Propofol and Michael Jackson

Propofol, a medication used for sedation and general anesthesia, is at the heart of the trial of Conrad Murray, Michael Jackson’s physician. According to the autopsy report, the cause of Michael Jackson’s June 25, 2009 death was “acute propofol intoxication”. In addition to propofol, a number of other sedating prescription medications were found in his system.

The problem in Michael Jackson’s case was not the propofol, but the location and manner in which it was administered.

Propofol is a medication used very commonly in surgery. It is able to be titrated to achieve a specific level of sedation, ranging from moderate sedation to general anesthesia. Unfortunately, the response of two patients to similar doses can be quite different. During propofol induced sedation a patient requires very close monitoring by an experienced anesthesia provider. Appropriate emergency equipment and medications must be available.

Why is propofol used for surgery if it is so dangerous?

Propofol is one of the best and safest anesthetics currently available, so long as it is used correctly. It has a quick onset allowing a very rapid surgery induction. It is metabolized quite quickly allowing patients to wake very quickly after surgery. It reduces the need for narcotics and the respiratory depression and nausea associated with these.

Who should administer propofol?

This one is tricky as there is an ongoing turf battle between anesthesiologists and RN’s. Many states prohibit nurse administered propofol. Utah is currently not one of those states. The labeling of propofol states that it should only be “administered by persons trained in the administration of general anesthesia and not involved in the surgical procedure”.

My own opinion is that in most cases, the use of propofol is routine and could be easily administered by an anesthesiologist or RN. However, when and if there is an unusual response to propofol requiring more intense monitoring or resuscitation an anesthesiologist certainly has more experience and training to handle the unexpected.

In our office, we only use board certified anesthesiologists to administer propofol. I would consider this an important question to ask your plastic surgeon.

Where should propofol be used?

Propofol should be used only in appropriate settings with adequate medical and emergency support. Appropriate locations would include certified operating rooms, endoscopy suites, or the intensive care unit. Home is certainly not an appropriate location.

Board Certified plastic surgeons are required to operate in accredited operating rooms. The gold standard of accreditation for plastic surgeons is the AAAASF. The AAAASF requires propofol administration only by an anesthesiologist or nurse anesthetist, prohibiting nurse administered propofol

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