"Lethal dose" of propofol = 25 mg?

[Fastrach]

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Dr. Conrad Murray, a Las Vegas cardiologist who became Jackson's personal physician weeks before his death, is the target of a manslaughter investigation by the Los Angeles Police Department. According to a search warrant affidavit unsealed Monday in Houston, Murray told investigators he administered a 25 mg dose of propofol around 10:40 a.m. after spending the night injecting Jackson with two sedatives in an unsuccessful attempt to get him to sleep.
The warrant, dated July 23, states that lethal levels of propofol were found in Jackson's system. Besides the propofol and two sedatives, the coroner's toxicology report found other substances in Jackson's system but they were not believed to have been a factor in the singer's death, the official said.

 

[ultm8frisbee]

Obviously big enough considering everything else he had on board, i.e. benzo's, narc's, and whatever else he tried. Enough to take a 40kg white woman out.

 

[ProRealDoc]

Dr. Conrad Murray, a Las Vegas cardiologist who became Jackson's personal physician weeks before his death, is the target of a manslaughter investigation by the Los Angeles Police Department. According to a search warrant affidavit unsealed Monday in Houston, Murray told investigators he administered a 25 mg dose of propofol around 10:40 a.m. after spending the night injecting Jackson with two sedatives in an unsuccessful attempt to get him to sleep.
The warrant, dated July 23, states that lethal levels of propofol were found in Jackson's system. Besides the propofol and two sedatives, the coroner's toxicology report found other substances in Jackson's system but they were not believed to have been a factor in the singer's death, the official said.

Maybe he thought propofol is 1mg/ml and gave him 25cc

 

[SleepIsGood]

Obviously this was a huge dose for MJ.

Surprisingly this was a doctor who administered this medication, propofol. I'm surprised how patients can trust a NURSE (ie CRNA) with this potent medication. Propofol should be used by a properly trained physician.

This clearly shows the value and grave importance of having a board certified Anesthesiologist for any general anesthestic or even 'sedation'.

I can tell you with a 100% assurance, a board certified anesthesiologist would not have had this sort of outcome at this dose of propofol. How do I know that, we do it EVERY day.

 

[Pooh & Annie]

Obviously this was a huge dose for MJ.

Surprisingly this was a doctor who administered this medication, propofol. I'm surprised how patients can trust a NURSE (ie CRNA) with this potent medication. Propofol should be used by a properly trained physician.

This clearly shows the value and grave importance of having a board certified Anesthesiologist for any general anesthestic or even 'sedation'.

I can tell you with a 100% assurance, a board certified anesthesiologist would not have had this sort of outcome at this dose of propofol. How do I know that, we do it EVERY day.

To have this happen, the guy must have given the dose, then just walked away. How else would he not have caught the fact that MJ was apneic?

 

[jwk]

Obviously this was a huge dose for MJ.

Surprisingly this was a doctor who administered this medication, propofol. I'm surprised how patients can trust a NURSE (ie CRNA) with this potent medication. Propofol should be used by a properly trained physician.

This clearly shows the value and grave importance of having a board certified Anesthesiologist for any general anesthestic or even 'sedation'.

I can tell you with a 100% assurance, a board certified anesthesiologist would not have had this sort of outcome at this dose of propofol. How do I know that, we do it EVERY day.

No offense, but give me a friggin break. Really.

This shows the importance of having a trained ANESTHESIA provider giving propofol - NOT a GI doc, NOT a cardiologist (especially those that can apparently be bought), NOT ANYONE except someone trained in anesthesia. Where have I heard that before? Oh yeah - it's on the package insert for propofol. Duh.

 

[jwk]

The warrant, dated July 23, states that lethal levels of propofol were found in Jackson's system. Besides the propofol and two sedatives, the coroner's toxicology report found other substances in Jackson's system but they were not believed to have been a factor in the singer's death, the official said.

Ok you junior forensic pathologists - what constitutes a "lethal level" of propofol? 25mg in the whatever the volume of distribution is of a perhaps 60-65kg adult male doesn't sound like a "lethal level".

I'm with Pro - if this cardiologist is STUPID enough to give propofol in this setting (or any setting for that matter) maybe he was stupid enough to think that it was 1mg/cc. Maybe he thinks all injectable medicines are that way - maybe he thought it was just like the Ativan and Versed.

 

[dhb]

I'm with Pro - if this cardiologist is STUPID enough to give propofol in this setting (or any setting for that matter) maybe he was stupid enough to think that it was 1mg/cc. Maybe he thinks all injectable medicines are that way - maybe he thought it was just like the Ativan and Versed.

after spending the night injecting Jackson with two sedatives in an unsuccessful attempt to get him to sleep

Clearly the dude is not a stud

 

[coprolalia]

I'm willing to bet it was more like 25mL of propofol, not 25mg. The media never gets the story exactly right. I hope you guys aren't so naive as to think they do.

-copro

 

[IDBasco]

Did anyone notice that the doc did 30 mins of CPR before calling 911? I'm pretty sure I read that somewhere. Now I'm still a student, so there is plenty I don't know, but for some reason I have to think that he was trying to cover up what he had done before getting anyone involved.

Would the propofol have been less detectable at that point? I know half life is dependent on metabolism, excretion, etc. though in this case, things are certainly different when your blood flow is based on CPR. Just a curiosity for me. It seems like a doc that was doing the right thing would have had someone on the phone as soon as something happened.

 

[pgg]

I'm willing to bet it was more like 25mL of propofol, not 25mg. The media never gets the story exactly right. I hope you guys aren't so naive as to think they do.

-copro

I don't know ... a couple versions I read stated that he'd originally been using 50 mg and wanted to wean him down to 25 mg, whatever that means. But it seemed like they got the units right. Maybe the media messed up mL and mg, or maybe the guy thought propofol was 1 mg/mL and gave him 10x the dose he thought he gave, or maybe he's simply lying about how much he gave in an effort to make his actions seem less ridiculously irresponsible.

I bet that quack also lied about the extent of the polypharmacy that preceded the propofol. I doubt forensics can reliably estimate the dose of a substance given. The account I read was something like 10 of diazepam, 4 of lorazepam, 4 or 6 of midazolam (all over about 10 hours) ... then the propofol. That's a lot for a benzo-naive patient but not for someone who's been getting concoctions like this every day for years.

Once or twice a year we hear about dentists bumping off patients because they mixed nitrous, benzos, opiates, and/or propofol. They don't use a lot but it's their lack of understanding or appreciation for the synergistic effects that get them.

Would the propofol have been less detectable at that point?

Probably. One, as you said, even with CPR, there's not much circulation to speak of so metabolism would be greatly reduced. Two, mass spec is extremely sensitive - people murdered with succinylcholine still have detectable amounts of that drug in their blood, and that's metabolized by enzymes in the blood itself. Three, you'd still have detectable levels of metabolites in the blood & urine >24 hours later.

 

[jwk]

Did anyone notice that the doc did 30 mins of CPR before calling 911?

It just keeps getting crazier - now they're releasing the doc's cellphone records that seem to indicate he was making phone calls while supposedly doing CPR - and they weren't to 911.

 

[nap$ter]

looks worse than my record keeping; people.com?

dude says it was 25mg - so 2.5 cc? pretty precise.. who knows what dose, or when; we'll never find out.

don't think this is a great example to back up the crna vs md vs anesthesiologist with sole propofol rights - cmon. dude murray was a chucklehead. this just proves to me that whack jobs shouldn't give propofol to other whack jobs at home for sleep. period.

think i'll get some sleep.

 

[CambieMD]

Dr. Conrad Murray, a Las Vegas cardiologist who became Jackson's personal physician weeks before his death, is the target of a manslaughter investigation by the Los Angeles Police Department. According to a search warrant affidavit unsealed Monday in Houston, Murray told investigators he administered a 25 mg dose of propofol around 10:40 a.m. after spending the night injecting Jackson with two sedatives in an unsuccessful attempt to get him to sleep.
The warrant, dated July 23, states that lethal levels of propofol were found in Jackson's system. Besides the propofol and two sedatives, the coroner's toxicology report found other substances in Jackson's system but they were not believed to have been a factor in the singer's death, the official said.

The ME is training to rob Dr. Murray of a possible defense. He may blame the other drugs that MJ had on board for his death.

It seems that Dr. Murray will be charged. As a former pcp I came accross patients who made unreasonable and sometimes unsafe requests of me.
Dr. Murray complied with the unreasonable/unsafe request of a patient. He exercised poor judgement. This man had no business practicing medicine. This man had 6 children for 5 different women. This speaks to poor judgement.

I cannot draw the conclusion that only anesthesiologists should deliver sedation. Those who deliver sedation should have advanced trainig in airway management and show an unsrestanding of the sedatives that they want to deliver. What will .2 mg of flumazenil do. The usual dose is .6-1 mg.
I heard of another case of sedation causing apnea and the doc responded inappropriately. The pt suffered severe anoxic brain injury.


Cambie

p.s.

What's up with all of F-bombs all over this forum. That serves no good purpose.

 

[Frank Rizzo]

p.s.

What's up with all of F-bombs all over this forum. That serves no good purpose.

I disagree... from our friends at Scientific American:

"Holy @$#%! According to neuroscientists from Britain’s Keele University, dropping the f-bomb can actually relieve physical pain. In the upcoming August 5th issue of the journal NeuroReport, the researchers say swearing is a different phenomenon than most language. It activates emotional centers in the right side of the brain, rather than those &#*@ing cerebral areas reserved for regular #$#y communication in the left hemisphere.

The researchers had groups of undergraduate students submerge their hands in a tub of witch$@&#* cold water and repeat the swear word of their choice. And students could tolerate the icy abyss much longer than when they were only allowed to say more socially acceptable words. The researchers say the foul-mouthed students also had increased heart rates, which indicates that swearing activates a &#*@ing classic “fight or flight” response. You know, when you act all bad$(# to downplay the fact that you’re scared @$#%^ss.

The study suggests that swearing is an ancient social phenomenon with both emotional and physical effects. And also that socially acceptable words don’t mean @$#% when your pain really hurts like a son-of-a-%@&$#."

 

[Impromptu]

Quote from a 90 year old, somewhat delerious female patient today, "What the f--- am I doing in this f---ing hospital?" She got twice the therapeutic dose.

 

[eventualeventer]

What is the LD-50 of f-bombs? Is it expressed as a rate (are they rapidly metabolized)? 20 f***s/kg/min?

 

[eventualeventer]

What is the LD-50 of f-bombs? Is it expressed as a rate (are they rapidly metabolized)? 20 f***s/kg/min?

 

[Gimlet]

More fallout from the MJ propofol publicity....this is an interesting story. When I first heard about it I thought it was a ridiculous request, but after reading the bolded below, I'm not so sure. I don't know if murder is an appropriate charge for either Conrad Murphy or this surgeon, but some sort of criminal negligence certainly sounds reasonable for both:

Father wants daughter's cause of death changed to homicide
By Mike Johnson of the Journal Sentinel

A man whose daughter never regained consciousness and later died in 2003 after she was given excessive amounts of the same anesthesia drug involved in Michael Jackson's death is asking the Waukesha County medical examiner's office to change the cause of her death to homicide.

Julie Rubenzer, 38, stopped breathing Sept. 25, 2003, while undergoing breast implant surgery at a doctor's office in Florida. The 1984 graduate of Waukesha South High School died three months later at a Brookfield nursing home.

Florida records show that Rubenzer received excessive amounts of the anesthetic propofol during surgery.

The plastic surgeon, Kurt Dangl, lost his medical license as a result, according to an order issued by a Florida administrative law judge in February 2005.

The Waukesha County medical examiner's office determined that Rubenzer died from a lack of oxygen as an accidental complication of surgery. The medical examiner's officer listed her manner of death as an accident.

In the Jackson case, the Los Angeles County coroner recently ruled Jackson's June 25 death a homicide after forensic tests showed propofol combined with at least two other drugs caused him to die. Physician Conrad Murray gave the drugs to Jackson, according to court records.

Don Ayer, Rubenzer's father, said that when he saw news reports that Jackson's death was a homicide, he decided to ask the Waukesha County medical examiner to change his daughter's death certificate.

In a letter to Medical Examiner Lynda Biedrzycki, Ayer states, "Julie's death was a result of reckless and egregious malpractice. Had she been a prominent person, such as Michael Jackson, there would have been a criminal charge, and the cause of death would have been 'homicide.'"

Biedrzycki said she received Ayer's letter Wednesday and will give his request serious consideration.

She added, "He's comparing it to the Michael Jackson case. What do I know about the case except what is in the newspaper?"

Biedrzycki said that when she ruled Rubenzer's death an accident, she did so after reviewing pages and pages of medical records from Florida.

At the time, though, the administrative hearing on whether to revoke Dangl's license had not been held. Biedrzycki said she would review the records from the administrative hearing, which Ayer submitted along with his letter.

No criminal charges were filed against Dangl in Florida in the Rubenzer case. Dangl had a cosmetic surgery center in Sarasota, Fla.

The state attorney's office in Sarasota County investigated and officials found no evidence that Dangl was intentionally negligent in Rubenzer's death.

Florida health investigators said Dangl tried to function as both surgeon and anesthesiologist and administered such high doses of anesthesia that it caused the patient to stop breathing.

In addition to the propofol, Rubenzer was given several other drugs, including Demerol, Valium and Versed. Demerol is a pain medication and Valium and Versed are sedatives. All three medications can decrease respiration.

Even if his daughter's cause of death is changed to homicide, Ayer said he is not sure "where that would take us."

But he said he would continue to push for tougher laws, perhaps at the federal level, on the use of anesthesia during office surgeries.

 

[Gimlet]

Here's another story from 2004 about this lady's plastic surgeon: apparently he was an oral surgeon by training...interesting to hear, based on some recent threads on here about OMFS-provided anesthesia.

Highlights:

Her surgeon, Dr. Kurt Dangl, a dentist and oral surgeon by training, advertised his services on a Web site, complete with testimonials and the magic phrase "board-certified."

But Dangl was not certified by any board recognized by the state. And he did not have admitting privileges at any hospital. Even more worrisome: "He cut corners by not having an anesthesiologist or a nurse anesthetist in the room."
...
The surgery went well for about two hours. Then, while still under what an expert later called "a dazzling array of anesthetic agents," Rubenzer was propped up so the breast implants could be adjusted.

According to Matt, "As soon as we laid her down, she just crashed on the table" and went into cardiac arrest. Dangl, he says, "threw a tantrum. He just stood there and he said, 'I don't need this today.' "

Matt says Dangl forced air into her lungs with an Ambu Bag, a disposable artificial ventilation bag. But when he stopped, Rubenzer's heart wasn't beating.

"I said to him, 'Doctor, she is flat-lined. She needs chest compressions.' He said no, don't give chest compressions. He was afraid it would mess up her surgery."

😱

 

[excalibur]

"Forced air into her lungs with an Ambu bag"???

Please tell me this lady undergoing breast implants was intubated prior to surgery

 

[Bertelman]

"Forced air into her lungs with an Ambu bag"???

Please tell me this lady undergoing breast implants was intubated prior to surgery

That'd be a big NO. Sounds like she was riding the local/sedation train through his outpatient clinic.

 

[Jalopycat]

Is it possible that after Dr. Murray left the room, Jackson saw the propofol syringe sitting there and decided to take matters into his own hands, not knowing that he could kill himself with it?

There was no mention if Dr. Murray left the syringe still attached to the IV line.

 

[aphistis]

Is it possible that after Dr. Murray left the room, Jackson saw the propofol syringe sitting there and decided to take matters into his own hands, not knowing that he could kill himself with it?

There was no mention if Dr. Murray left the syringe still attached to the IV line.

One hopes Murray would've noticed the additional propofol missing from the syringe. If he had, you can be damned sure he would've leaped on that as a way to exculpate himself.

 

[Narcotized]

This shows the importance of having a trained ANESTHESIA provider giving propofol - NOT a GI doc, NOT a cardiologist, NOT ANYONE except someone trained in anesthesia.

Exactly why I tell people, as sad as it was, the truth is MJ/Propofol is the strongest positive for anesthesiology job securtity to come around in a very long time.

 

[Anesthesia Team]

Obviously this was a huge dose for MJ.

Surprisingly this was a doctor who administered this medication, propofol. I'm surprised how patients can trust a NURSE (ie CRNA) with this potent medication. Propofol should be used by a properly trained physician.

This clearly shows the value and grave importance of having a board certified Anesthesiologist for any general anesthestic or even 'sedation'.

I can tell you with a 100% assurance, a board certified anesthesiologist would not have had this sort of outcome at this dose of propofol. How do I know that, we do it EVERY day.

Wow,

Interesting comment that you make. Why dont you read the ASA guidelines that state that a CRNA is a trained anesthesia professional. In fact CRNAs deliver over 75% of the anesthesia across the US on a daily basis- and do it safely. CRNAs can operate independently in some states and in others work as a team. The comment you make shows your ignorance towards the Anesthesia Team. You need to let your ego down and join the team. Oh by the way, seeing that as a resident by Law you have to have immediate MDA supervision aren't you unqualified also? One more thing since every CRNA has to have at least one year critical care experience prior to training (most have 3-5yrs) and then 2.5 - 3.5 of anesthesia training when you take away your one year scut internship we actually have more anesthesia training then you do, resident MD.

My reply is sharp because you chose to demonstrate your ignorance by lambasting a colleague because you feel threatened or inadequate in some way (maybe you should openly tell the CRNAs at your institution this and not hide behind an alias. I bet you get beat down by dang near every MDA) And wasnt it a Cardiologist who has more years of medical training then you that killed the patient? Go Figure!

 

[Matty44]

First of all, as you can see from my profile, I'm not an MD. I'm not quite sure what you are claiming to be (MD/PhD/CRNA?). But you're making what should be a pretty obvious mistake in your assumption that 1 yr of medical training = 1 yr of medical training, regardless of what type of training that is. If a cardiologist has 9 yrs of total training and an anesthesiologist has 7 or 8, that by no means implies that the cardiologist is equally or better qualified to administer anesthetic drugs. Maybe this is a brash assumption (however i highly doubt it), but at the end of my AA training I'd expect I'll have a better handle on administering anesthesia than any cardiologist. And there's no way that you can equate 4 yrs of ICU nursing plus 2.5-3 yrs CRNA training with that of an anesthesiologist 7-8 yrs of med school/residency. C'mon man, if you're gonna be a midlevel anesthesia provider, be proud of that...I sure am. We (AAs and CRNAs) both have a great deal of knowledge when it comes to anesthesia, but an MD (or DO) we are not.

 

[jwk]

Wow,

Interesting comment that you make. Why dont you read the ASA guidelines that state that a CRNA is a trained anesthesia professional. In fact CRNAs deliver over 75% of the anesthesia across the US on a daily basis- and do it safely. CRNAs can operate independently in some states and in others work as a team. The comment you make shows your ignorance towards the Anesthesia Team. You need to let your ego down and join the team. Oh by the way, seeing that as a resident by Law you have to have immediate MDA supervision aren’t you unqualified also? One more thing since every CRNA has to have at least one year critical care experience prior to training (most have 3-5yrs) and then 2.5 - 3.5 of anesthesia training when you take away your one year scut internship we actually have more anesthesia training then you do, resident MD.

My reply is sharp because you chose to demonstrate your ignorance by lambasting a colleague because you feel threatened or inadequate in some way (maybe you should openly tell the CRNAs at your institution this and not hide behind an alias. I bet you get beat down by dang near every MDA) And wasnt it a Cardiologist who has more years of medical training then you that killed the patient? Go Figure!

You sign up for SDN, and resurrect a thread that has been dormant for almost four months just to make THIS assinine post? 🤣

 

[error404]

... and banned.

Hope it was worth setting up the sham account.

 

[Frank Rizzo]

Excellent first post!!!

Douche.

 

[soundmind]

It just keeps getting crazier - now they're releasing the doc's cellphone records that seem to indicate he was making phone calls while supposedly doing CPR - and they weren't to 911.

Tell me about it. I thought it couldn't get any crazier. Check this out.

this is from the preliminary hearing.

DDA Q: Did you find saline bag that had been apparently cut open? Fleak: Yes I did.
DDA Q: Find anything in that saline bag? Fleak: A bottle of Propofol inside that cut-open bag.
DDA shows Fleak a photo.Flea: Yes (that's what she found).

Notes from bodyguard witness:
Murray then pointed at the IV bag and said "remove that and put it in the blue bag"
Alberto noticed that there was a bottle inside of the saline bag. At the bottom of the bag, there was milk like substance. The bottle was "at the bottom of the bag"
There was another IV bag hanging on the IV stand, Murray didn't instruct Alberto to remove the second IV bag

Also, there was a detatched syringe found under the bed. murray claims that's what MJ used to inject himself with while he was out the room.

Det. Fleak: I did describe it as a broken syringe because the two pieces are separated from each other. I should have ...they're not broken.

Syringe on the table, needle on the floor.

I spoke with a nurse who administers propofol and she said the needle couldn't be accidently taken off. That one would have to untwist it off. Since murray is claiming that MJ injected himself with that syringe, could MJ have still been conscious enough to untwist the syringe right after injecting that large dose of prop. into him?

 

[Precedex]

Obviously this was a huge dose for MJ.

Surprisingly this was a doctor who administered this medication, propofol. I'm surprised how patients can trust a NURSE (ie CRNA) with this potent medication. Propofol should be used by a properly trained physician.

This clearly shows the value and grave importance of having a board certified Anesthesiologist for any general anesthestic or even 'sedation'.

Disagree strongly and not feasible. You need someone who has a clue however which didn't seem to be the case here.

 

[Ronin2258]

I still think Robin Williams had the best quote on his latest tracks: "A doctor said using propofol to sleep is like doing chemotherapy because you're tired of shaving your f***ing head."

That said, I thought I am going to be hearing about this case from patients who are going under general for a while.

I have been wondering if he was using propofol as a drip, like ICU sedation and the press misread mcg and put mg. I never saw a picture of the bag and bottle, and he may have had a 100cc bottle. My take is the guy was probably counting drops per minute, as I saw no mention of a pump. 25mcg/kg/min is about 50 drops (going off 20drops=1ml,) a second at 10mg/ml, not an unreasonable thing to count.

Have they pulled this twit's credentials yet? He needs to be out of medicine. Permanently.

 

[jetproppilot]

Dr. Conrad Murray, a Las Vegas cardiologist who became Jackson's personal physician weeks before his death, is the target of a manslaughter investigation by the Los Angeles Police Department. According to a search warrant affidavit unsealed Monday in Houston, Murray told investigators he administered a 25 mg dose of propofol around 10:40 a.m. after spending the night injecting Jackson with two sedatives in an unsuccessful attempt to get him to sleep.
The warrant, dated July 23, states that lethal levels of propofol were found in Jackson's system. Besides the propofol and two sedatives, the coroner's toxicology report found other substances in Jackson's system but they were not believed to have been a factor in the singer's death, the official said.

Dr Murray is

FULL OF S H IT. HE'S LYING.

I could give your

EIGHTY YEAR OLD GRANDMOTHER 25 MILLIGRAMS OF PROPOFOL,

and she'd still be on this planet saying

"JESUS THAT S H IT BURNED MY ARM, SONNY! WHAT ARE YOU DOING TO ME???"

albeit 5 minutes later....

"Yes ma'am it burns, yes. We give lidocaine before for some unknown reason since it doesn't matter."

TWENTY FIVE MILLIGRAMS.

$%^&#%$^#&#

Put the crack pipe down, Dr Murray, you

LYING PIECE OF S H I T.

You administered a drug known to cause respiratory depression IN A CLIENT'S HOUSE, Dr Murray.

You, I'm sure, are not comfortable providing advanced pulmonary rescuscitation, so

WHAT THE F U CK WERE YOU DOING GIVING PROPOFOL????

Btw your

25 mg claim is a

TOTAL LIE.

TWENTY FIVE MILLIGRAMS OF PROPOFOL WOULD NOT HAVE KILLED MICHAEL JACKSON. PERIOD.

I give propofol for a living man.

You may be able to bulls h i t the plaintiff attorneys, butcha can't bull s h i t me.

Maybe you should've consulted an ANESTHESIOLOGIST before contriving your COMPLETELY DISHONEST story. 👎

TO PRE MEDS, MED STUDENTS, RESIDENTS, THERE IS A MORAL TO THIS STORY THAT YOU CAN TAKE HOME, THAT WILL HELP YOU IN YOUR CAREER...I posted about this VERY IMPORTANT FACT not long ago...some post about surgeons intubating in the ICU or something...my point WAS:

Don't get in over your head.

There are no heroes in this business.

Call a colleague when you feel that YUKKY feeling.

 

[Ronin2258]

There is that, Jet. I have the same sentiment.

 

[Dhanwanthari]

will the below apply to at home celebrity sleep studies? 25mg of propofal will require this.

Coming this july to a GI, bronchi suite, cath lab near you....

3.2.4 *During regional anesthesia (with no sedation) or local anesthesia (with no sedation), the adequacy of ventilation shall be evaluated by continual observation of qualitative clinical signs. During moderate or deep sedation the adequacy of ventilation shall be evaluated by continual observation of qualitative clinical signs and monitoring for the presence of exhaled carbon dioxide unless precluded or invalidated by the nature of the patient, procedure, or equipment.

http://www.asahq.org/For-Members/Clinical-Information/Standards-Guidelines-and-Statements.aspx

 

[Dhanwanthari]

Correction: I should say 25 mg prop with adjuncts "could" require etco2.

 

[soundmind]

My field isn't anesthesia, so does anyone know about how much propofol it would take to bring down an elephant? Because the coroner in this case believes it was intentional and said that mj had enough propofol in him to kill an elephant.

murray said he only gave 25 mg. And the syringe he claims mj injected himself with that sent him into cardiac arrest is a 100cc. But he had a whole bottle full of propofol inside him.

Also, I found this article

Michael Jackson received the fatal dose of Propofol through an IV in his leg, and law enforcement believes Dr. Conrad Murray may have tried covering it up ... this according to law enforcement sources and an anesthesiologist who reviewed the case for the LAPD.

Dr. Murray told cops he administered only a very small amount of Propofol -- 2.5ml shortly before Jackson died. But Dr. John Dombrowski, a noted anesthesiologist and member of the board of the American Society of Anesthesiologists who reviewed the LAPD file for detectives, tells TMZ that 2.5ml couldn't put Jackson to sleep, much less kill him. Indeed, the Coroner's report notes the level of Propofol found in Jackson's body was equivalent to that found during "general anesthesia for major surgery."

A small, empty, 20ml bottle of Propofol was found in the bedroom, but there was a secret compartment in a nearby closet that could be the key to the prosecution's case. Several days after Jackson's death, law enforcement found numerous bottles of Propofol in that closet, including a large, empty, 100ml bottle with a large tear in the rubber stopper.

The tear could be critical evidence. There are two ways of administering Propofol. The first is sticking a syringe into the rubber stopper, withdrawing a small amount and then injecting it into the tubing. The second way is by using a spike -- which creates a tear in the rubber stop -- and connects the entire bottle of Propofol to the tube.

Dr. Dombrowski says if a spike is used to connect the bottle directly to the IV tube, the doctor must use an infusion pump to regulate the flow of Propofol -- otherwise, the patient could easily OD. There was no infusion pump found in Jackson's home.

Dr. Dombrowski and law enforcement sources believe Dr. Murray may have connected the 100ml bottle of Propofol to the tube, and then either tried regulating the flow by eyeballing it or just letting it flow by itself ... and Dr. Dombrowski calls either scenario "reckless." Remember, Dr. Murray himself told detectives at one point he walked out of Jackson's room to go to the bathroom.

If Dr. Murray did indeed attach the 100ml bottle to the tube and the contents emptied into Jackson's system, that would be 40 times more Propofol than Dr. Murray said he administered.

There is no explanation for the empty bottle of Propofol in the hidden compartment.

But add that full empty bottle to another bottle of propofol dumped inside a cut open IV bag????

I never saw a picture of the bag and bottle, and he may have had a 100cc bottle.

It was only shown in court.

 

[omniatlas]

My field isn't anesthesia, so does anyone know about how much propofol it would take to bring down an elephant?

No, but they did bring down an elephant with electricity.

[YOUTUBE]http://www.youtube.com/watch?v=RkBU3aYsf0Q[/YOUTUBE]

 

[drccw]

Apparently placing a balloon pump is now part of ACLS.... I didn't get that update.

But Murray told Nguyen's attending physician that he had detected a pulse so, acting in "good faith," Nguyen said, she and her team continued to attempt to resuscitate Jackson. They made an agreement with Murray that if another attempt and resuscitation efforts with a balloon pump proved futile, she said, they would pronounce him dead. The procedure was unsuccessful and Jackson was pronounced dead.

http://news.yahoo.com/michael-jackson-death-trial-er-doctor-says-murray-160810986.html

 

[pseudoknot]

Apparently placing a balloon pump is now part of ACLS.... I didn't get that update.

Obviously there are times when we deviate from the ACLS guidelines and in this case you had a bizarre situation involving a celebrity and a personal physician accompanying the patient during resuscitation. I think a lot of people would have done things a little differently under those circumstances.

 

[soon2b]

So Dr. Murray is an idiot but so was MJ. What pathetic wimpy excuse for a human being needs to have propofol or ativan or versed to sleep? That is just ridiculous. Here's an idea, pull your inflated head out of your ass, close your eyes and count sheep or something.

 

[pgg]

So Dr. Murray is an idiot but so was MJ. What pathetic wimpy excuse for a human being needs to have propofol or ativan or versed to sleep? That is just ridiculous. Here's an idea, pull your inflated head out of your ass, close your eyes and count sheep or something.

 

[Per4mer8]

So Dr. Murray is an idiot but so was MJ. What pathetic wimpy excuse for a human being needs to have propofol or ativan or versed to sleep? That is just ridiculous. Here's an idea, pull your inflated head out of your ass, close your eyes and count sheep or something.

So your saying poor medical judgement from a lay person deserves attacking? He was paying a "Dr" crazy money monthly to put him to sleep, 99.9% of lay people would trust ANY doc to do this because most people are naive to how specialized we get. With that said Murray is obviously a quack with horrible judgement.

Also while obviously Propofol is not a sleep aid do you know how many people in this country use benzos nightly? Lots, prescribed by docs, in offices. I'm not saying benzos are the DOC or that they should be used nightly or chronically at all but it happens.

 

[fakin' the funk]

When I first heard about MJ getting propofol "to sleep," I assumed it was for hours at MAC doses (25-50mcg/kg/min).

Then when I heard about this "adding 50mg or 25mg propofol to the IV infusion" business, that sounded reasonable in the context of getting someone already close to "sleep" off to sleep who already has lots of long-acting benzos on board.

But this stuff with the torn open 100ml bottle makes it more likely that either
a) he was just dripping in straight propofol and guessing by eye, or
b) these numbers of "25 or 50" came from him adding 25ml, or 50ml, or a ballpark dose for 25-50mcg/kg/min to the IV bag that was dripping in.

In any case, it seems unrealistic that 25mg or 50mg is a lethal dose regardless of what Murray says and that some sort of eyeballed infusion was going on.

 

[hoyden]

The most hilarious is, IMHO, the defense's claim, that MJ killed himself by drinking propofol.

And all the media are playing along with it - "no MJ fingerprints on the bottles, blah blah blah"

Is there anybody, who is going to tell the prosecution( and the jurors, and the judge and everybody), that this assumption is plain ignorant ( to be PC)?

 

[ghost dog]

So Dr. Murray is an idiot but so was MJ. What pathetic wimpy excuse for a human being needs to have propofol or ativan or versed to sleep? That is just ridiculous. Here's an idea, pull your inflated head out of your ass, close your eyes and count sheep or something.

A very wise man once said : ethics > profits.

Now this physician has to pay the piper for grossly violating this tenet.

$ 150,000 /month for one pt (MJ)? Yes sir, no sir, three bag full sir.

 

[cincincyreds]

Hopefully some justice will prevail on this Dr. Murray. He basically killed another man out of the need for more money, plain and simple. I mean, how hard would it have been for him to find a real anesthesiologist in order to give Michael the white juice. Michael would probably still be alive today, unless he developed propofol infusion syndrome.

Hopefully, they will lock him up forever and throw away the key.

 

[Per4mer8]

So the expert witness Dr. Steinberg I believe, a cardiologist from the CA medical board says there were at least 6 deviations from standard of care...... The one that caught my eye is that he said Dr. Murray should have administered Flumazenil..... Oh and actually have a BVM around just in case, you know, MJ stopped breathing once receiving the fancy white sleep aid.🙄

 

[slunk]

So the expert witness Dr. Steinberg I believe, a cardiologist from the CA medical board says there were at least 6 deviations from standard of care...... The one that caught my eye is that he said Dr. Murray should have administered Flumazenil..... Oh and actually have a BVM around just in case, you know, MJ stopped breathing once receiving the fancy white sleep aid.🙄

Agreed.

This is laughable. Why are the expert witnesses for the case a cardiologist and a pulm-crit care doc?

Do they consult a cardiologist for an infectious disease related criminal case too?

Do they have more credibility than an anesthesiologist for a case such as this one? I know the public is clueless as to what we do but I would think that the judicial system should at least recognize our expertise here.