Lethal nitrous oxide (N2O) intoxication during surgery: the contribution of immunohistochemistry in identifying the cause of death: a case report

Journal of Medical Case Reports

Case Report

Camilla Cecannecchia¹  Benedetta Baldari¹  Maria Antonella Bosco²  Andrea Cioffi²  Giovanni Gurgoglione²  Stefania De Simone² 

[1] Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy;Section of Forensic Science, Section of Legal Medicine, Department of Clinical and Experimental Medicine, University of Foggia, Viale Europa 12, 71122, Foggia, Italy;

关键词: Nitrous oxide;    NO;    Forensic histopathology;    Asphyxia;    Hypoxia;    Selectins;    HIF 1-α;    Anaesthesia;   

DOI  :  10.1186/s13256-023-04159-7

 received in 2023-03-22, accepted in 2023-09-01,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundNitrous oxide (N2O) is a gas used in medicine for its analgesic, anxiolytic and amnesic properties. It is a drug considered safe if adequately administered. In the literature, accidental N2O-related deaths are rare. They are mostly related to inhalation of this substance for recreational and autoerotic purposes; rarely are reported deaths due to incorrect administration of medical gas in anesthesia. The diagnosis of death from acute N2O intoxication is complex and is generally an exclusion diagnosis: the macroscopic and microscopic post-mortem signs are entirely nonspecific. Furthermore, the circumstantial data are not always supportive and can even be confusing, mainly if the death occurred inside a hospital.Case presentationWe describe a particular case of death from acute nitrous oxide poisoning in a hospital environment, of a Caucasian male of 72-years-old. The intoxication occurred during a minimally invasive vascular surgery due to an incorrect assembly of the supply lines of medical gases (O2 and N2O). The identification of the cause of death resulted from the analysis of circumstantial data, macroscopic and microscopic autoptic findings, and immunohistochemical investigations based on the search for antibodies anti E-selectin, P-selectin, and HIF 1-α.ConclusionAlthough not pathognomonic of asphyxiation by N2O, the latter molecules are a valid and early marker of hypoxic insult. Therefore, in concert with all other findings, it may constitute valid support for the forensic pathologist to ascertain the cause of death in case of suspected intoxication by N2O.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

【 图 表 】

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Fig. 6