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Table 1 Qualitative and quantitative data resulted from the literature review. NR not reported

From: Nitrous oxide intoxication: systematic literature review and proposal of new diagnostic possibilities

Case report

No. of cases

Clinical/macroscopic findings

Histological findings

Toxicological samples

Toxicological technique

Toxicological results

Crime scene/anamnesis

Modality

Mehta 1974

1

Cyanosis, respiratory arrest

NR

NR

NR

NR

Anesthesia induced venously, then deepened with pure N2O for six breaths

Anestesiologucal accident

 

1

Extremely pale

NR

NR

NR

NR

Dental anestesia with 75% N2O

Anesthesiological accident

Mody 1975

1

Cyanosis, respiratory arrest

NR

NR

NR

NR

Dental anestesia with 75% N2O

Anesthesiological accident

DiMaio and Garriott 1978

4

Acute visceral congestion

NR

Blood, lung air

HSGC

8.97 ml/dl in blood; 4.8, 9.3, 4. 6 in the blood; in lung air 13.6 %, 12.3 %, and 22.7 %

N2O tank connected to a rubber tube held in the mouth; open tank of N2O in a car

Recreational use

LiPuma et al 1982

2

Pneumomediastinum, sore throat, neck swelling, bilateral emphysema of the neck and supraclavicular regions hoarseness., injected pharynx, dried exudation at the corners of both eyes

NR

NR

NR

NR

Many cartridges of N2O inhaled few hours before

Recreational use

Duncan and Moore 1984

4

Cyanosis

NR

NR

NR

NR

Anesthesia machine failure, cross connection

Anesthesiological accident

Fraunfelder 1988

1

N R

NR

NR

NR

NR

Plastic bag over victim’s head and a canister pf N2O

Recreational use

Leadbeatter 1988

1

NR

NR

Blood, urine, and air in cylinders

NR

Traces of N2O in blood

Anesthesiological machine with 95% N2O and 5% O2

Autoerotical activities

Chadly et al 1989

1

Heavy and edematous lungs, abundant congestion, multiorgan congestion

Contraction bands in myocardial fibers, multiviscer congestion

NR

NR

NR

Anesthesiological machine in an operating theater

Suicide

Wagner et al 1992

5

Lung congestion

NR

Blood and air in the left mainstem bronchus

NR

Positive for N2O

Plastic garbage bag close around the head with a belt and a N2O cartridge in the bag

NR

Gowitt and Hanzlick 1992

1

Decomposition

NR

NR

NR

Negative for N2O

Head covered with a plastic bag and a N2O tank nearby

Autoerotical activities

Prahlow and Lantz 1994

1

NR

NR

Blood and lungs

NR

35 ug/mL in blood, 45 ug/mL in lungs

Head covered with a plastic bag and a N2O tank in another room

Recreational use

Winek et al 1995

1

Cyanosis, congestion, and edema of tracheal mucosa, lung tissue, and bronchi

Acute cerebral edema and hyperemia, spongy degeneration and vacuolation of the myelin sheath, scattered axonal swelling

Hearth blood, lungs, bile, urine

HSGC

All samples were positive

Plastic mask on the face connected to a N2O cylinder

Recreational use

Hwang et al 1996

1

Frostbite on the left cheek

NR

NR

NR

NR

N2O sniffed directly from a cylinder in contact with the left cheek

Recreational use

Shields et al 2005

1

NR

NR

NR

NR

NR

A plastic bag encircled the victim’s head connected by a tube to a N2O canister

Authoerothical activities accident

Herff et al 2007

6

Respiratory arrest

NR

NR

NR

NR

Oxigen pipeline connecten to N2O tank

Anesthesiological accident

Poli et al 2010

8

Decomposition

NR

Air from the stomach (buried), from trachea (not buried); blood, urine, liver, bile, kidney, fat, brain

HSGC/ECD

5.28-83.63 g/m3 (air)

Cross connection between O2 and N2O lines in a hospital

Anesthesiological accident

Potocka-Banas et al 2011

1

Lung edema

Cerebral edema, acute anoxic lesions of the myocardium

NR

GC, LC e GC.MS

Negative for exogenous organic compounds

Man found with a lot o whipped cream canisters and a professional anesthesia machine

Recreational use

Bäckström et al 2015

2

Cyanosis, congestion of inner organs

NR

NR

NR

Negative for alcohol and illicit drugs

Modified gas mask connected to a whipped cream pump on the face; gas mask connected to a N2O cylinder

Authoerotical activities accident

Giuliani et al 2015

1

NR

NR

Brain, lung, peripheral blood

HS-GC-MS

47 μm/g in the brain

27 μm/g in the lung, 370 microgr/g in the blood

NR

NR

Lin and Bause 2017

1

NR

NR

NR

NR

NR

The dentist found with tube detached from the inhaler, held in the left hand, and held tightly between the teeth. The tube was connected to an N2O cylinder

Anesthesiological accident/suicide

Lee et al 2017

1

Cianosis

NR

NR

NR

NR

Death after dental anesthesia, % of O2 administrated not reported

Anesthesiological accident

Leth and Astrup 2017

1

Severe lung stasis and edema, cyanosis, dark lividity

NR

Lung and brain

HGCMS

NR

Plastic bag on the face filled with N2O from a cartridge for whipped cream dispenders

Suicide