Advertisement

Forensic Toxicology

, Volume 37, Issue 1, pp 250–253 | Cite as

Postmortem detection of rocuronium and sugammadex by LC/MS in the blood of a patient who died on postoperative day 8

  • Yoshiaki IwamuroEmail author
  • Takaya Murakami
  • Reiko Ishimaru
  • Satoshi Chinaka
Case Report

Abstract

Purpose

This case report describes the purposeful forensic detection of both the muscle relaxant rocuronium and the reversal agent sugammadex in the blood of a patient who died 8 days after surgery.

Methods

The two compounds were analyzed by liquid chromatography/mass spectrometry (LC/MS).

Results

The molar concentrations of the two compounds were almost the same, indicating that rocuronium had lost its muscle relaxant effect, because rocuronium and sugammadex formed a 1:1 complex in the blood due to their high affinities.

Conclusions

When a muscle relaxant is detected in a forensic sample, the presence of its reversal agent should also be investigated.

Keywords

Muscle relaxant Rocuronium Muscle relaxant reversal agent Sugammadex LC/MS 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare no conflict of interest.

Ethical standards

This article does not contain any studies involving living human participants or animals performed by any of the authors.

References

  1. 1.
    Hartley EL, Alcock R (2015) Rocuronium versus suxamethonium: a survey of first-line muscle relaxant use in UK prehospital rapid sequence induction. Prehospital Disaster Med 30:184–186CrossRefGoogle Scholar
  2. 2.
    Johnstone RE, Katz RL, Stanley TH (2011) Homicides using muscle relaxants, opioids, and anesthetic drugs. Anesthesiology 114:713–716CrossRefGoogle Scholar
  3. 3.
    Bom A, Bradley M, Cameron K, Clark JK, Egmond J, Feilden H, MacLean EJ, Muir AW, Palin R, Rees DC, Zhang M-Q (2002) A novel concept of reversing neuromuscular block: chemical encapsulation of rocuronium bromide by a cyclodextrin-based synthetic host. Angew Chem Int Ed 41:265–270CrossRefGoogle Scholar
  4. 4.
    Boer HD, Egmond J, Pol P, Bom A, Booij LHDJ (2006) Chemical encapsulation of rocuronium by synthetic cyclodextrin derivatives: reversal of neuromuscular block in anaesthetized Rhesus monkeys. Br J Anaesth 96:201–206CrossRefGoogle Scholar
  5. 5.
    Staals LM, Snoeck MMJ, Driessen JJ, Hamersvelt HW, Flockton EA, Heuvel MW, Hunter JM (2010) Reduced clearance of rocuronium and sugammadex in patients with severe to end-stage renal failure: a pharmacokinetic study. Br J Anaesth 104:31–39CrossRefGoogle Scholar
  6. 6.
    Rezonja K, Mars T, Jerin A, Kozelj G, Pozar-Lukanovic N, Sostaric M (2016) Dexamethasone does not diminish sugammadex reversal of neuromuscular block—clinical study in surgical patients undergoing general anesthesia. BMC Anesth 16:101–111CrossRefGoogle Scholar
  7. 7.
    Epemolu O, Mayer I, Hope F, Scullion P, Desmond P (2002) Liquid chromatography/mass spectrometric bioanalysis of a modified γ-cyclodextrin (Org 25969) and rocuronium bromide (Org 9426) in guinea pig plasma and urine: its application to determine the plasma pharmacokinetics of Org 25969. Rapid Commun Mass Spectr 16:1946–1952CrossRefGoogle Scholar
  8. 8.
    Zwart MAH, Bruggencate-Broeders J, Hal HJM, Megens R(H)JJJ, Frasa H(W)LH (2011) Determination of sugammadex in human plasma, urine, and dialysate using a high-performance liquid chromatography/tandem mass spectrometry assay. J Chromatogr B 879:1573–1586CrossRefGoogle Scholar
  9. 9.
    Farenc C, Enjalbal C, Sanchez P, Bressolle F, Audran M, Martinez J, Aubagnac J-L (2001) Quantitative determination of rocuronium in human plasma by liquid chromatography–electrospray ionization mass spectrometry. J Chromatogr A 910:61–67CrossRefGoogle Scholar
  10. 10.
    Merck ZEMURON. http://www.merck.ca/static/pdf/ZEMURON-PM_E.pdf. Accessed July 31, 2018
  11. 11.
    Merck BRIDION. http://www.merck.ca/static/pdf/BRIDION-PM_E.pdf. Accessed July 31, 2018
  12. 12.
    Panhuizen IF, Gold SJA, Buerkle C, Snoeck MMJ, Harper NJN, Kaspers MJGH, Heuvel MW, Hollmann MW (2015) Efficacy, safety and pharmacokinetics of sugammadex 4 mg kg−1 for reversal of deep neuromuscular blockade in patients with severe renal impairment. Br J Anaesth 114:777–784CrossRefGoogle Scholar

Copyright information

© Japanese Association of Forensic Toxicology and Springer Japan KK, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Forensic Science LaboratoryIshikawa Prefectural Police HeadquartersKanazawaJapan

Personalised recommendations