Death after excessive propofol abuse

Abuse of the anaesthetic agent propofol (2,6-diisopropylphenol) is rare, bu t we report a case of a 26-year-old male nurse in which the autopsy showed unspecific signs of intoxication and criminological evidence pointed toward s propofol abuse and/or overdose. Intravenously administered propofol is a fast and short-acting narcotic agent, therefore it seemed questionable whet her the deceased would have been able to self-administer a lethal overdose before losing consciousness. The blood and brain concentrations corresponde d to those found 1-2 min after bolus administration of a narcotic standard dose of 2.5 mg propofol/kg body weight. Extremely high propofol concentrati ons were found in the urine indicating excessive abuse before death. Howeve r, due to the short half-lift: of propofol, the cumulative effects of repea ted injections should not be relevant for toxicity, since this would result in a blood level increase of only 1-2 mug/ml. Furthermore, the detection a nd quantitation of propofol in three different hair segments indicated chro nic propofol abuse by the deceased. The results of the investigation sugges t that death was not caused by a propofol overdose but by respiratory depre ssion resulting from overly rapid injection.