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July 03, 2009
BehindTheMedspeak: Diprivan (Propofol) and Michael Jackson
Reader Nikolas R. Schiller last evening sent me a link to a July 1, 2009 TMZ story reporting that propofol (Diprivan) was found at Michael Jackson's house after he died.
TMZ did a very nice reporting job about the drug, accurate in every respect about its indicated use, side effects and risks.
Wrote TMZ, "We're told the drug propofol was discovered at the residence. The drug is used to put people under anesthesia before surgery. It is an extremely powerful drug that is only available to medical personnel. As one source said, 'There is no conceivable way this drug can be properly prescribed for home use.'"
"The drug can only be administered with an IV. Interestingly, propofol burns [on injection] and the drug lidocaine is used to reduce the pain associated with the propofol injection. As we first reported, lidocaine was found near Jackson's body."
"One of the major side effects of propofol is cardiac arrest if it's taken in combination with narcotic painkillers, however, propofol is so powerful it can stop someone's heart on its own."
"Sources say the drug is so inappropriate and reckless for home use, if a doctor facilitated it for Jackson and it caused his death, he or she could be prosecuted for manslaughter."
Precisely.
Propofol can also cause respiratory arrest if given in a large enough dose.
Which — in my experience of having used it for for over 20 years in thousands of patients — can be a relatively small dose in terms of milligrams which turns out, for a particularly sensitive patient, to be plenty big.
Only people capable of expertly maintaining an airway — up to and including emergency endotracheal intubation — can safely use this drug.
Emergency resuscitation equipment including a source of oxygen and a breathing bag and mask must always be present for backup use.
That propofol is routinely employed in settings and by practitioners — doctors, dentists and nurses — who have no business using it does not mean it's safe.
It only means those foolhardy people (and their unwitting patients) have — so far — been very lucky.
July 3, 2009 at 04:01 PM | Permalink
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Comments
Then don't read something that's over a month old.
Posted by: Rocketboy | Aug 27, 2009 12:35:03 PM
Absolutely positively sick of hearing about this twisted pedophile...
Posted by: Jesse | Aug 26, 2009 9:38:40 PM
Turns out it was quite a cocktail Murray gave Jackson all night long as he simultaneously must have been fighting his own need for sleep:
http://www.thesmokinggun.com/archive/years/2009/0824091jackson1.html
(See page 3 especially.)
What a nightmarish world Murray stepped into. He must have felt that the salary of $150K/month paid by the concert promoter would be worth all the creepiness (though I think I read he had yet to received his first check).
So after Murray has his license taken away, serves some time, and moves to, say, the foothills of the Andes to avoid dismemberment by fans and family, what will he do for a living? Lectures? I can just see the PowerPoint presentation now...
How to Monitor Patients You've
Brought Near Coma Using Only:
● Finger Oximeter (w. blinking pulse LED)
● Chair
● Your Heavy, Heavy Eyes
Posted by: Mike Harney | Aug 26, 2009 7:43:34 PM
Doc Joe:
Fortunately, the EKG & nuclear stress test proved OK. We are grateful.
But...that does not excuse the incompetence of the hospital, the surgeon, and the nurses involved.
Diprivan is a dangerous drug in the wrong hands.
The hospital is Mercy Medical Center in Redding, California. Catholic Health Care West. They don't have procedures in place that would stop this kind of thing from occurring.
All of you, be forewarned.
Posted by: FW | Jul 15, 2009 11:09:22 PM
A late post, I know. But Doc, my partner just crashed with an overdose of Diprivan. He was undergoing endoscopy in the basement OR of a hospital. The drug was administered by a regular RN into a bad IV. The surgeon had her give more drug. Next thing you know, Code Blue. No nearby oxygen or paddles. They kept him alive by CPR until the trauma team arrived from way upstairs.
He ended up intubated and in ICU for 24 hrs.
Since they released him he's had mild tachycardia - resting 103 to 126. All the time for 2 weeks. He see's the cardiologist for an EKG and nuclear stress test tomorrow. Depending on what's found, we may be getting in touch with you.
I found you through your interview for "The Great Debate: NAPS"
This drug is apparently dangerous when put into incompetent hands.
Posted by: FW | Jul 15, 2009 12:27:10 AM
Frightening that someone would have brought it out of the operating room and into his home. This story isn't over yet.
Posted by: Jesse | Jul 4, 2009 11:09:42 AM
Hey Joe where you goin with that Propofol in your hand
Goin down to dose my old lady ...caught her messin around with another man
Posted by: fritz | Jul 4, 2009 9:27:36 AM
Thank you for posting this. Is it true that someone anesthetized by propofol would not attain REM sleep? If so, isn't it basically the equivalent of an insomniac just lying in bed but not sleeping? IOW over time, if the person was never really getting recuperative sleep and was in fact prevented from getting it because he was anesthetized, would that be a strain on the heart?
Posted by: YesBiscuit! | Jul 4, 2009 7:12:22 AM
to Ray:
Diprivan equals propofol equals (as Joe knows) Milk of Amnesia (so called because it is a white milky-looking liquid, as opposed to most other drugs which are clear liquids).
Posted by: enicideme | Jul 4, 2009 1:35:07 AM
Agreed. . .we use this in the ER regularly, and have a resp therapist and airway equipment at the bed side. It is crazy to think that he may have been using this. As far as I know, this doesn't cause any kind of buzz or euphoria (unlike low doses of Ketamine!) so I guess the rumors about him using it to sleep might be crazy but true. Of course, that would mean he would have an IV drip of this going for 8 hours. . . I am looking forward (morbidly) to see his tox screen, I'm guessing it will be a long list.
Posted by: enicideme | Jul 4, 2009 1:33:00 AM
Hey Joe,
On TV a few moments ago they are claiming a drug called Driprivol sp? was found also.
What's the story on that one?
Posted by: Ray | Jul 3, 2009 5:04:59 PM
Wow-weeeeeeeeeeeee!!! Someone's nuts are on the block!
Posted by: jo | Jul 3, 2009 4:28:07 PM
