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Monday, February 21, 2011
Reality is sometimes stranger than fiction
In this month’s (March) issue of Anesthesiology, Johnstone et al. present several case reports where anesthetic drugs, and neuromuscular blocking agents (NMB) in particular, are used in homicides. Reading the accounts of the authors and their involvement in the investigations and trials was fascinating. Although Michael Jackson’s death highlighted to the public the risk of anesthetic drugs being misused and the possible resultant deaths, many of us do not think of NMB as drugs that are being abused or misused. Unfortunately, many of us are aware of the diversion of opioids (especially fentanyl) and propofol by our colleagues and their subsequent abuse, sometimes resulting in mortality; we consequently have departmental policies to prevent diversion of these drugs. But NMB? Really?

Walking into the OR, I can clearly see how easy it would be to take some NMB out of the OR without creating any suspicion. After reading the accounts in the case reports, this realization had a chilling effect on myself.

But what is the solution? The authors suggest that we might have to better control and track these drugs, and that disturbs me even more than the case reports. The case reports are rare events. Anesthesiologists provide care to millions of patients each year and in all of these cases NMB are available. Do we now need to create Sisyphean paperwork in order to try to ferret out that less than one-in-a-million case where someone happens to pocket a vial of NMB? I don’t think so.

On the other hand, Johnstone et al. are correct in noting that we, as anesthesiologists, may find ourselves in a position to assist in an investigation. Consider this: On the internet, one can find a website, complete with video, that will show you step-by-step how to build a homemade bomb. What makes you think that there is neither a site currently, nor will there ever be one in the future, that would help any non-anesthesiologist learn about NMB and how they could be used to cause paralysis?

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Posted by Amr Abouleish MD, MBA
Amr Abouleish
About the Author

J. Lance Lichtor, M.D
J. Lance Lichtor, M.D. is a professor of anesthesiology and pediatrics at The University of Massachusetts Medical School. He is the web editor and an associate editor for Anesthesiology.

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