Background: Suffocation is a general term that encompasses several forms of asphyxia either from lack of gas in the breathable environment, or from obstruction of the external airways (smothering) or the internal airways (choking), or from a pressure on the chest or abdomen or a body position restricting respiratory movement (traumatic and positional asphyxia, respectively). Study Design: It’s a cross sectional prospective study. Place of Study: Mortuary of Osmania general hospital, Hyderabad. Duration of Study: 2­year study period 2013­2015. Material and Method: out of 9812 autopsies conducted at mortuary of Osmania General Hospital, during two year period 46 cases of suffocations were identified and autopsy was done. Observation and Discussion: The most common cause of suffocation is smothering comprising about 39% of the study sample. i.e. 18 cases followed by traumatic and/or positional asphyxia (26%). The least common cause in the study sample is autoerotic asphyxia. Most of the accidental suffocation deaths are associated with alcohol intoxication comprising almost 56.25% of cases, whereas majority of victims of homicidal suffocation deaths are non­alcoholic. Choking as a cause of sudden death has been recognized and well documented since the time of Hippocrates [11] and it is mostly accidental. The chances of choking are higher if the subject is under the influence of alcohol (cafe coronary) as supported by Hangen RK. Conclusion: The percentage of suffocation deaths in relation to the total Post Mortem Examination is miniscule i.e. 0.5%, but still it is one of the most important cause of death in terms of its complex mechanism. Suffocation deaths cannot be attributed to a single entity but to a spectrum of smothering, choking, traumatic/positional asphyxia, entrapment/ environmental types of deaths. Further studies on different populations are required, particularly to obtain evidence­based data to support our common body of knowledge and assess the discrepancies with the textbook literature. 

Keywords: Asphyxia; Suffocation; Alcohol Intoxication.