Distribution of drugs in various tissues in a brain dead man

• Published in: Forensic science international 1997-11, Vol.90 (1), p.103-109
• Main Authors: Jitsufuchi, Narumi, Kudo, Keiko, Imamura, Tohru, Kimura, Kojiro, Ikeda, Noriaki
• Format: Article
• Language: English
• Subjects: Analgesics, Opioid - pharmacokinetics; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthetics, Local - pharmacokinetics; Autopsies; Autopsy - methods; Biological and medical sciences; Blood flow; Blood levels; Brain; Brain Chemistry; Brain death; Brain Death - metabolism; Brain Death - pathology; Calibration; Cardiac arrest; Cerebellum; Cerebral blood flow; Cerebrovascular Circulation; Clinical death. Palliative care. Organ gift and preservation; Distribution; Drug dosages; Drugs; Gas chromatography; Gas Chromatography-Mass Spectrometry; Human tissues; Humans; Hypnotics and Sedatives - pharmacokinetics; Lidocaine; Lidocaine - pharmacokinetics; Lobes; Male; Mass spectrometry; Mass spectroscopy; Medical sciences; Medulla oblongata; Mepivacaine; Mepivacaine - pharmacokinetics; Middle Aged; Pentazocine; Pentazocine - pharmacokinetics; Postmortem Changes; Ratios; Respiration; Surgery; Thiamylal; Thiamylal - pharmacokinetics; Time Factors; Tissue Distribution; Tissues
• ISSN: 0379-0738; 1872-6283
• DOI: 10.1016/S0379-0738(97)00155-2

We examined the distribution of drugs in a 49-year-old brain-dead man. Our objective was to determine the possibility of diagnosing how and at what point the patient became brain dead. The presence of mepivacaine, pentazocine, lidocaine and thiamylal in various tissues, including seven regions of the brain were confirmed, using gas chromatography/mass spectrometry. Tissue-to-blood concentration ratios of mepivacaine, pentazocine and lidocaine in the brain were higher than these ratios in other tissues, while ratios of thiamylal were lower. Therefore, cerebral blood flow was likely to have ceased between the administration of the former drugs and that of the latter drug, in agreement with clinical records. Among seven regions of the brain, the ratios of the former three drugs were high in occipital and parietal lobes, and were low in the cerebellum and medulla oblongata. On the other hand, the ratios of the latter drug were high in the cerebellum and the medulla oblongata. Therefore, cerebral blood flow presumably ceased first in occipital and parietal lobes, and last in the cerebellum and the medulla oblongata. Based on these results, assessment of concentrations of drugs in human tissues, including various regions of brain is useful to determine the time and progression of brain death.