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    Jackson's Death Puts Propofol in the Spotlight

    By Phil Miller

    The FDA has received 440 reports of deaths suspected to be related to propofol since the approval of Diprivan in 1989.   Only one of those deaths, however, has caused public scrutiny of the drug.

    Since Michael Jackson was found dead on June 25, through what is believed to be cardiac arrest caused by an infusion of propofol, there has been heightened media and public interest in the sedative.  

    According to reports cited in Anesthesiology News and elsewhere, anesthesiologists have seen a growing level of trepidation among patients concerning the potential risks posed by propofol.   Before the death of the famous singer, patient curiosity about specific drugs used in anesthesiology was minimal to non-existent.  Today, anesthesiologists report that patients are increasingly likely to ask about the “Michael Jackson drug.”

    The central issue for many anesthesiologists is not the relative safety of propofol or the settings in which it should be administered.   Rather, anesthesiologists and CRNAs are most concerned about who administers the drug.  

    The Michael Jackson case has focused attention on the fact that propofol is not always administered by anesthesiologists or CRNAs.   Michael Jackson’s personal doctor, Conrad Murray, M.D., has referred to himself as a cardiologist, though he is not board certified in that specialty.   Law enforcement officials have been cited as saying that Dr. Conrad gave Jackson propofol by IV early in the morning of the day he died.  According to the Associated Press, Dr. Murray had given Jackson propofol several times for insomnia before the dose that may have proved fatal.

    As reported in Anesthesiology News, many experts agree that it is extremely dangerous for anyone without training in anesthesia to administer propofol.   Included on the warning label of Diprivan are the following words: “for general anesthesia or monitored anesthesia care sedation, Diprivan Injectable Emulsion should be administered only by persons trained in the administration of general anesthesia and not involved in the conduct of surgical/diagnostic procedure. Patients should be continuously monitored, and facilities for maintenance of a patient airway, artificial ventilation, and oxygen enrichment and circulatory resuscitation must be immediately available.” 

    The label has further instructions for patients in intensive care units. Propofol “should be administered only by persons skilled in the management of critically ill patients and trained in cardiovascular resuscitation and airway management.” It has been reported that investigators have not found an electrocardiograph or a pulse oximeter in the Los Angeles house where Michael Jackson lived.
    In addition to raising patient concerns about the drug, the Michael Jackson incident also is highlighting the conflict taking place over propofol between anesthesiologists/ CRNAs and gastroenterologists.    The former believe they are the only medical professionals qualified to administer the sedative, while gastroenterologists believe the FDA should loosen restrictions on its use.   Some gastroenterologists believe that having an anesthesiologist provide sedation simply drives up the cost of procedures such as endoscopy.   For many anesthesiologists, however, safety issues trump economics when it comes to administering potentially dangerous drugs such as propofol.

    The real danger posed by the death of Michael Jackson, as it relates to propofol, is that it may lead to increased abuse of the drug.    It has been reported by anesthesiologists that some patients are asking whether propofol is available for home use.    Abuse of propofol, including abuse by anesthetists, reportedly was on the rise before Michael Jackson’s untimely death.   Whether the singer’s death will lead to greater safety measures in the use of the drug, or greater abuse by those who now know of its existence and effects, remains to be seen.

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