An Ohio killer appeared to gasp several times as a previously unused combination of drugs was used to execute him.
It took almost 25 minutes for Dennis McGuire to die after doses of two drugs, the sedative midazolam and the painkiller hydromorphone, were used in the lethal injection.
It was one of the longest executions since Ohio resumed capital punishment in 1999.
McGuire received the death penalty for the 1989 rape and fatal stabbing of Joy Stewart, a pregnant woman, in Preble County in western Ohio.
A Dayton Daily News reporter, who was present at the execution said; "At 10:29am, his eyes rolled back as if he were going to sleep, and at 10:35am, McGuire, who appeared to be unconscious, was convulsing, gagging and struggling to breathe."
McGuire's daughter, Amber, said "Oh my God" as she watched her father's final moments.
Officials opted for the new execution method when supplies of the state's previous drug dried up after the maker decided it no longer wanted it used for lethal injections.
Federal public defender Allen Bohnert called McGuire's death "a failed, agonising experiment by the state of Ohio".
Prior to the execution, McGuire's lawyers warned that he was at substantial risk of a medical phenomenon known as air hunger, which would cause him to experience terror as he strained to catch his breath.
But Ohio officials presented counter evidence disputing the risk.
A statement released by Carol Avery, the sister of McGuire's victim, said: "We have forgiven him, but that does not negate the need for him to pay for his actions."
Ms Stewart's slaying went unsolved for 10 months until McGuire, jailed on an unrelated assault and hoping to improve his legal situation, told investigators he had information about the woman's death.
His attempts to blame the crime on his brother-in-law quickly unravelled and soon he was accused of being the killer.
More than a decade later, DNA evidence confirmed McGuire's guilt, and he acknowledged that he was responsible in a letter to the state's governor last month.
McGuire, 53, sought a reprieve in recent weeks but his legal team's argument that a jury never got to hear the full extent of his chaotic and abusive childhood was dismissed.
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