Incapacitating agents review: 20 years after Nord Ost Siege

Abstract

Incapacitating agents are chemical weapons that produce a temporary disabling condition that persists for hours or days after exposure. Their main site of action is the central nervous system and includes substances that are considered depressants or stimulants. While not intended to cause death, can produce significant morbidity in affected patients. The objective of this narrative review is to update the toxicokinetics, toxicodynamics, diagnosis, and treatment of these chemicals, considering that 20 years have passed since the Nord Ost Siege, where a fentanyl derivative was used by Russian forces to neutralize a group of Chechen dissidents. A bibliographic search was carried out in PubMed, SciELO, and Cochrane Library databases as well as nonindexed scientific literature.

Keywords:

• Incapacitating agent
• chemical weapon
• 3-quinuclidinyl benzilate
• carfentanil
• nord ost siege

Acknowledgments

The author is grateful for the unconditional support of Ignacio M. Gallo (Biochemist, Mg. Toxicology) and Facundo J. Juárez (MD) from Prof. Alejandro Posadas National Hospital/National Poison Center (Argentina) for the publication of this scientific article. The author thanks the anonymous external reviewers chosen by the Editor who provided valuable comments on the manuscript that greatly improved it. To prepare the article, the author has relied on different artificial intelligence (AI) tools including Medline (PubMed), SciELO, Cochrane Library, UpToDate, Micromedex database and Google search engine for the bibliographic search, Google Translator and WordReference.com for language editing, and Mendeley (version 2.97.0) For bibliography management.

Declaration of interest

The writing of this article was motivated by the author’s particular interest in the topic and his goal of subspecializing in the diagnosis and treatment of patients exposed to chemical weapons. The author declares having no competing interests or affiliations to disclose related to the submission of this manuscript. He has not participated in and do not anticipate participation in any legal, regulatory, or advocacy proceedings related to the contents of the paper. This work has not received any external funding support.