실에서 근무하는 의료진의 프로포폴 남용", 대한법의학회지, 34(2), pp.101~107 (2010), 대한법의학회
- Eger EI, "Characteristics of anesthetic agents used for induction and maintenance of general anesthesia", Am J Health Syst Pharm Res, 61, pp.3~10 (2004)
- Kirby RR, "Death from Propofol: Accident, Suicide, or Murder?", Anesth Analg, 108, pp.1182~1184 (2009)
- Kranioti EF, "Lethal self administration of propofol (Diprivan) A case report and review of the literature", Forensic Sci Int, 167, pp.56~58 (2007)
- Fulton B, "Propofol. An overview of its pharmacology and a review of its clinical efficacy in intensive care sedation", Drugs, 50, pp.636~657 (1995)
- Marik PE., "Propofol: therapeutic indications and side-effects", Curr Pharm Des, 10, pp.3639~3649 (2004)
- Klausz G, "Evaluation of a fatal propofol intoxication due to self administration", Journal of Forensic and Legal Medicine, 16, pp.287~289 (2009)
- 조훈, "대장 내시경 검사시 수면 유도제로 Propofol의 효과에 관한 연구", 대한내과학회지, 69(1), pp.30~38 (2005), 대한내과학회
- Langley MS, "Profofol. A review of its pharmacodynamic and pharmacokinetic properties and use as intravenous anaesthetic", Drugs, 35, pp.334~372 (1988)
- Baset RC, "Disposition of Toxic Drugs and Chemicals in Man. 4th ed", pp.1325~1327 (1994), Chemical Toxicology Inst
- Schneider U, "Propofol dependency after treatment of tension headache", Addict Biol, 6, pp.263~265 (2001)
- Follette JW, "Anesthesiologist Addicted to Propofol", Anesthesiology, 77, pp.817~818 (1992)
- Soyka M, "Propofol dependency (letter)", Addiction, 92, pp.1369~1370 (1997)
- Roussin A, "Pharmacological and clinical evidences on the potential for abuse and dependence of propofol: a review of literature", Fundamental Clin Pharmacol, 21, pp.459~465 (2007)
- Chao TC, "The first fatal 2,6-diisopropylphenol(propofol) poisoning in Singapore: a case report", ForensicSci Int, 66, pp.1~7 (1994)
- Drummer OH, "A Fatality Due to Propofol Poisoning", J Forensic Sci, 37, pp.1186~1189 (1992)
- Iwersen-Bergmann S, "Death after excessive propofol abuse", Int J Legal Med, 114, pp.248~251 (2001)
- 이미순, "향정신성 의약품 지정", 대한의사협회지, 54(2), pp.189~196 (2011), 대한의사협회
- Ward CF, "Drug abuse in anesthesia training programs. A survey: 1970 through 1980", JAMA, 250, pp.922~925 (1983)
- Booth JV, "Substance abuse among physicians: a survey of academic anesthesiology programs", Anesth Analg, 95, pp.1024~1030 (2002)