{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T15:15:46Z","timestamp":1783091746827,"version":"3.54.6"},"reference-count":20,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T00:00:00Z","timestamp":1761696000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T00:00:00Z","timestamp":1761696000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100004091","name":"Kumamoto University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100004091","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Forensic Sci Med Pathol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Isoflurane is a volatile inhalation anesthetic used primarily in veterinary medicine and, recently, infrequently in human medical applications. However, it is sometimes abused for recreational or suicidal purposes by medical and research personnel. We present a forensic autopsy case of a man in his 40\u00a0s who was employed at a veterinary hospital and was suspected to have died from isoflurane poisoning. Autopsy findings showed no injuries or lesions, and the pathological findings of most organs suggested acute death. Routine gas chromatography\u2013mass spectrometry analysis for blood alcohol showed no ethanol, but showed a peak that was identified as isoflurane. Quantitative analysis of isoflurane in blood and tissues was performed by gas chromatography-mass spectrometry. The isoflurane concentrations in the left and right heart blood and femoral blood were 49.8, 54.6, and 44.7\u00a0\u00b5g\/mL, respectively. These concentrations were similar to those recorded in previous fatal isoflurane poisoning cases, and we concluded that the decedent had inhaled a high concentration of isoflurane using a plastic bag and died owing to acute toxicity resulting in respiratory failure. Tissue distribution patterns aligned with the lipophilic nature of isoflurane: adipose tissue had the highest isoflurane concentration (779.8\u00a0\u00b5g\/mL), and the concentrations were higher in liver (194.2\u00a0\u00b5g\/mL) and brain (149.0\u00a0\u00b5g\/mL) tissues than in others. This case highlights a grave concern regarding the management of drugs that may be abused in veterinary clinics in Japan. Stricter controls and pharmacist involvement in veterinary medication management are needed to prevent the abuse of these drugs.<\/jats:p>","DOI":"10.1007\/s12024-025-01121-5","type":"journal-article","created":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T09:57:25Z","timestamp":1761731845000},"page":"652-658","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Acute poisoning death resulting from a veterinary employee\u2019s isoflurane abuse"],"prefix":"10.1007","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0221-0645","authenticated-orcid":false,"given":"Ako","family":"Sasao","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyoko","family":"Hirata","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kosei","family":"Yonemitsu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuki","family":"Ohtsu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroshi","family":"Tsutsumi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shota","family":"Furukawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rie","family":"Sano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoko","family":"Nishitani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,10,29]]},"reference":[{"key":"1121_CR1","doi-asserted-by":"publisher","unstructured":"Milian RD. Inhalational anesthetics. In: Kaye AD and Urman RD, editors. Cambridge handbook of anesthesiology. Cambridge: Cambridge University Press 2023; 75\u201385; https:\/\/doi.org\/10.1017\/9781108936941.006","DOI":"10.1017\/9781108936941.006"},{"key":"1121_CR2","doi-asserted-by":"crossref","unstructured":"Stteffey EP, Mama KR, Brosnan RJ. Inhalation anesthetics. In: Grimm KA, Lamont LA, Tranquilli WJ, Greene SA, Robertson SA, editors Robertson SA, editors. Veterinary anesthesia and analgesia, the 5th edition of Lumb and Jones. New Jersey: Wiley-Blackwell; 2017. p. 297\u2013331.","DOI":"10.1002\/9781119421375.ch16"},{"key":"1121_CR3","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1016\/j.janh.2017.04.002","volume":"3","author":"GJ Crystal","year":"2017","unstructured":"Crystal GJ. Isoflurane and the coronary steal controversy of the 1980s: origin, resolution, and legacy. J Anesth Hist. 2017;3:56\u201362. https:\/\/doi.org\/10.1016\/j.janh.2017.04.002.","journal-title":"J Anesth Hist"},{"key":"1121_CR4","unstructured":"Japanese Pharmacopoeia. Isoflurane Forane\u00ae inhalation anesthetic [package insert], 7th ed. 2019; https:\/\/image.packageinsert.jp\/pdf.php?yjcode=1119701G1084"},{"key":"1121_CR5","doi-asserted-by":"publisher","DOI":"10.1186\/s13643-023-02331-0","author":"F Struijs","year":"2023","unstructured":"Struijs F, Hooijmans CR, Buijs M, Dahan A, Hoffmann S, Kiffen R, et al. Establishing a health-based recommended occupational exposure limit for isoflurane using experimental animal data: a systematic review protocol. Syst Rev. 2023. https:\/\/doi.org\/10.1186\/s13643-023-02331-0.","journal-title":"Syst Rev"},{"key":"1121_CR6","first-page":"1117","volume-title":"Disposition of toxic drugs and chemicals in man (11th edition)","author":"RC Baselt","year":"2017","unstructured":"Baselt RC. Disposition of toxic drugs and chemicals in man (11th edition). Seal Beach, California: Biomedical Publications; 2017. p. 1117\u20138."},{"key":"1121_CR7","doi-asserted-by":"publisher","DOI":"10.1111\/j.1556-4029.2007.00556.x","author":"CM Rosales","year":"2007","unstructured":"Rosales CM, Young T, Laster MJ, Eger EI, Garg U. Sevoflurane concentrations in blood, brain, and lung after sevoflurane-induced death. J Forensic Sci. 2007. https:\/\/doi.org\/10.1111\/j.1556-4029.2007.00556.x.","journal-title":"J Forensic Sci"},{"key":"1121_CR8","doi-asserted-by":"publisher","DOI":"10.1007\/s00414-002-0340-9","author":"M Pavlic","year":"2002","unstructured":"Pavlic M, Haidekker A, Grubwieser P, Rabl W. Fatal accident caused by isoflurane abuse. Int J Legal Med. 2002. https:\/\/doi.org\/10.1007\/s00414-002-0340-9.","journal-title":"Int J Legal Med"},{"key":"1121_CR9","doi-asserted-by":"publisher","first-page":"1408","DOI":"10.1520\/JFS12783J","volume":"34","author":"B Jacob","year":"1989","unstructured":"Jacob B, Heller C, Daldrup T, B\u00fcrrig KF, Barz J, Bonte W. Fatal accidental enflurane intoxication. J Forensic Sci. 1989;34:1408\u201312. https:\/\/doi.org\/10.1520\/JFS12783J.","journal-title":"J Forensic Sci"},{"key":"1121_CR10","doi-asserted-by":"publisher","DOI":"10.1520\/JFS13496J","author":"JJ Kuhlman","year":"1993","unstructured":"Kuhlman JJ, Magluilo J, Levine B, Smith ML. Two deaths involving isoflurane abuse. J Forensic Sci. 1993. https:\/\/doi.org\/10.1520\/JFS13496J.","journal-title":"J Forensic Sci"},{"key":"1121_CR11","first-page":"74","volume":"33","author":"MM Dooper","year":"1988","unstructured":"Dooper MM, Beerens J, Brenninkmeijer VJ, Gerlag PG. Fatal intoxication after ingestion of isoflurane. 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The use of de-identified clinical and autopsy information for publication was approved by the Ethics Committee for Epidemiological and General Research at the Faculty of Life Science, Kumamoto University (approval no. 943). All potentially identifying information has been removed.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"This case was investigated as a judicial autopsy under Japanese legal authority. The use of de-identified clinical and autopsy information for publication was approved by the Ethics Committee for Epidemiological and General Research at the Faculty of Life Science, Kumamoto University (approval no. 943). All potentially identifying information has been removed.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"None.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Generative AI and AI-assisted technologies in the writing process"}},{"value":"The authors did not receive support from any organization for the submitted work.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Financial interest"}},{"value":"The authors declare no competing interests.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}