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Elizabeth Holloway
08-24-2012, 11:21 AM
It's funny I should come to this board to ask this question, since I'm a nurse and work regularly with anesthesiologists. However, given the nature of the question and the fact that I'm a bit shy about my writing, I'm hoping someone here can help me.

In my latest WIP, a character is kidnapped from her home. The man who nabs her is a skilled anesthesiologist. What drug would an anesthesiologist use if he wanted to knock someone (without IV access) out quickly (within 10 min) and have her sleep for a few hours.

In my research, I've found chloroform would be quick, but it wears off too soon (10 min) and has adverse side-effects that would not work for the plot (severe, almost debilitating headache). I also came across a cocktail intramuscular injection of Ativan and Haldol, which would work as far as duration of effects, but I've seen for myself how long that takes to get someone to totally pass out (30min to 1hour) and that wouldn't work for the plot either. So, does anyone have any suggestions as to what an anesthesiologist, with unlimited access to anesthetics and analgesics, would use to knock out and kidnap a 16yo girl?

Muchas Gracias.

Snick
08-24-2012, 04:28 PM
I am not an anesthesiologist, and I don't know even as much as you do, but I think that the answer is a two stage knockout. The chloroform would do the initial knockout, and an injection of a longer acting drug could follow in a few minutes. As I understand it, that is how most anesthesia is done. I think that there is no single drug that would work without there being a fair chance of an overdose.

BTW, I didn't realize it at the time but being an anesthesiologist would have been an excellent career choice for me.

WeaselFire
08-24-2012, 05:48 PM
Propofol would be most common now. Pentathol used to be. But they're intravenous, so you can't just jab someone with a needle. Maybe chloroform, then an IV.

Then again, the knife/gun and "Scream and I kill you" approach has always worked for me. Um... I mean others. Yeah, others... :)

Jeff

Elizabeth Holloway
08-25-2012, 05:38 PM
Then again, the knife/gun and "Scream and I kill you" approach has always worked for me. Um... I mean others. Yeah, others... :)

Hahaha! Thanks for the laugh!

Thanks, everyone, for responding. I think I'm going to go with Ketamine, thanks to a PM from a very helpful AWer.

If anyone has any other ideas, however, I'd still love to hear it.

Beth

GeorgeK
08-26-2012, 05:14 PM
The anaesthesiologists don't own the drugs that they work with. If he took drugs from the institution that would be figured out eventually. He might get by with a one time thing but if this is an ongoing thing he will be caught unless he manages to pass blame for the thefts on someone else. Alternately he could be shorting patients but surgeons tend to notice when their patients wake up during surgery.

The simplest drug that he could make at home with a small investment in lab equipment would be ether. He could also buy some black market rohypnol.

veinglory
08-26-2012, 08:40 PM
There isn't going to be chloroform lying around a modern hospitall They could use isoflourane or halothane but *all* of these carry a serious rosk of killing the victim when delivered in an uncontrolled 'drops on a rag' sort of way.

Al Stevens
08-26-2012, 09:08 PM
There isn't going to be chloroform lying around a modern hospitall.But it's easy to make at home.

veinglory
08-26-2012, 09:10 PM
Sure, but he will have access to superior product at work, and these bottle have an overfill he could save aside without it without it ever showing up on the books.

Pyekett
08-26-2012, 09:20 PM
Anesthesiologists have the highest rate of addiction in the medical profession. There are a lot of different theories. Men's Health (http://www.menshealth.com/health/junkie-or) did an article for the general reader on this. It's more on the sensational side than a technical article, but the primary person profiled is a real guy (http://www.thefix.com/content/jeffrey-junig-1), and the problems are real.

Diversion of substances from patient care definitely happens. It's hard to do without being caught, but when it does happen, odds are that this is the route (just because it is such a big problem).

Added: There's a theory detailed near the end of the MH article that anesthesiologists are exposed unintentionally to substances in the course of long operations, and this may drive some of the problem. The MH article was published in 2006. I don't know what the current thinking is. A technical article from 2008 (Addiction and Substance Abuse in Anesthesiology (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2766183/) from Anesthesiology) has further cites and review of the literature to that point.

Elizabeth Holloway
08-27-2012, 04:31 AM
I was trying to stay away from chloroform. I know it's not common in the hospital environment, and I figured an anesthesiologist would have something better and less cliche up his sleeve.

As for access to the drugs, it would be very easy for an anesthesiologist to get his hands on the drugs he uses during surgery. Veinglory is right, meds like this come in pre-measured vials. If the whole vial is not needed for the surgery, then the rest could easily be stashed. As a nurse, I commonly waste leftover narcotics that I could easily pocket (if I did that sort of thing, which I don't.). Yes, there are safety measures in place (I'm required to waste leftover narcotics with an other RN) but you could get around these things fairly easily, if you really wanted to (which I don't. Really. I'm not a druggie-nurse).

Access to the drug is not a problem. My biggest issues are time to onset of effects if given intramuscularly since IV access is not possible, duration of effects, and side-effects/adverse reactions (my character cares for the girl he's kidnapping and doesn't want to hurt her).

GeorgeK
08-27-2012, 04:49 PM
Sure, but he will have access to superior product at work, and these bottle have an overfill he could save aside without it without it ever showing up on the books.

What do you mean by an, "overfill," and how do you propose he transport the stolen product? The bottles are tracked closely. Also the problem with halothane and isoflurane is that they are designed for an operating room staffed by an anesthetist with a well stocked drug tray. There is a thin line between anaesthesia and apnea with those drugs. They're not the kinds of things that can be used on the fly outside of a controlled environment. Ether, however has a wide safety margin although people do tend to wake up with a hangover. Nitrous oxide would be another choice but it would require pressurized tanks like halothane etc.

GeorgeK
08-27-2012, 04:53 PM
meds like this come in pre-measured vials..

It depends on which drugs that you are talking about. Inhalation agents and many other drugs do not come in vials. As Pyekett pointed out there's a high rate of substance abuse among aneasthesia personell so they get watched closer. Another thing to consider on your choice of drugs is the route of administration. Some things need to be injected into a blood vessel, some can be intramuscular or subcuticular, some can be imbibed or inhaled. The simplest solution is to make up a ficticious drug that suits your needs.

veinglory
08-27-2012, 06:21 PM
I mean that many producers actually over fill their bottle by a predictable amount so there is slightly more in the vial than it states on the label. It is also true that disposal is not generally witnessed by multiple people, and no one searches you going in and out. Thus I have no trouble at all seeing a useful amount of isoflourane or some such being lifted.

That would leave only the task of making a delivery system using parts that can be bought over the internet, e.g. a mask and some substrate to put the anesthetic on. Once he had a deliver a few inches from the mouth there is a lot more control.

I don't know for sure but I bet you could induce while someone is still asleep, because we aren't sensitive to smells while sleeping.

Maryn
08-27-2012, 06:36 PM
I'm not sure about that. I've been brought to full wakefulness by skunk more than once, when on the second floor of a house with the windows open. And when our kids were babies, the smell of a dirty diaper could wake me.

Maryn, whose nose is not especially sensitive

GeorgeK
08-27-2012, 07:16 PM
I mean that many producers actually over fill their bottle by a predictable amount so there is slightly more in the vial than it states on the label. It is also true that disposal is not generally witnessed by multiple people, and no one searches you going in and out. Thus I have no trouble at all seeing a useful amount of isoflourane or some such being lifted.

That would leave only the task of making a delivery system using parts that can be bought over the internet, e.g. a mask and some substrate to put the anesthetic on. Once he had a deliver a few inches from the mouth there is a lot more control.

I don't know for sure but I bet you could induce while someone is still asleep, because we aren't sensitive to smells while sleeping.

Halothane and isoflurane don't come in vials. They are inhalation agents in large cannisters about the size of a large construction worker sized thermos. Those cannisters are sent back to the manufacturer, not discarded (at least in the OR's where I've worked). There are paralytic agents in vials like pancuronium or succinyl choline as well as vials of other injectible agents. There are kits for procedures where sometimes unopened vials are discarded, but those contain local anaesthetics like lidocaine not systemic stuff. I suppose there might theoretically be crash cart kits (I've never seen one) where vials of narcotics and benzodiazepines might exist and not be tracked if not used.

It's actually probably easier for a nurse to steal from a hospital than a physician. I'd imagine a pharmacist would have the easiest time.

The cases that I have heard of, they'd pocket a syringe or vial or pills of something ordered for a patient and then give the patient a shot of saline. I actually had that happen to me when I was a patient. The nurse was hired after I retired. She didn't know I was a physician and her documentation of pills given to me did not match what I was actually given. I told the Dr the next morning and a phone call from him resulted in a drug test on her and she was gone.

Smells can wake the average person, especially the nasty smell of the inhalation agents. They smell like a mix of plastic and solvents.

Al Stevens
08-27-2012, 07:24 PM
It's fiction. Slip him a mickey. Any (fictional) underworld bartender knows how to do it.

veinglory
08-27-2012, 07:31 PM
Halothane and isoflurane don't come in vials. They are inhalation agents in large cannisters about the size of a large construction worker sized thermos.

Iso and halothane containers come in a range of sizes including plastic bottles one can, and in my case have, slipped into a pocket. (Just to transport them in my case, of course) And measuring out from these bottles i usually had a few mls left over. (Which I disposed of). Just getting the stuff into the anesthesia machine will require decanted amounts, I would think.

And it is well documented that smells do not wake people up, even very noxious ones. http://abcnews.go.com/Technology/story?id=99515&page=1#.UDuSSaCWPRE

Someone inventive could use a set up like this to great effect http://www.ncbi.nlm.nih.gov/pubmed/17984268 (http://www.ncbi.nlm.nih.gov/pubmed/17984268)
Then all he would need is a small gas canister and mask.

IMHO, I appreciate it when people come up with something plausible in real life.

Al Stevens
08-27-2012, 08:15 PM
I'll gladly forsake reality to spare my readers some jargon-laden info-dump or them having to stop reading so they can look up some technical and esoteric term or name. I like Al Capp's approach. Kickapoo Joy Juice.

"She selected a vial from the tray and slipped it into the pocket of her smock. This stuff would keep him under for a while."

(ta-dum + rim shot)

GeorgeK
08-28-2012, 01:14 AM
Iso and halothane containers come in a range of sizes including plastic bottles one can, and in my case have, slipped into a pocket. (Just to transport them in my case, of course) And measuring out from these bottles i usually had a few mls left over. (Which I disposed of). Just getting the stuff into the anesthesia machine will require decanted amounts, I would think.

And it is well documented that smells do not wake people up, even very noxious ones. http://abcnews.go.com/Technology/story?id=99515&page=1#.UDuSSaCWPRE

Someone inventive could use a set up like this to great effect http://www.ncbi.nlm.nih.gov/pubmed/17984268 (http://www.ncbi.nlm.nih.gov/pubmed/17984268)
Then all he would need is a small gas canister and mask.

IMHO, I appreciate it when people come up with something plausible in real life.


I do not accept that article as being well documented about smells not waking people up. The issue in the article is regarding a very slow increase in aroma/stench and that is true just like you can boil a frog if the water starts out cold. Evolutionarily we need to be awoken with sudden changes in any sensory stimulus otherwise you don't wake up until the bear is already eating you. For someone to use inhalation agents on someone in a natural sleep and not wake them up they will need to go very slow or the smell could wake them, the gas blowing on their face could wake them, the creepy villain and his heavy breathing could wake them.

I grant that there may be sizes of inhalation cannisters that I have not seen, but there is still the safety issue. For those agents, (halothane and isoflurane) there is a high risk of overdose and death. Before you turn those on, you have your laryngoscope ready and ET tube ready to intubate. There is a reason that many states ban their use outside of hospitals and surgery centers (assuming the laws haven't changed since I retired). If the villain is kidnapping the victim, then presumably the villain wants the victim alive and the villain needs to make a getaway without having to hold the victim's airway open. There are far safer products to that end and the anaesthesiologist would know that, unless it was was someone incompetent.

Elizabeth Holloway
08-28-2012, 05:44 AM
If the villain is kidnapping the victim, then presumably the villain wants the victim alive and the villain needs to make a getaway without having to hold the victim's airway open. There are far safer products to that end and the anaesthesiologist would know that, unless it was was someone incompetent.

Which is the reason I think I'm going to go with an IM injection of Ketamine. I can't have my baddie worried about airway (too much) while he's throwing her over his shoulder and getting the hell out of Dodge.

Al, don't worry. :) I wasn't planning on listing a medical info-dump during this scene. I really just wanted to know if it was possible within the confines of my plot (no IV access, no advanced life support equipment, girl needs to be a knocked out fast and stay out for at least an hour). And if it was possible, how would it be delivered (drops on a rag vs. IM injection). While I have no problem being creative to make a plot work, for this story and since the character IS an anesthesiologist, I'd like it to at least be plausible.

:)

GeorgeK
08-28-2012, 04:38 PM
...I can't have my baddie worried about airway (too much) while he's throwing her over his shoulder and getting the hell out of Dodge.

...(no IV access, no advanced life support equipment, girl needs to be a knocked out fast and stay out for at least an hour). And if it was possible, how would it be delivered (drops on a rag vs. IM injection). While I have no problem being creative to make a plot work, for this story and since the character IS an anesthesiologist, I'd like it to at least be plausible.

:)
I'll PM you

NikkiSloan
08-30-2012, 09:58 PM
I'm not sure about that. I've been brought to full wakefulness by skunk more than once, when on the second floor of a house with the windows open. And when our kids were babies, the smell of a dirty diaper could wake me.

Maryn, whose nose is not especially sensitive

Same here - a dog fart awakens me from a dead sleep, but probably because I'm on constant alert due to the unfortunate habits of one of my dogs. A skunk could probably spray my head and I wouldn't notice right away.

Zeddo
06-13-2013, 07:54 AM
Sorry to resurrect an old thread, but I've got the same problem as other here, but with a slightly different twist. I've googled, but just get more confused.

The villains use a quick-acting inhaled anesthetic to abduct a 5 year old. They keep him "sleeping" (doesn't have to be completely anesthetized) for 24 hours before he's rescued unharmed and taken to hospital. Tests reveal traces in his blood of whatever was used to keep him unconscious.

The drug was supplied by a nurse, but administered by someone without medical training. Would isofluorane be a possibility? Is there a less-dangerous drug that would render the child unconscious within a few seconds? How quickly would a child recover consciousness once the drug is stopped?