Establishment of the methods for diagnosing cause of death following drug administration

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We have experienced a case where a patient died during spinal anesthesia induced by tetracaine, and the cause of death was supposed to be high spinal anesthesia. In order to prove high spinal anesthesia, we first establish the sensitive method to determine tetracaine and its metabolite using GC/MS, and measured the tissue levels of tetracaine and its metabolite in the case and blood levels following normal spinal anesthesia. Distribution of tetracaine and its metabolite in rabbits after high versus normal spinal anesthesia was also measured, and we could establish the method to diagnose high spinal anesthesia. Using this method, the cause of death of the case was proved to be high spinal anesthesia.Chlorthexidine is an effective antibacterial agent and has been widely used in hospital as an antiseptic agent and as a disinfectant. Because chlorhexidine gluconate solution can be found in many places in a hispital, accidental intravenous injection of this fluid into a patient is possible. We have established a simple and reliable HPLC method using a polymer-coated ODS column and determined the serum levels of a patient who died after a suspected intravenous injection of chlorhexidine gluconate.Sudden unexpected death is occasionally seen in psychiatric patients, and various cuases of death including cardiovascular insufficiency have been reported. We found microscopic cardiopulmonary abnormalities in 2 cases of sudden death in obese psychiatric patients whose blood levels of psychiatric drugs were not high enough. Therefore, these abnormalities may be significant findings in obese psychiatric patients and may help in investigations into the manner of death.