FORENSIC SCIENCE,AUTOPSY SURGEON AND FORENSIC DEATH INVESTIGATOR.

IntraoperativeDeaths
Deaths during diagnostic or operative procedures

DR. Roman Al Mamun

12/4/2017

• Deaths due to underlying disease• Disruption of a vital organ during a procedure•

Air embolism occurring during surgery• Anesthetic-related deaths• Cause of death
cannot be ascertained
 IntraoperativeDeaths

IntraoperativeDeaths :
Deaths during diagnostic or operative procedures fall into five categories:

• Deaths due to underlying disease

• Disruption of a vital organ during a procedure
• Air embolism occurring during surgery
• Anesthetic-related deaths
• Cause of death cannot be ascertained
1.DEATHS DUE TO UNDERLYING DISEASE:

The first group includes deaths occurring because of an underlying disease

process that necessitated the operative/diagnostic procedure. These deaths are not
due to the procedures being carried out. An example is an individual put on a
cardiac bypass pump for coronary bypass surgery, whose heart, when removed
from the pump, does not come back.
II. DISRUPTION OF A VITAL ORGAN DURING A PROCEDURE:

The second group includes deaths due to inadvertent mechanical disruption of a

vital organ during a procedure, e.g., the surgeon, while going through the
sternum, inadvertently punctures the heart.
A. A number of deaths have occurred when catheters being passed into the
right atrium, right ventricle, or pulmonary artery have perforated one of
these chambers or the artery.
B. Perforation of the coronary artery can occur during angiography or an
angioplastic procedure.
C. Some of the mechanical disruptions are not unexpected when one
realizes that one is dealing with a diseased and often friable vessel or organ.
III. AIR EMBOLISM OCCURRING DURING SURGERY:

A. This occurs most commonly in surgery of the:

1. Central nervous system
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Roman Al Mamun
DR.
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2. During laminectomy procedures.

B. Any time death occurs during procedures such as these, one should
immediately suspect air embolism.
C. Air can be demonstrated in the epicardial vessels of the heart as well as in the
right ventricle and atrium.
IV. ANESTHETIC-RELATED DEATHS:

Examples of such deaths are:

1. Intubation of the esophagus

2. Administering the wrong gases
3. Drug overdoses
4. Allergic reactions to iodine-based dyes
5. Malignant hyperthermia
a. When it occurs, it is usually associated with halogenated anesthetics and
succinylcholine.
b. Characterized by a rapid rise in body temperature and a two- to
threefold increase in total body oxygen consumption; other symptoms include
arrhythmias,tachycardia,and skeletal muscle rigidity.
c. Individual involved usually has a genetic predisposition to the
syndrome.
d. May be fulminant or insidious; may or may not occur every time
anesthesia is administered.
e. Complications include rhabdomyolysis, electrolyte abnormalities
(especially hyperkalemia), and
disseminated intravascular coagulopathy (DIC).

Occasionally death is due to an overdose of a drug or the wrong medication is

given. This is more common in emergency rooms.
Deaths complicating local anesthesia are due to either an allergic reaction to the
agent or an overdose.

1. Allergic reactions are very rare.

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DR.
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2. More common is either a straight overdose or inadvertent intravascular or

intrathecal injection of the agent.
3. Most local anesthetics are cardiotoxic and thus can cause a fatal cardiac
arrhythmia.
4. Epinephrine is usually added to local anesthetics. If the local anesthetic is
injected intravascularly, the epinephrine can potentiate the toxic effect of the agent
on the myocardium.

V. CAUSE OF DEATH CANNOT BE ASCERTAINED

The fifth category includes cases where, after a careful investigation of

the circumstances surrounding the death, a complete autopsy, and toxicology
analysis, no cause of death can be ascertained. The mechanism in such deaths
appears to be cardiac, but what the underlying process(es) is which results in death
is unknown.

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Roman Al Mamun
DR.