Hino Yukiko, Kudo Keiko, Kiyoshima Akiko, Ikeda Noriaki
Department of Forensic Pathology and Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Leg Med (Tokyo). 2002 Mar;4(1):55-9. doi: 10.1016/s1344-6223(01)00043-8.
A 56-year-old Japanese woman died after being given 10 mg of tetracaine to induce spinal anesthesia in preparation for orthopedic surgery. Autopsy findings and microscopic analysis revealed no external injuries or disease, and further toxicological examinations were carried out to determine the cause of death. For this we used gas chromatography-mass spectrometry. Tetracaine was not detected in most tissue samples, but the metabolite, p-butylaminobenzoic acid, was clearly detected in all samples. The concentration of the metabolite in the brain stem (234.7 ng/g) was higher than in the cerebrum (30.5 ng/g), cerebellum (36.7 ng/g), whole blood of the left heart (164.8 ng/ml) and whole blood of the left femoral vein (84.0 ng/ml). These distribution patterns were exactly same as rabbits sacrificed by high spinal anesthesia. Our findings suggest that tetracaine spread to the high regions of cerebrospinal nerves and acted directly on the central nervous system. Therefore, the cause of her death was high spinal anesthesia induced by tetracaine. This is apparently the first toxicologically proven case in which spinal anesthesia affected high brain centers.
一名56岁的日本女性在接受10毫克丁卡因以诱导脊髓麻醉准备进行骨科手术时死亡。尸检结果和显微镜分析未发现外部损伤或疾病，为确定死因进行了进一步的毒理学检查。为此我们使用了气相色谱 - 质谱联用技术。在大多数组织样本中未检测到丁卡因，但在所有样本中均清晰检测到代谢产物对丁氨基苯甲酸。代谢产物在脑干中的浓度（234.7纳克/克）高于大脑（30.5纳克/克）、小脑（36.7纳克/克）、左心全血（164.8纳克/毫升）和左股静脉全血（84.0纳克/毫升）中的浓度。这些分布模式与通过高位脊髓麻醉处死的兔子完全相同。我们的研究结果表明，丁卡因扩散到脑脊神经的高位区域并直接作用于中枢神经系统。因此，她的死因是丁卡因诱导的高位脊髓麻醉。这显然是首例经毒理学证实的脊髓麻醉影响高脑中枢的病例。
