Fatal Administration of Propofol: A Comprehensive Narrative Forensic Review of Propofol Deaths From Accidents, Suicides, and Homicides.

Accidental death, suicide, and homicide have resulted from the intravenous injection of propofol. There have been at least 30 accidental victims of propofol self-administration; more than 75% were medical workers who chronically used it as a recreational drug. At least 13 of the 14 individuals who committed suicide by injecting themselves with propofol were either a physician or a nurse. A fatal injection of propofol was used to murder a minimum of 10 people; for many of these deceased persons, neither the drug nor homicide was initially suspected at the time of death. Therefore, the discovery of an intravenous needle mark wound, or additional clinical history, may lead to further evaluation of the death scene or the victim or both and result in the appropriate toxicology studies of the deceased person, which can establish that the cause of death was from propofol and the manner of death was homicide. A meticulous and thorough examination of the cutaneous and mucosal surfaces of a dead person may provide the essential forensic dermatology clue to either the cause of death (which is the specific illness, pathophysiologic aberration, or trauma that results in the individual's dying) or the manner of death (which is the situation of how the death occurred, such as the consequence to an accident, a suicide, a homicide or a natural sequela of disease, aging or bodily malfunctioning) or both. In summary, propofol intravenous injection can result in accidental death, suicide, or homicide; the number of needle mark wounds can be multiple or solitary. A thorough search of the death scene and a comprehensive forensic examination of the victim may be useful in establishing the manner of death when the cause of death has been attributed to propofol injection. The intent of this paper is to provide a comprehensive narrative forensic review of propofol deaths from accidents, suicides, and homicides.