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HPLC-DAD Determination of Mepivacaine in Cerebrospinal Fluid From a Fatal Case

NCJ Number
Journal of Forensic Sciences Volume: 52 Issue: 5 Dated: September 2007 Pages: 1223-1225
Maria Nieddu Ph.D.; Gianpiero Boatto Ph.D.; Domenico Serra; Aldo Soro M.D.; Salvatore Lorenzoni M.D.; Francesco Lubinu Ph.D.
Date Published
September 2007
3 pages
This paper describes a fatal case in Italy in which the decedent died shortly after being administered mepivacaine hydrochloride (2 percent), a local anesthetic.
In March 2005, a 58-year-old man suffering from kidney stones was hospitalized for lithotripsy. Routine blood and urine chemistries were normal, and no previous reactions to general anesthesia or other drugs were reported. Preanesthesia with Fentanest was administered at 8:15 am, followed by place-regional L3-L4 epidural anesthesia with 16 ml of mepivacaine (2 percent), which is regularly used as a local anesthetic. At 9:35 am, while the ureteroscopy was being positioned, the man experienced sustained bradycardia, followed by loss of consciousness, cardio-circulatory arrest, deep coma, and cyanosis. At 10:10 am, he was taken to the intensive care unit, where he died just over 2 hours later. An autopsy was performed 5 days after his death. The findings were typical of cardiac shock from ischemic origin. Cerebrospinal fluid (CSF) was obtained several hours after death, and mepivacaine was identified by gas chromatography-mass spectrometry, and its concentration was determined with high performance liquid chromatography with diode array detection. The mepivacaine concentration in the sample was 264 mg/ml. The concentration equated to approximately 30 mg in a CSF volume of 120 ml. This compares to an injected amount of 320 mg. Therefore, it is improbable that mepivacaine contributed to the man's death. This is the first reported fatality in which the mepivacaine concentration in CSF has been determined. 5 references