Pulmonary edema

[Alf]

Hello. My first post here. I recently came across some information regarding pentobarbital injections and pulmonary edema. As per the reports overdose of drugs such as pentobarbital and sodium thiopental causes pulmonary edema, which gives a drowning feeling to executed inmates.

Does anyone know if this pulpulmonary edema is caused only in case of lethal injection or in oral lethal overdose as well?

You can read about it here:

 

[Aap]

Sigh. Consider the source. The US Supreme Court specifically rejected this argument and noted that even if this were the case, which medical science does not agree with or at best is not decided upon, the individual would be insensate before this occurs. Watch dignitas videos of thiopental or pentobarbital injections and note how unbelievably fast death comes. animal hearts can stop before the injection is finished.

this is a bullshit anti capital punishment argument, and, as the US Supreme Court notes, for years inmates petitioned to have their lethal injections ONLY be pentobarbital.

flash pulmonary edema, if it occurs, occurs long after consciousness is lost. It's like saying OMG _______ method caused someone's heart to stop it must be terrible. Everyone's heart stops in death.

lit is incredibly convenient that this user's one and only post is some bullshit fear mongering.

 

[GoodPersonEffed]

Forgive me if this sounds harsh, but I'm seriously asking, did you actually listen to the link? I did. That's why I gave the OP an angry react, to highlight that it's off, not because I'm pissed off.

The issue is that in lethal injection for inmates, the protocol is the injection of three drugs, not all at once. In the report they say that it's the first drug that is the issue, midazolam, which is supposed to anesthetize the inmate prior to the other drugs being injected. First, midazolam was considered to be the primary cause of pulmonary edema, because the inmates are given a 500mg fast dose, when the norm is 1-2mg given slowly. Second, they said that midazolam is not reliable for causing anesthetization. So inmates were given pulmonary edema with a massive push of midazolam, which could have then been exacerbated by the other two drugs, and the midazolam didn't knock all of them out.

Folks who suicide with pentobarbital don't go throught the lethal injection protocol. If they have an assisted suicide, they might be given a benzo first to calm them, and midazolam is a benzo, but they're not given a massive dose. Then they either drink the pentobarbital or are given it via injection or IV. One cannot inject themselves with pentobarbital because it takes effect so quickly, they would lose consciousness before giving themselves a lethal dose. That's why they drink it if it's not assisted, unless they have the ability to set up a drip that will continue after they lose consciousness.

Not that it matters in this discussion, but since nembutal causes such rapid loss of consciousness and is reliable to do so, I don't understand the point of using midazolam for the purpose of anesthesia. They briefly mentioned something that made it sound like perhaps they don't use the lethal dose of nembutal, but the only dose they revealed was for midazolam; please correct me if I'm wrong about that.


OP, I don't mean to scare you off if you're legit, but sometimes folks join, make one post like this to generate fear, and then never post again. I hope you're not here to "rescue" people from suicide with fearmongering, but even if you are, the report is no cause for fear.

 

[Aap]

The pulmonary edema associated with pentobarbital only lethal injections was the argument raised to the us Supreme Court in order to stop the resumption of federal lethal injections. Either way, it is not a concern.

 

[Alf]

Forgive me if this sounds harsh, but I'm seriously asking, did you actually listen to the link? I did. That's why I gave the OP an angry react, to highlight that it's off, not because I'm pissed off.

The issue is that in lethal injection for inmates, the protocol is the injection of three drugs, not all at once. In the report they say that it's the first drug that is the issue, midazolam, which is supposed to anesthetize the inmate prior to the other drugs being injected. First, midazolam was considered to be the primary cause of pulmonary edema, because the inmates are given a 500mg fast dose, when the norm is 1-2mg given slowly. Second, they said that midazolam is not reliable for causing anesthetization. So inmates were given pulmonary edema with a massive push of midazolam, which could have then been exacerbated by the other two drugs, and the midazolam didn't knock all of them out.

Folks who suicide with pentobarbital don't go throught the lethal injection protocol. If they have an assisted suicide, they might be given a benzo first to calm them, and midazolam is a benzo, but they're not given a massive dose. Then they either drink the pentobarbital or are given it via injection or IV. One cannot inject themselves with pentobarbital because it takes effect so quickly, they would lose consciousness before giving themselves a lethal dose. That's why they drink it if it's not assisted, unless they have the ability to set up a drip that will continue after they lose consciousness.

Not that it matters in this discussion, but since nembutal causes such rapid loss of consciousness and is reliable to do so, I don't understand the point of using midazolam for the purpose of anesthesia. They briefly mentioned something that made it sound like perhaps they don't use the lethal dose of nembutal, but the only dose they revealed was for midazolam; please correct me if I'm wrong about that.


OP, I don't mean to scare you off if you're legit, but sometimes folks join, make one post like this to generate fear, and then never post again. I hope you're not here to "rescue" people from suicide with fearmongering, but even if you are, the report is no cause for fear.

It isn't midazolam alone that causes pulmonary edema as per the link. The article states: "If we increase a dose of almost any medication and give it intravenously, you may have a thousand drugs capable of causing pulmonary edema when given at a higher than therapeutic dosage."

My question was rather simple, whether oral dosage of pentobarbital can also cause pulmonary edema as in the case of injections.

My intention is not to cause fear. I have some good reasons to investigate this matter and thought this place might be the right place to discuss, which I think is obvious why.

 

[Meditation guide]

About the accusation of fear mongering; I doubt that anyone is going to be afraid due to that post.

I think if it's taken orally there is no pulmonary edema.

It's a legitimate question the OP asks. If they have an ulterior motive it's not going to do much in my opinion to cause fear in anyone. I so far have not heard of anyone who has pentobarbital here.

 

[Aap]

The answer, again, is NO. Not a risk from oral or IV pentobarbital. If it did cause pulmonary edema, it would be long after consciousness is lost. It doesn't, though. This only became a "concern" when a new angle was sought to stop federal executions.

 

[Sherri]

Hello. My first post here. I recently came across some information regarding pentobarbital injections and pulmonary edema. As per the reports overdose of drugs such as pentobarbital and sodium thiopental causes pulmonary edema, which gives a drowning feeling to executed inmates.

Does anyone know if this pulpulmonary edema is caused only in case of lethal injection or in oral lethal overdose as well?

You can read about it here:

Death sentences should be banned. I think a life sentence of jail is the biggest punishment.

 

[Sherri]

I would much prefer death and I'm sure a lot of prisoners feel that way. It's so odd how they often manage to screw up the execution though so the prisoner suffers. One time they didn't hit the vein and injected the drugs into a muscle.

So you kill someone's family for example and give them eternal sleep? That's not justice. Justice is you doing a life sentence and consider everyday the wrong you did to someone and their families. But of course I respect your opinion.

 

[GoodPersonEffed]

It isn't midazolam alone that causes pulmonary edema as per the link. The article states: "If we increase a dose of almost any medication and give it intravenously, you may have a thousand drugs capable of causing pulmonary edema when given at a higher than therapeutic dosage."

You didn't link the article, you linked the audio. But okay, so other drugs can cause it...intravenously. However in the audio they clearly stated that, in this investigation of multiple cases, midazolam was what they were viewing as the primary cause and why, which I put in bold. They did not indicate the other drugs, including pentobarbital, were the primary cause. If pentobarbital were given without other drugs and pulmonary edema was still discovered, then it would be somewhat relevant to our purposes.

My question was rather simple, whether oral dosage of pentobarbital can also cause pulmonary edema as in the case of injections.

Yes, it's a simple question. The confusion came from using a source that primarily focused on midazolam as the primary cause.

Google search results for "pentobarbital pulmonary edema" potentially indicate that pentobarbital can cause pulmonary edema regardless of how it's taken.

According to this article, "Delayed complications of barbiturate toxicity in survivors include aspiration with and without pneumonia, pulmonary edema, cerebral edema and infarct, and multiorgan failure [1]."

I'd do more searching and provide more evidence to be certain, but I'm on a tablet and every time I come back to what I'm typing, a bunch of it is lost. So, the information is out there, I'd suggest using that search term to find more evidence. It seems that CNS depression can cause pulmonary edema, and that's what pentobarbital does. I also found another link that had only the barest of information, not even an abstract, it was a French study from 1970 of three women who suicided with pentobarbital and had pulmonary edema, I can only speculate they took it orally, but I have no way of knowing. I'm sure there's plenty more information out there, I didn't have to look far to find what I did.

My intention is not to cause fear. I have some good reasons to investigate this matter and thought this place might be the right place to discuss, which I think is obvious why.

Yes, this would be an obvious place to discuss it and, sincerely, hooray if that's not your intention.

 

[Alf]

Google search results for "pentobarbital pulmonary edema" potentially indicate that pentobarbital can cause pulmonary edema regardless of how it's taken.

If that is indeed the case, then how painless can death from pentobarbital overdose be? Unless, as someone suggested here, the anesthetic effect of the pentobarbital or sodium thiopental renders the person incapable of feeling anything.

 

[GoodPersonEffed]

Unless, as someone suggested here, the anesthetic effect of the pentobarbital or sodium thiopental renders the person incapable of feeling anything.

That's generally how it works. Rapid loss of consciousness. So rapid that one can't self-inject a fatal dose of pentobarbital. I have no knowledge of sodium thoipental, and I'm confused as to why that's now being introduced into the discussion.

Edit: Sorry, I overlooked it in the OP.

 

[Meditation guide]

If that is indeed the case, then how painless can death from pentobarbital overdose be? Unless, as someone suggested here, the anesthetic effect of the pentobarbital or sodium thiopental renders the person incapable of feeling anything.

You can look at videos on youtube or other places where you can see how people die on pentobarbital. They do not drown, they close their eyes and die in about five minutes.

Dignitas uses the following protocol to assist suicides: an oral dose of an antiemetic drug, followed approximately half an hour later by a lethal overdose of 15 grams of powdered pentobarbital dissolved in a glass of water. If necessary, the drugs can be ingested via a drinking straw.

It shuts down the nervous system.

I found a scientific study that said pentobarbital actually provides a protective affect to the lungs.

 

[Alf]

You can look at videos on youtube or other places where you can see how people die on pentobarbital. They do not drown, they close their eyes and die in about five minutes.

The videos I have seen don't show the entire process, only the drinking and going unconscious part is shown and one towards the end where the person is dead.

 

[Meditation guide]

The videos I have seen don't show the entire process, only the drinking and going unconscious part is shown and one towards the end where the person is dead.

Did they look like they were drowning as they went unconscious?

 

[Alf]

Did they look like they were drowning as they went unconscious?

No. What is a more pertinent question to me is whether after being unconscious there is the feeling of drowning due to pulmonary edema? What if the person feels it but can't express it? (something similar to the rare phenomenon of a person feeling the pain of surgery while under anesthesia and apparently unconscious)

 

[Aap]

You are conflating multiple issues. People do not feel pain while anesthetized. It is the literal definition of anesthesia. The phenomenon you describe is when anesthetic is too little (and usually when an inhaled anesthetic gas is empty), and the individual literally wakes up but cannot move due to the paralytics used during surgery.

For the last time neither IV nor oral pentobarbital create a situation where the recipient feels like they are "drowning" due to pulmonary edema. This was never a concern raised until the US began resuming lethal injections on a federal level...this year.

Death from N is incredibly rapid and as peaceful as death can be. I'm not sure why you want to argue this point.

 

[Deleted member 22624]

It seems very clear to me that:

1. The high concentration front caused by ***injecting any*** drug has a very high risk of causing a PE.
2. Visible effects from feeling of drowning would be masked by subsequent LI drugs

Its that simple. Hence I upvoted OP, sorry for the angry face Aap, I always appreciate your posts but this is a very valid fear with clear quality evidence and for some reason you seem to me to have overlooked the substantial suffering this could cause

 

[Alf]

You are conflating multiple issues. People do not feel pain while anesthetized. It is the literal definition of anesthesia. The phenomenon you describe is when anesthetic is too little (and usually when an inhaled anesthetic gas is empty), and the individual literally wakes up but cannot move due to the paralytics used during surgery.

That sounds right to me, and just the kind of answers I'm looking for.

Death from N is incredibly rapid and as peaceful as death can be. I'm not sure why you want to argue this point.

I understand what you're saying and I mostly thought the same way until I read about pulmonary edema and decided to study it. I'm not arguing to prove a point here, so in case you think I am putting forth a definitive view of mine then you're wrong. I'm merely trying to see what others have to say on this which might help me understand the issue better.

 

[Aap]

Anyone is certainly entitled to whatever opinion they wish, but not their own facts. Medical science can easily describe the mechanism by which death can occur in 20 seconds following a pentobarbital injection. However, No one can describe a mechanism in which the lungs become flooded with fluid in this same amount of time unless it involves a water hose down the throat.

No one is suggesting, including the NPR interview sourced, that oral barbiturates cause flash pulmonary edema. The reason is because they do not cause this. Taking a claim that no one is making and then asking it to be confirmed or denied is one thing. Taking something no one is saying and asking it to be disproved is another.

 

[Deleted member 22624]

Anyone is certainly entitled to whatever opinion they wish, but not their own facts. Medical science can easily describe the mechanism by which death can occur in 20 seconds following a pentobarbital injection. However, No one can describe a mechanism in which the lungs become flooded with fluid in this same amount of time unless it involves a water hose down the throat.

No one is suggesting, including the NPR interview sourced, that oral barbiturates cause flash pulmonary edema. The reason is because they do not cause this. Taking a claim that no one is making and then asking it to be confirmed or denied is one thing. Taking something no one is saying and asking it to be disproved is another.

Not the concentrated front of toxins hitting the lungs as per a rapid injection well above the theraputic dose, damaging the fragile lung membrane?

 

[Aap]

No. That would not remote cause pulmonary edema in that timeframe. Barbiturates do no touch lung tissue, nor does anything that flows through the lungs. They are always in the vasculature. Anything that could destroy the lungs to that degree you describe (something directly and irreversibly cellulotoxic) would eat through the capillaries, flood the lungs with blood (not fluid) and prevent anything from reaching the brain.

Again, EVERY time this is administered for euthanasia (in animals or humans), the result is the same. A rapid, rapid and peaceful incapacitation and death. Are you suggesting animals die a horrible death from this? Are you suggesting the dignitas videos or accounts of barbiturate injection are fake?

 

[Deleted member 22624]

Thanks for replying again. I don't know if animals suffer, and I doubt dignitas would fake videos. But this evidence needs an explanation: why do so many inmates appear to gasp like that? Why are their lungs filled with fluid? Why were their deaths so slow?

Edit: and iirc the text that the videos link to did say there was blood in at least some of the lungs. You say that it would prevent the substance reaching the brain, and that's exactly what seems to have happened, judging by the slow death and low concentrations of pentobarbital in their blood post-mortem

 

[Aap]

You are conflating multiple issues, not the least of which is this is data from the 3 drug cocktail, which often doesn't even involve pentobarbital. People gasp from agonal breathing during death. It is what happens. Death often does not look pretty and can smell and sound unpleasant. The data you describe of "slow" deaths is from the 3 drug cocktail. I would not doubt reports of underdosing or using expired medications. Do we know if the pulmonary edema occurred from the sedative vs the KCl or how quickly or slowly it occurred? Nope.

In any case, dosages of the sedating agent in the 3 drug cocktail (be it versed, amidate, thiopental, or pentobarbital) are NOT designed to cause death. They are designed to cause sedation prior to the paralytic and KCl. Paralytics do not work instantly, and during this time, the body struggles to breathe until the diaphragm is paralyzed.

I'll give you another example of a "prolonged" death that looked unpleasant to the observers. Ohio used a versed/dilaudid cocktail. After injection, the unconscious inmate struggled to breathe for 20 minutes before expiring. Did this sound bad? Sure. Was this unexpected to anyone medically trained? No, of course not. This is what an opioid overdose looks like. Was the individual conscious? Nope. Was it painful? Definitely not.

Individuals under pentobarbital injections and receiving adequate dosing for the purpose of death do no feel pain beyond injection site burning. This is not controversial. Do not confuse objections to capital punishment as some newfangled proof that pentobarbital is now magically the worst possible way imaginable to die.

Anyone who has seen dignitas videos or animals euthanized knows that this is simply not the case. Don't agree with me? Those that don't should throw away the N they do not have. In other words, it is a (misguided) academic exercise in hand wringing.

Every national veterinary and assisted suicide organization view pentobarbital as a gold standard for speed and peacefulness for a reason. Confusing the politics of lethal injection and citing a protocol that veterinary organizations do not view as humane and conflating that with pentobarbital only lethal injections is muddying the issue to the point of irrelevancy.

 

[Alf]

Confusing the politics of lethal injection and citing a protocol that veterinary organizations do not view as humane and conflating that with pentobarbital only lethal injections is muddying the issue to the point of irrelevancy.

The article I shared does mention pulmonary edema in case of pentobarbital as well as sodium thiopental injection, so it is certainly not irrelevant. Here's another link :https://www.washingtonpost.com/nati...a7e3ca-e40f-11ea-82d8-5e55d47e90ca_story.html

 

[Aap]

By all means friend, yell to the skies that pentobarbital is not peaceful, but keep reading.

Again, this article deals with the three drug protocol. Do you want to know how bullshit and misleading this article is? Look at the quote below:

" "You can be paralyzed and totally awake," says Susi Vassallo, a toxicologist and professor of emergency medicine at New York University. She says that in a hospital setting, paralytics aren't used because they eliminate the doctors' ability to monitor their patients.

"We never paralyze the patient, because we need to look at them. We need to see if their face shows any pain. We need to make sure they're unconscious," Vassallo says. "But if they're paralyzed, we don't know anything. They could be having a seizure. They could be screaming. Whatever they're doing, we don't see or hear anything.""


This is CATEGORICALLY and DEFINITIVELY untrue. Not a little untrue, but completely. Paralytics are used in nearly every surgery performed in America. Nearly every. Single. One.

Read the above again and rectify the quote from the article and the fact paralytics are on the WHO list of essential medicines and used daily in hospitals. The answer is this is a biased article and more concerned with a political agenda than facts.

The article is misleading in parts, untrue in others (see above), about a three drug protocol, and completely contrary to what the AVA and assisted suicide organizations view as among the least painful and most humane manners of euthanasia.

If you are arguing this because you are against capital punishment, you are arguing with the wrong person in the wrong place. If you are arguing this because you have N, then throw it away. If you are arguing this because you feel pentobarbital is inhumane, then take it up with the AVA and any number of assisted suicide organizations (they will laugh at you). Why again are you arguing this?