Anesthesia administered prior to lethal injection may not be sufficient to prevent the condemned person from experiencing suffocation and severe pain, according to a report in The Lancet medical journal.

“It is possible that some of these inmates were fully aware during their executions,” investigators Dr. Leonidas G. Koniaris’ and colleagues suggest.

But generally, subjects are not monitored and are paralyzed during the process, so “any suffering of the inmate would be undetectable.”

The death penalty, legal in many states in the US, is most often executed by lethal injection, consisting of sodium thiopental for anesthesia, followed by pancuronium bromide to induce paralysis and potassium chloride to arrest the heart.

To investigate whether anesthesia methods are adequate in death penalty cases, Dr. Koniaris, at the University of Miami in Florida, and colleagues requested protocol information from the states of Texas and Virginia.

They found that medical personnel who administered the executions typically had no training in anesthesia, and there was no assessment of depth of anesthesia or loss of consciousness.

Furthermore, their calculations suggest that the typical 2-gram dose of thiopental used may be inadequate when the process takes longer than normal, the prisoner is anxious, or has developed a high tolerance to sedatives.

The investigators were able to obtain autopsy results from four other states. These suggest that thiopental concentrations in the blood were often lower than needed to induce unconsciousness.

Even animals are no longer subjected to paralysis when being put down, according to the American Veterinary Medical Association, the authors note.

“To prevent unnecessary cruelty and suffering, cessation and pubic review of lethal injections is warranted,” they conclude.

“It would be a cruel way to die,” a Lancet editorial maintains, “awake, paralyzed, unable to move, to breathe, while potassium burned through your veins.”

The cruelty involved, plus the unfair application of the death penalty that depends on where a defendant lives, his ethnicity, and how much money he has, leads the editorialists to conclude that capital punishment is “an American atrocity.”

SOURCE: Lancet, April 16, 2005.