Artigo Original
Como citar: Chambriard C. . Persp Med Legal Pericia Med. Vol. 11, 2026; 260850.
https://dx.doi.org/10.47005/260850
Recebido em 28/07/2026
Aceito em 03/08/2026
Los autores no informan ningún conflicto de intereses.
From Classical Asphyxia to a Two-Axis Etiopathogenetic Model for Medicolegal Classification
Resumo
A interrupção fatal da ventilação provocada por fármacos constitui problema relevante para a Medicina Legal, pois agente causal, mecanismo fisiopatológico, evento terminal e modalidade médico-legal da morte frequentemente são tratados como equivalentes. A classificação etiopatogênica de Hygino de Carvalho Hercules distingue asfixias naturais e violentas e distribui os agentes farmacológicos entre diferentes mecanismos: drogas contraturantes (espasmo), curarizantes (paralisia flácida) e depressoras (parada respiratória central), evidenciando utilidade mecanística, mas limitação etiológica. Objetivou-se reproduzir essa classificação, identificar sua limitação e propor um modelo etiopatogênico em dois eixos, aplicado a dois casos médico-legais. Realizou-se estudo descritivo, retrospectivo e conceitual, com revisão narrativa da literatura e análise integrada dos achados do local, da necropsia e da toxicologia forense. O Eixo I identifica a etiologia farmacológica ou tóxica; o Eixo II define o mecanismo respiratório predominante: depressão central, bloqueio neuromuscular com paralisia flácida, espasmo ou rigidez, mecanismo misto ou indeterminado. Neste estudo, “asfixia farmacológica” designa a categoria ampla, enquanto “asfixia medicamentosa” restringe-se aos casos envolvendo medicamentos. O primeiro caso envolveu vecurônio e mecanismo periférico flácido; o segundo, fentanila, midazolam, tramadol e outro anestésico, configurando mecanismo predominantemente central ou misto. Conclui-se que “asfixia farmacológica” possui utilidade didática como categoria etiológica, desde que qualificada pelo mecanismo e sem substituir a intoxicação como causa básica quando esta iniciar a cadeia fatal. A proposta amplia a precisão etiológica, fisiopatológica e causal.
Palavras Chave: asfixia farmacológica; insuficiência respiratória; intoxicação; bloqueio neuromuscular; opioides; toxicologia forense.
Abstract
Fatal interruption of ventilation caused by drugs is a relevant issue in forensic medicine because the causal agent, pathophysiological mechanism, terminal event, and manner of death are often treated as equivalent concepts. Hygino de Carvalho Hercules’ classical etiopathogenetic classification distinguishes natural from violent asphyxias and distributes pharmacological agents according to mechanism: contracturant drugs (spasm), curare-like agents (flaccid paralysis), and depressant drugs (central respiratory arrest). Although mechanistically useful, this classification has etiological limitations. This study reproduces the original classification, identifies its classificatory limitation, and proposes a two-axis etiopathogenetic model applied to two medicolegal cases. A descriptive, retrospective, and conceptual study was performed, combining a narrative literature review with an integrated analysis of scene findings, autopsy data, and forensic toxicology. Axis I identifies the pharmacological or toxic etiology, whereas Axis II defines the predominant respiratory mechanism as central depression, neuromuscular blockade with flaccid paralysis, muscular spasm or rigidity, a mixed mechanism, or an undetermined mechanism. Here, “pharmacological asphyxia” designates the broader category, whereas “medication-induced asphyxia” is restricted to cases involving medicinal products. The first case involved vecuronium and a peripheral flaccid mechanism; the second involved fentanyl, midazolam, tramadol, and another anesthetic agent, supporting a predominantly central or mixed mechanism. “Pharmacological asphyxia” is a useful etiological umbrella for educational purposes, provided it is qualified by the underlying mechanism and does not replace poisoning as the underlying cause when
Keywords (MeSH): pharmacological asphyxia; respiratory failure; poisoning; neuromuscular blockade; opioids; forensic toxicology.
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