Lethal injection

San Quentin State Prison ' s Lethal Injection Execution Room located in California, USA. 2010.

Lethal injection is a method of execution that consists of continuously injecting a lethal amount of various combined drugs intravenously, successively producing unconsciousness, respiratory paralysis, and cardiac arrest.

Its use is legal in China, Vietnam and the United States.

Lethal injection is also used for the application of euthanasia in countries that have legalized this practice (the Netherlands, Belgium, Colombia, Spain, Luxembourg, New Zealand and Canada), although for this use chloride is dispensed with potassium and a benzodiazepine (midazolam) is administered in sequence to decrease the level of consciousness before inducing coma, a local anesthetic (lidocaine) to avoid pain caused by coma-inducing drugs, a hypnotic (propofol or thiopental) to put the patient in a state of deep coma and finally a neuromuscular blocker (rocuronium, vecuronium, atracurium or cisatracurium) is administered which causes respiratory arrest and the patient dies of asphyxia.

Components

Hypnotics, sedatives and analgesics

These depressant drugs are the first to be administered and their function is to inhibit brain function, causing what is known as anesthetic hypnosis, a state where consciousness is lost and the senses are suppressed. It is essential that they act appropriately so that the executed person does not react to the action of the substances that are then introduced into the bloodstream.

• Sodium Tiopental is an immediate and short-lived barbiturate, which is used as an anesthesia inducer and to produce short-lived general anesthesia. Its intravenous effect appears quickly (30 to 40 sec) and persists from 10 to 30 min. It lacks muscle or analgesic relaxing properties and its main function is to produce loss of consciousness.
• Midazolam, is a short depressive action substance on the limbic system, with sedative, ansiolytic, amnestic, anticonvulsant and muscle relaxing properties. In high doses it produces a state of sopor and unconsciousness.
• Hidromorphone is an opioid analgesic, semi-synthetic derivative of morphine. It is indicated to combat intense pain. In combination with sedatives it contributes to the action of these.
• Etomidato, used in the state of Florida as a drug to anesthetize the prisoner.
• Diazepam, after being declared unconstitutional the electric chair in the state of Nebraska, said state executed the prisoner Carey Dean Moore with a new protocol of four drugs (diazepam, fentanyl, cisatracury and potassium chloride) in which this medication was included. This has been the only execution performed by Nebraska through lethal injection.
• Fentanilo, a drug used by the state of Nebraska in the only lethal injection execution.

Neuromuscular blockers

Called muscle relaxants, they cause a mismatch between the neuroelectric impulse and the striated muscle, which prevents its contraction, resulting in generalized paralysis, including that of the respiratory muscles, which stops breathing, with consequent suffocation.

• Pancuronium, non-polarizing mioneural blocker, is used to produce pre or intranesthesic relaxation and in the treatment of tetanus.
• Vecuronium, derived from the previous one.
• Rocuronio, used by several states, including Florida.
• Cisatracurio, used by the state of Nebraska to execute Carey Dean Moore being the only execution performed in this state by lethal injection.

Potassium ion donating agents

They saturate the tissue environment with potassium ions (K⁺) preventing their flow to the outside of the cardiac muscle cells, which leads to their paralysis.

• Potassium chloride solution.
• Potassium acetate is present in the Florida state's lethal injection protocol next to the etomidate and the rocuronium.

Modalities of use

In Texas, one of the states in the United States where execution is carried out by lethal injection, three substances are used together: sodium thiopental, pancuronium bromide and potassium chloride. Sodium thiopental is a hypnotic, the second is a non-depolarizing neuromuscular plaque blocker, which paralyzes the diaphragm and thoracic muscles, thus stopping respiration, and potassium chloride prevents depolarization of the heart muscle, causing it to arrest (or arrest). cardiac).

Another combination includes the use of midazolam, mixed or not with hydromorphone; vecuronium and potassium chloride.

Disputes

There is currently a debate in the United States, in the states where this injection system of the three substances is established as an execution system, whether it really produces a painless death or if there is suffering on the part of the convicted person.

On September 15, 2009, American inmate Romell Broom survived his execution by lethal injection at the Southern Correctional Facility in Lucasville, Ohio. The governor of the state, Ted Strickland, decided to suspend the execution and postpone it for a week after the condemned man had received 18 punctures in various parts of the body.

On February 22, 2018, the state of Alabama had to stay the execution of Doyle Lee Hamm, who had been sentenced to die by lethal injection. According to the doctors who treated him for his illness, his veins were so deteriorated that they could have burst during execution, causing the prisoner additional suffering. David was convicted in 1987 of shooting a motel clerk to the head during a robbery.