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Rapid Responses: Rapid Responses published:
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The State of Palestine
- G Smith (11 February 2002)
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IMMOBILIZING AGENTS FOR CHECHEN TERRORISTS
- Sebastiano Mercadante (4 June 2003)
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G Smith, GP
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Sir/Madam When are the Western media and political parties - the BMJ included going to look at the Palestinian Israel conflict with fair eyes. In your article 'The psychology of terrorists, you state: 'A quarter century of restrictions and retaliation has not lessened the threat to Israel from violent Palestinian groups, and questions from human rights organisations on the legality of that response have been damaging' This is both persecutory and erroneous. Over three times as many Palestinians have been killed in the last year as Israelis. In the first few months it ws ten to one. It's time to stop pussy footing around the likes of Ariel Sharon and the immense Israeli lobbying groups and start listening to the facts. G Smith |
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Sebastiano Mercadante, Director La Maddalena Cancer Center,90145 Palermo
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Dear Sir - Russian government revealed to have used a gas mixture, including fentanyl and halothane, to incapacitate Chechen terrorists in the attempt to liberate the hostages in Moscow (1). Only recently, someone contested the official explanation provided by Russian government. This theory has been confuted by elementary notions about clinical and pharmacokinetic characteristics, which make these products unable to produce the disastrous effects observed at Moscow theatre (2). Carfentanil is a potent opioid which is used as rapid immobilizing agent for veterinary procedures in large wild animals, like bisons, bears, elks, ostriches, horses or domestic goats, often associated with other agents, like xylazine or detomidine, by darting (even from a helicopter), or delivering directly in the buccal cavity. Time to immobilization appears to be dose-dependent and more rapid than that produced by etorphine, another rapid and potent opioid agonist (3). Carfentanil induces rapid catatonic immobilization, characterized by limb and neck hyperextension. Undesidered adverse effects of immobilization are muscle rigidity, bradypnea, and oxygen desaturation. Of interest, recycling and renarcotization has been reported as possible cause of death of animals treated with a relatively low dose antagonist regimen, and a high ratio naloxone-carfentanil is required (4). It is likely that massive doses of carfentanil were used (the way to delivery by inhalational route and saturate the room space remains mysterious) in the theatre to obtain the fastest and maximum possible effect with the terrorists, but without taking into account the high possibilities of hostage involvement and, as it happens in immobilizing animals where doses cannot be precisely delivered, some victims would be expected. In the theatre naloxone syringes were found and it is possible that naloxone doses were not enough to reverse respiratory insufficiency, as it occurs in animals, which die as a complication of immobilization. Authorities should really give clear explanation, rather than providing generic and not exhaustive information, to the scientific world. Sebastiano Mercadante
1 - Schiermeier Q. Hostage deaths put gas weapons in spotlight. Nature 2002;420:7. 2- Rieder J, Keller C, Hoffmann G, Lirk P. Moscow theatre siege and aneshetic drugs. Lancet 2003;361:1131. 3- Heard DJ, Nichols WW, Buss D, Kollias GV. Comparative cardiopulmonary effects of intramuscularly administered etorphine and carfentanil in goats. Am J Vet Res 1996;57:87-96. 4- Miller MW, Wild MA, Lance WR. Efficacy and safety of naltrexone hydrochloride for antagonizing carfentanil citrate immobilization in captive Rocky Mountain elk (Cervus elaphus nelsoni). J Wild Dis 1996;32:234-239. Competing interests: None declared |
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