Controversy surrounds execution drugs

Convicted killer Dennis McGuire’s lawyers have argued that the two-drug combination the state plans to use to carry out his execution Thursday is untested and could lead to an inhumane condition called “air hunger.”

Medical professionals say that, although the combination of midazolam and hydromorphone is untested for use in executions, the drugs are well known and trusted in the medical field. When used in combination at the dosage levels planned they should quickly render McGuire unconscious and unaware of pain as his breathing then heart function stop.

I don’t believe that with this two drug combination, granted it has never been tried, that air hunger would be a real issue,” said Dennis Sullivan, director of the Center for Bioethics at Cedarville University.

Under the old three-drug combination used in most states before Danish-based Lundbeck banned the use of their product pentobarbital in executions, the process involved a sedative, a muscle relaxant and then a drug to stop the heart.

“Pentobarbital is induction of anesthetic to achieve a level of deep sedation to allow other drugs to be given,” Sullivan explained. “This is followed by a muscle relaxant drug (commonly Pancuronium bromide). This accomplished two things, deep anesthesia and the inability of the patient to move.”

Then the third drug, commonly potassium chloride, would be injected to stop the heart. Sullivan said that potassium chloride, when administered without proper anesthesia, could be very painful.

Cedarville associate professor of pharmacy Marty Eng explained that the new two-drug process also begins with a sedative, midazolam.

“The second drug (hydromorphone) is usually used for pain, severe pain,” he said. “Often times the side effects of that we worry about are things like causing the person to be too sedated, causing their breathing to slow down dangerously, especially in combination with the first drug.”

Together the drugs have a calming effect followed by unconsciousness, pain reduction and then cessation of breathing.

“Essentially these act on a part of the brain center that controls our automatic breathing. So by blocking that part of the brain you functionally stop breathing,” Eng said.

Heart function would stop soon after.

“Given the fast action of the two drugs and the level of doses that are planned, you would be unconscious long before the cessation of breathing,” Eng said.

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