Clinical effects and lethal and forensic aspects of propofol

Abstract

Propofol is a potent intravenous anesthetic agent that rapidly induces sedation and unconsciousness. The potential for propofol dependency, recreational use, and abuse has only recently been recognized, and several cases of accidental overdose and suicide have emerged. In addition, the first documented case of murder using propofol was reported a few months ago, and a high profile case of suspected homicide with propofol is currently under investigation. A number of analytical methods have been employed to detect and quantify propofol concentrations in biological specimens. The reported propofol-related deaths and postmortem blood and tissue levels are reviewed. Importantly, limitations of propofol detection are discussed, and future considerations are presented. Because propofol has the potential for diversion with lethal consequences, the forensic scientist must have a basic understanding of its clinical indications and uses, pharmacologic properties, and detection methods. In addition, medical institutions should develop systems to prevent and detect diversion of this potential drug of abuse.

© 2010 American Academy of Forensic Sciences.

Figures

Figure 1

Structural formula of propofol.

Figure 2

Metabolism of propofol. Less than 1% of propofol is excreted unchanged in the urine. Forty percent of propofol is rapidly conjugated by the liver to glucuronide (Glu) and excreted by the kidneys. Alternatively, 60% of propofol is hydroxylated (OH), subsequently conjugated to glucuronide (Glu) or sulfate (OSO3), and then excreted in the urine.