Michael Jackson abusing propofol?

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AP Exclusive: Insomniac Jackson begged for drug

AP, Jun 30, 2009 6:36 pm PDT
Michael Jackson was so distraught over persistent insomnia in recent months that he pleaded for a powerful sedative despite warnings it could be harmful, says a nutritionist who was working with the singer as he prepared his comeback bid. Cherilyn Lee, a registered nurse whose specialty includes nutritional counseling, said Tuesday that she repeatedly rejected his demands for the drug, Diprivan, which is given intravenously.
But a frantic phone call she received from Jackson four days before his death made her fear that he somehow obtained Diprivan or another drug to induce sleep, Lee said.
While in Florida on June 21, Lee was contacted by a member of Jackson's staff.
"He called and was very frantic and said, `Michael needs to see you right away.' I said, 'What's wrong?' And I could hear Michael in the background ..., 'One side of my body is hot, it's hot, and one side of my body is cold. It's very cold,'" Lee said.
"I said, `Tell him he needs to go the hospital. I don't know what's going on, but he needs to go to the hospital ... right away."
"At that point, I knew that somebody had given him something that hit the central nervous system," she said, adding, "He was in trouble Sunday and he was crying out."
Jackson did not go to the hospital. He died June 25 after suffering cardiac arrest, his family said. Autopsies have been conducted, but an official cause of death is not expected for several weeks.
"I don't know what happened there. The only thing I can say is he was adamant about this drug," Lee said.
Following Jackson's death, allegations emerged that the 50-year-old King of Pop had been consuming painkillers, sedatives and antidepressants. But Lee said she encountered a man tortured by sleep deprivation and one who expressed opposition to recreational drug use.
"He wasn't looking to get high or feel good and sedated from drugs," she said. "This was a person who was not on drugs. This was a person who was seeking help, desperately, to get some sleep, to get some rest."
Jackson was rehearsing hard for what would have been his big comeback — his "This Is It" tour, a series of performances that would have strained his aging dancer's body. Also, pain had been a part of his life since 1984, when his scalp was severely burned during a Pepsi commercial shoot.
Several months ago, Jackson had begun badgering Lee about Diprivan, also known as Propofol, Lee said. It is an intravenous anesthetic drug widely used in operating rooms to induce unconsciousness. It is generally given through an IV needle in the hand.
Patients given Propofol take less time to regain consciousness than those administered certain other drugs, and they report waking up more clear-headed and refreshed, said University of Chicago psychopharmacologist James Zacny.
It has also been implicated in drug abuse, with people using it to "chill out" or to commit suicide, Zacny said. Accidental deaths linked to abuse have been reported. The powerful drug has a very narrow therapeutic window, meaning it doesn't take doses much larger than the medically recommended amount to stop a person's breathing.
An overdose that stops breathing can result in a buildup of carbon dioxide, causing the heart to beat erratically and leading to cardiac arrest, said Dr. John Dombrowski, a member of the board of directors of the American Society of Anesthesiologists.
Because it is given intravenously and is not the kind of prescription drug typically available from pharmacists, abuse cases have involved anesthesiologists, nurses and other hospital staffers with easy access to the drug, Zacny said.
In recent months, Lee said, Jackson waved away her warnings about it.
"I had an IV and when it hit my vein, I was sleeping. That's what I want," Lee said Jackson told her.
"I said, 'Michael, the only problem with you taking this medication' — and I had a chill in my body and tears in my eyes three months ago — 'the only problem is you're going to take it and you're not going to wake up," she recalled.
According to Lee, Jackson said it had been given to him before but he didn't want to discuss the circumstances or identify the doctor involved.
The singer also drew his own distinctions when it came to drugs versus prescription medicine.
"He said, `I don't like drugs. I don't want any drugs. My doctor told me this is a safe medicine,'" Lee said. The next day, she said she brought a copy of the Physician's Desk Reference to show him the section on Diprivan.
"He said, 'No, my doctor said it's safe. It works quick and it's safe as long as somebody's here to monitor me and wake me up. It's going be OK,'" Lee said. She said he did not give the doctor's name.
Lee said at one point, she spent the night with Jackson to monitor him while he slept. She said she gave him herbal remedies and stayed in a corner chair in his vast bedroom.
After he settled in bed, Lee told Jackson to turn down the lights and music — he had classical music playing in the house. "He also had a computer on the bed because he loved Walt Disney," she said. "He was watching Donald Duck and it was ongoing. I said, `Maybe if we put on softer music,' and he said, `No, this is how I go to sleep.'"
Three and a half hours later, Jackson jumped up and looked at Lee, eyes wide open, according to Lee. "This is what happens to me," she quoted him as saying. "All I want is to be able to sleep. I want to be able to sleep eight hours. I know I'll feel better the next day."
Lee, 56, is licensed as a registered nurse and nurse practitioner in California, according to the state Board of Registered Nursing's Web site. She attended Los Angeles Southwest College and the Charles Drew University of Medicine and Sciences in Los Angeles.
Comedian Dick Gregory, who knows Lee and her work, said he believes Jackson's insomnia had its roots in the pop star's 2005 trial on child molestation charges. Jackson's health had deteriorated so much that his parents called Gregory, a natural foods proponent, for help.
Gregory said Jackson wasn't eating or drinking at the time and, after he was persuaded by Gregory to undergo testing, ended up hospitalized for severe dehydration.
But Jackson obviously was healthy enough to withstand the level of medical scrutiny needed to insure him for the upcoming high-stakes London concerts, Gregory said. "That you don't trick," he said of the exams.
Lee, who has also worked with Stevie Wonder, Marla Gibbs, Reynaldo Rey and other celebrities, said she was introduced to Jackson by the mother of one of his staff members. Jackson's three children had minor cold symptoms and their pediatrician was out of town.
Lee said she went to the house in January, the first of about 10 visits there through April, and treated the children with vitamins. Michael, intrigued, asked what else she did and took her up on her claim she could boost his energy.
After running blood tests, she devised protein shakes for him and gave him an intravenous vitamin and mineral mixture — known as a "Myers cocktail," after Dr. John Myers — which Lee said she uses routinely in her practice.
"It wasn't that he felt sick," she said. "He just wanted more energy."
Lee said she decided to speak out to protect Jackson's reputation from what she considers unfounded allegations of drug abuse or shortcomings as a parent.
"I think it's so wrong for people to say these things about him," she said. "He was a wonderful, loving father who wanted the best for his children."
___
AP Medical Writer Lindsey Tanner in Chicago and AP Television Writer David Bauder in New York contributed to this report
 
Another thread on it too.

Anderson 360 just had him talking to Gupta about it. Gupta called it "milk of amnesia".

Let's get the ASA pres on about it!


AP Exclusive: Insomniac Jackson begged for drug

AP, Jun 30, 2009 6:36 pm PDT
Michael Jackson was so distraught over persistent insomnia in recent months that he pleaded for a powerful sedative despite warnings it could be harmful, says a nutritionist who was working with the singer as he prepared his comeback bid. Cherilyn Lee, a registered nurse whose specialty includes nutritional counseling, said Tuesday that she repeatedly rejected his demands for the drug, Diprivan, which is given intravenously.
But a frantic phone call she received from Jackson four days before his death made her fear that he somehow obtained Diprivan or another drug to induce sleep, Lee said.
While in Florida on June 21, Lee was contacted by a member of Jackson's staff.
"He called and was very frantic and said, `Michael needs to see you right away.' I said, 'What's wrong?' And I could hear Michael in the background ..., 'One side of my body is hot, it's hot, and one side of my body is cold. It's very cold,'" Lee said.
"I said, `Tell him he needs to go the hospital. I don't know what's going on, but he needs to go to the hospital ... right away."
"At that point, I knew that somebody had given him something that hit the central nervous system," she said, adding, "He was in trouble Sunday and he was crying out."
Jackson did not go to the hospital. He died June 25 after suffering cardiac arrest, his family said. Autopsies have been conducted, but an official cause of death is not expected for several weeks.
"I don't know what happened there. The only thing I can say is he was adamant about this drug," Lee said.
Following Jackson's death, allegations emerged that the 50-year-old King of Pop had been consuming painkillers, sedatives and antidepressants. But Lee said she encountered a man tortured by sleep deprivation and one who expressed opposition to recreational drug use.
"He wasn't looking to get high or feel good and sedated from drugs," she said. "This was a person who was not on drugs. This was a person who was seeking help, desperately, to get some sleep, to get some rest."
Jackson was rehearsing hard for what would have been his big comeback — his "This Is It" tour, a series of performances that would have strained his aging dancer's body. Also, pain had been a part of his life since 1984, when his scalp was severely burned during a Pepsi commercial shoot.
Several months ago, Jackson had begun badgering Lee about Diprivan, also known as Propofol, Lee said. It is an intravenous anesthetic drug widely used in operating rooms to induce unconsciousness. It is generally given through an IV needle in the hand.
Patients given Propofol take less time to regain consciousness than those administered certain other drugs, and they report waking up more clear-headed and refreshed, said University of Chicago psychopharmacologist James Zacny.
It has also been implicated in drug abuse, with people using it to "chill out" or to commit suicide, Zacny said. Accidental deaths linked to abuse have been reported. The powerful drug has a very narrow therapeutic window, meaning it doesn't take doses much larger than the medically recommended amount to stop a person's breathing.
An overdose that stops breathing can result in a buildup of carbon dioxide, causing the heart to beat erratically and leading to cardiac arrest, said Dr. John Dombrowski, a member of the board of directors of the American Society of Anesthesiologists.
Because it is given intravenously and is not the kind of prescription drug typically available from pharmacists, abuse cases have involved anesthesiologists, nurses and other hospital staffers with easy access to the drug, Zacny said.
In recent months, Lee said, Jackson waved away her warnings about it.
"I had an IV and when it hit my vein, I was sleeping. That's what I want," Lee said Jackson told her.
"I said, 'Michael, the only problem with you taking this medication' — and I had a chill in my body and tears in my eyes three months ago — 'the only problem is you're going to take it and you're not going to wake up," she recalled.
According to Lee, Jackson said it had been given to him before but he didn't want to discuss the circumstances or identify the doctor involved.
The singer also drew his own distinctions when it came to drugs versus prescription medicine.
"He said, `I don't like drugs. I don't want any drugs. My doctor told me this is a safe medicine,'" Lee said. The next day, she said she brought a copy of the Physician's Desk Reference to show him the section on Diprivan.
"He said, 'No, my doctor said it's safe. It works quick and it's safe as long as somebody's here to monitor me and wake me up. It's going be OK,'" Lee said. She said he did not give the doctor's name.
Lee said at one point, she spent the night with Jackson to monitor him while he slept. She said she gave him herbal remedies and stayed in a corner chair in his vast bedroom.
After he settled in bed, Lee told Jackson to turn down the lights and music — he had classical music playing in the house. "He also had a computer on the bed because he loved Walt Disney," she said. "He was watching Donald Duck and it was ongoing. I said, `Maybe if we put on softer music,' and he said, `No, this is how I go to sleep.'"
Three and a half hours later, Jackson jumped up and looked at Lee, eyes wide open, according to Lee. "This is what happens to me," she quoted him as saying. "All I want is to be able to sleep. I want to be able to sleep eight hours. I know I'll feel better the next day."
Lee, 56, is licensed as a registered nurse and nurse practitioner in California, according to the state Board of Registered Nursing's Web site. She attended Los Angeles Southwest College and the Charles Drew University of Medicine and Sciences in Los Angeles.
Comedian Dick Gregory, who knows Lee and her work, said he believes Jackson's insomnia had its roots in the pop star's 2005 trial on child molestation charges. Jackson's health had deteriorated so much that his parents called Gregory, a natural foods proponent, for help.
Gregory said Jackson wasn't eating or drinking at the time and, after he was persuaded by Gregory to undergo testing, ended up hospitalized for severe dehydration.
But Jackson obviously was healthy enough to withstand the level of medical scrutiny needed to insure him for the upcoming high-stakes London concerts, Gregory said. "That you don't trick," he said of the exams.
Lee, who has also worked with Stevie Wonder, Marla Gibbs, Reynaldo Rey and other celebrities, said she was introduced to Jackson by the mother of one of his staff members. Jackson's three children had minor cold symptoms and their pediatrician was out of town.
Lee said she went to the house in January, the first of about 10 visits there through April, and treated the children with vitamins. Michael, intrigued, asked what else she did and took her up on her claim she could boost his energy.
After running blood tests, she devised protein shakes for him and gave him an intravenous vitamin and mineral mixture — known as a "Myers cocktail," after Dr. John Myers — which Lee said she uses routinely in her practice.
"It wasn't that he felt sick," she said. "He just wanted more energy."
Lee said she decided to speak out to protect Jackson's reputation from what she considers unfounded allegations of drug abuse or shortcomings as a parent.
"I think it's so wrong for people to say these things about him," she said. "He was a wonderful, loving father who wanted the best for his children."
___
AP Medical Writer Lindsey Tanner in Chicago and AP Television Writer David Bauder in New York contributed to this report
 
Another thread on it too.

Anderson 360 just had him talking to Gupta about it. Gupta called it "milk of amnesia".

Let's get the ASA pres on about it!

why?
 

because ANESTHESIOLOGISTS are more qualified to talk about it propofol..not Sanjay Gupta who does neurosurg.

notice how it was a nurse that Michael Jackson had initially gone to get propfol. He knew where he could get the drugs.

The docs all denied him.
 

Because in terms of anesthesia, anesthesiologists are the experts. They need an expert to speak on these things instead of always going to Gupta, who looked as comfortable speaking about anesthesia as I would about the intricacies of pediatric neurological malignancies.
 
You know what this means... If propofol is not already handled as a controlled substance in your hospital/pharmacy, it soon will be.
 
Because in terms of anesthesia, anesthesiologists are the experts. They need an expert to speak on these things instead of always going to Gupta, who looked as comfortable speaking about anesthesia as I would about the intricacies of pediatric neurological malignancies.

I thought he did a reasonable job in explaining propofol

1) its used for sleep only by hospital personell
2) it should only be used for people who know how to administer "oxygen" and put a breathing tube in
3) he never heard of it being used outside a medical setting

what else does the public need to know?

Its good for anesthesiologists since NOW it will be less likely that other medical personell will be allowed to utilize propofol. the black box warning will become larger. what do you guys think?
 
Agree about propofol use by others.

Yeah, I guess he didn't do that bad, but I'd rather see Dr. Roger Moore, M.D. , Pres of ASA, up on Anderson 360 than Gupta.

I thought he did a reasonable job in explaining propofol

1) its used for sleep only by hospital personell
2) it should only be used for people who know how to administer "oxygen" and put a breathing tube in
3) he never heard of it being used outside a medical setting

what else does the public need to know?

Its good for anesthesiologists since NOW it will be less likely that other medical personell will be allowed to utilize propofol. the black box warning will become larger. what do you guys think?
 
Agree about propofol use by others.

Yeah, I guess he didn't do that bad, but I'd rather see Dr. Roger Moore, M.D. , Pres of ASA, up on Anderson 360 than Gupta.
roger moore is busy doing other things namely getting ab igger chair for his office at deborah.
 
because ANESTHESIOLOGISTS are more qualified to talk about it propofol..not Sanjay Gupta who does neurosurg.

notice how it was a nurse that Michael Jackson had initially gone to get propfol. He knew where he could get the drugs.

The docs all denied him.

i suppose gupta wasn't the best, but didn't seem to do THAT bad.
 
I thought he did a reasonable job in explaining propofol

1) its used for sleep only by hospital personell
2) it should only be used for people who know how to administer "oxygen" and put a breathing tube in
3) he never heard of it being used outside a medical setting

what else does the public need to know?

Its good for anesthesiologists since NOW it will be less likely that other medical personell will be allowed to utilize propofol. the black box warning will become larger. what do you guys think?

I think mace is right on here. I've heard MJ had a number of what looked like IV starts on him. If that's true, and someone was giving him the dip who wasn't trained in anesthesia, then the public is finally going to understand the importance of having ONLY trained anesthesia pro's giving this stuff. Bad for MJ, bad for the music industry, but the silver lining is public recognition of an important issue. Too damn bad it was MJ... big loss👎
 
I think mace is right on here. I've heard MJ had a number of what looked like IV starts on him. If that's true, and someone was giving him the dip who wasn't trained in anesthesia, then the public is finally going to understand the importance of having ONLY trained anesthesia pro's giving this stuff. Bad for MJ, bad for the music industry, but the silver lining is public recognition of an important issue. Too damn bad it was MJ... big loss👎


The message to the public and which the ASA should emphasize is, "If you don't want to end up like MJ, you should always make sure you have the best trained person taking care of your anesthetic". If that means always having an anesthesiologist present then so be it. Period.
 
Its good for anesthesiologists since NOW it will be less likely that other medical personell will be allowed to utilize propofol.


Come on...with all the necessary fights with CRNAs and such are you really saying that "other medical personell" should not be using Propofol? That's such and old fight...so out of date...so reactionary.

I know you are not saying that EM and CCM shouldn't be using Propofol, but given the history of anesthesia trying to limit Propofol in the past, such a comment is too inflammatory.

...but yeah, RNs shouldn't be playing with it

HH
 
Come on...with all the necessary fights with CRNAs and such are you really saying that "other medical personell" should not be using Propofol? That's such and old fight...so out of date...so reactionary.

I know you are not saying that EM and CCM shouldn't be using Propofol, but given the history of anesthesia trying to limit Propofol in the past, such a comment is too inflammatory.

...but yeah, RNs shouldn't be playing with it

HH

i honestly dont care how inflammatory it iis I dont believe the er docs or critical care docs should be using it. I really dont. do you want to politicize this. fine. then more people will die but you wont know about it because they are not a celeb like MJ was
 
Come on...with all the necessary fights with CRNAs and such are you really saying that "other medical personell" should not be using Propofol? That's such and old fight...so out of date...so reactionary.

I know you are not saying that EM and CCM shouldn't be using Propofol, but given the history of anesthesia trying to limit Propofol in the past, such a comment is too inflammatory.

...but yeah, RNs shouldn't be playing with it

HH

Actually many of these specialists that you mentioned should not administer Propofol to non intubated patients because they simply don't have the training needed to properly titrate an anesthetic safely to the desired level while monitoring the patient and keeping the airway open simultaneously.
It's really more demanding than many people might imagine.
The fact that untrained people are giving Propofol to patients in many places does not make it right, it is cheaper but it's not right.
And being a physician (non anesthesiologist) does not make you an expert on administering anesthetics, actually any CRNA would be 10 times safer than you in that situation.
 
Actually many of these specialists that you mentioned should not administer Propofol to non intubated patients because they simply don't have the training needed to properly titrate an anesthetic safely to the desired level while monitoring the patient and keeping the airway open simultaneously.
It's really more demanding than many people might imagine.
The fact that untrained people are giving Propofol to patients in many places does not make it right, it is cheaper but it's not right.
And being a physician (non anesthesiologist) does not make you an expert on administering anesthetics, actually any CRNA would be 10 times safer than you in that situation.

Do you honestly (without pride or policitcs) believe that an EM doc can't use propofol safely for concious sedation while someone else reduces a tib-fib?

HH
 
Do you honestly (without pride or policitcs) believe that an EM doc can't use propofol safely for concious sedation while someone else reduces a tib-fib?

HH

If I break my leg and need a closed reduction I will ask for a professional anesthesia provider who knows how to administer a general anesthetic (what you call conscious sedation I call GA).
It's very dangerous for an ER guy to tell a nurse to give a certain dose of Propofol while he is busy puling on a leg and no one is really watching the patient!
All it takes is few minutes of apnea my friend.
Again the fact that it is being done and that they are getting away with it does not make it right.
It is definitely cheaper but not right.
 
Do you honestly (without pride or policitcs) believe that an EM doc can't use propofol safely for concious sedation while someone else reduces a tib-fib?

HH

99% of the time, things may be fine. It's that other 1% of the time that most of us are worried about...
 
Do you honestly (without pride or policitcs) believe that an EM doc can't use propofol safely for concious sedation while someone else reduces a tib-fib?

HH

I'm assuming you are a ER doc. Nothing against you guys, but I've seen REALLY REALLY bad situations in the ER where a ER resident or attending couldnt intubate a pt. At my hosp they just etomidate and vec EVERYONE.

That's dangerous especially when you cant secure a definitive airway.

As an anesthesiologist, atleast if a pt decompensates or stops breathing, your sixth sense kicks in to tk care of business and SAVE that pt's life.
 
Do you honestly (without pride or policitcs) believe that an EM doc can't use propofol safely for concious sedation while someone else reduces a tib-fib?

HH

its attitudes like yours that is probably at the heart of why we have a dead celebrity. and people actually buy the s**t that you are selling
 
If I break my leg and need a closed reduction I will ask for a professional anesthesia provider who knows how to administer a general anesthetic (what you call conscious sedation I call GA).
It's very dangerous for an ER guy to tell a nurse to give a certain dose of Propofol while he is busy puling on a leg and no one is really watching the patient!
All it takes is few minutes of apnea my friend.
Again the fact that it is being done and that they are getting away with it does not make it right.
It is definitely cheaper but not right.

I agree that a small community EM doc asking a nurse to push propofol and then reducing a fracture is a bad idea. That is why in my question to you I specifically stated that "someone else" reduces the tib-fib.

The setting is as follows:
Nurse documenting
EM doc responsible for monitoring patient giving the propofol with all monitor and airway tools out and ready
Bone doc getting OK from EM doc and does reduction (EM doc has nothing physically to do with the reduction)
 
An anesthesiologist discussing Propofol with Fox News. The saga continues.

http://www.foxnews.com/story/0,2933,529712,00.html

And here is Dr. Nearman on MSNBC

http://mms.tveyes.com/Transcript.asp?StationID=205&DateTime=7/1/2009+12:02:35+PM&PlayClip=TRUE

Agreed that it's too bad someone died, but it does emphasize the importance of trained professionals (anesthesia personnel) being the only personnel permitted to administer propofol for sedation or general anesthesia.
Proud of my pops...
Following along in the family bizz...
Zach
 
I agree that a small community EM doc asking a nurse to push propofol and then reducing a fracture is a bad idea. That is why in my question to you I specifically stated that "someone else" reduces the tib-fib.

The setting is as follows:
Nurse documenting
EM doc responsible for monitoring patient giving the propofol with all monitor and airway tools out and ready
Bone doc getting OK from EM doc and does reduction (EM doc has nothing physically to do with the reduction)
What you just described is the ER physician acting as an anesthesia provider without proper training.
If there is no anesthesiologist, CRNA or AA available, and as long as the patient agrees to have anesthesia administered by some one who is not trained in anesthesia, and as long as the patient is not me, this would be OK.
 
What you just described is the ER physician acting as an anesthesia provider without proper training.
If there is no anesthesiologist, CRNA or AA available, and as long as the patient agrees to have anesthesia administered by some one who is not trained in anesthesia, and as long as the patient is not me, this would be OK.


Agree with Plankton. Why would any physician not trained in anesthesia want to put themselves on the line by sedating people without proper training. That's called taking unnecessary liability.
 
Our hospital policy is that propofol, pentothal, ketamine, etomidate, and brevital, are administered by anesthesia personnel ONLY, except for propofol infusions on intubated and ventilated patients in the ICU. No debate needed - and pharmacy will not provide it to anyone else.
 
I've read this forum for a good while now, just never had a reason to post since I'm not an MD. What do you guys think about the DEA getting involved in this situation? Have you ever heard of someone using propofol in the home without an appropriate medical professional (i.e. anesthesiologist) at least on standby?
 
Our hospital policy is that propofol, pentothal, ketamine, etomidate, and brevital, are administered by anesthesia personnel ONLY, except for propofol infusions on intubated and ventilated patients in the ICU. No debate needed - and pharmacy will not provide it to anyone else.

Smart policy.

Non-anes trained PMR- Pain doc.

Fentanyl and versed for my patients, and only once every 2 weeks at that.
That's how we did it in fellowship. Propofol is an anesthetic, not a sedative. Should not be used by non-anesthetists. That is how I trained the fellows.
 
I've read this forum for a good while now, just never had a reason to post since I'm not an MD. What do you guys think about the DEA getting involved in this situation? Have you ever heard of someone using propofol in the home without an appropriate medical professional (i.e. anesthesiologist) at least on standby?

Propofol is an ANESTHETIC drug. There is NO reason to use it outside a hospital or surgery center, period. If the idiot cardiologist or someone else used it on MJ at home, they should lose their license and be prosecuted.

BTW - rule #1 in ACLS - CALL FOR HELP. That's why you don't do CPR for 30 minutes and then go find someone, which is what the idiot cardiologist did.
 
Propofol is an ANESTHETIC drug. There is NO reason to use it outside a hospital or surgery center, period. If the idiot cardiologist or someone else used it on MJ at home, they should lose their license and be prosecuted.

BTW - rule #1 in ACLS - CALL FOR HELP. That's why you don't do CPR for 30 minutes and then go find someone, which is what the idiot cardiologist did.

last i can remember via AHA guidelines, unwitnessed unresponsiveness calls for CPR first, then go call for help (if not immediately available).
witnessed unresponsiveness gets 911 first, then CPR.
 
Propofol is a powerful medication used exclusively for Anesthesia or sedation under strict monitoring criteria, by trained personnel who are able to rescue the patient should they stop breathing spontaneously or should their blood pressure become too low as a result of using the drug.
There is absolutely no known indication for using this medication at home regardless of who is using it or what equipment is available.



I've read this forum for a good while now, just never had a reason to post since I'm not an MD. What do you guys think about the DEA getting involved in this situation? Have you ever heard of someone using propofol in the home without an appropriate medical professional (i.e. anesthesiologist) at least on standby?
 
last i can remember via AHA guidelines, unwitnessed unresponsiveness calls for CPR first, then go call for help (if not immediately available).
witnessed unresponsiveness gets 911 first, then CPR.

😕
We are talking about a cardiologist here not a lay person!
This means: patient uresponsive----> assess ABC and start CPR if needed.
 
😕
We are talking about a cardiologist here not a lay person!
This means: patient uresponsive----> assess ABC and start CPR if needed.

What do you call a cardiologist without a defibrillator and drugs? A LAYPERSON 😉
 
last i can remember via AHA guidelines, unwitnessed unresponsiveness calls for CPR first, then go call for help (if not immediately available).
witnessed unresponsiveness gets 911 first, then CPR.

Ain't gonna look up em up now 😉 but...

1-Determine unresponsiveness 2-Call for help.

In an ADULT, CPR generally does nothing without DEFIBRILLATION. And even if you do a couple cycles of CPR first - you don't do it for 30 minutes (which is what has been reported) before you run downstairs and try and get someone to call for help.

Witnessed or unwitnessed arrests with CPR in the field and without defibrillation have essentially zero survivability.
 
Propofol is a powerful medication used exclusively for Anesthesia or sedation under strict monitoring criteria, by trained personnel who are able to rescue the patient should they stop breathing spontaneously or should their blood pressure become too low as a result of using the drug.
There is absolutely no known indication for using this medication at home regardless of who is using it or what equipment is available.

the problem with medicine is absolutes. there are no absolutes in medicine. I figured that out the longer im around.

I would be ok with home use of propofol if a minor procedure was being done and the guy giving propofol was an anesthesiologist and full monitors nasal cannula was used and all rescue equipment was available including sux and some pressors. Thats safe in my opinion. there is no difference from the above scenario than a surgery center. just location.

Did they find oxygen at his house? nasal cannula? other anesthesia paraphanalia? these are questions that pierce right to the heart of the matter. was there an iv in MJ?
 
That is true but every study shows that the highest chance of sucess is with defibrillation and maybe with med. So could 2 min of CPR be justified - yes- but 30 is totally out of protocol.

😕
We are talking about a cardiologist here not a lay person!
This means: patient uresponsive----> assess ABC and start CPR if needed.
 
the problem with medicine is absolutes. there are no absolutes in medicine. I figured that out the longer im around.

I would be ok with home use of propofol if a minor procedure was being done and the guy giving propofol was an anesthesiologist and full monitors nasal cannula was used and all rescue equipment was available including sux and some pressors. Thats safe in my opinion. there is no difference from the above scenario than a surgery center. just location.

Did they find oxygen at his house? nasal cannula? other anesthesia paraphanalia? these are questions that pierce right to the heart of the matter. was there an iv in MJ?

What if there was no procedure performed, as appears to be the case here? What if administration of propofol for sleep WAS the procedure? Do you justify that?

Would you do that?
 
I hope this doesn't cause a scare like the whole fentanyl ordeal last year. I had at least 4 pt refuse fentanyl last yr b/c they heard of people using it on the street and dying. Despite my best efforts to address their concerns, all were adamant about avoiding fent.
No big deal, we have plenty of other things, but the fact that I was limited was annoying.
 
I hope this doesn't cause a scare like the whole fentanyl ordeal last year. I had at least 4 pt refuse fentanyl last yr b/c they heard of people using it on the street and dying. Despite my best efforts to address their concerns, all were adamant about avoiding fent.
No big deal, we have plenty of other things, but the fact that I was limited was annoying.

Maybe it will give us an excuse to use more ketamine.
 
Not to change the subject from MJ, but what do you think about non-anesthesia people using pentobarb? Ketamine? At my program, non-anesthesia people sedate kids for MRI's, procedures, etc, with these drugs many, many times a day....it's usually an NP and an RN running things in the room with an MD assigned to the unit but not present during actual sedations.
 
What if there was no procedure performed, as appears to be the case here? What if administration of propofol for sleep WAS the procedure? Do you justify that?

Would you do that?


What I don't get is why it had to be propofol. I mean, there are plenty of other drugs that can sedate people or help people sleep. I'm not very knowledgeable about anesthetics, obviously, but I know about drugs in my area of specialty and it just seems like an extreme choice to choose propofol. Thoughts/opinions?
 
What I don't get is why it had to be propofol. I mean, there are plenty of other drugs that can sedate people or help people sleep. I'm not very knowledgeable about anesthetics, obviously, but I know about drugs in my area of specialty and it just seems like an extreme choice to choose propofol. Thoughts/opinions?

When people take narcotics and sedatives regularly they develop tolerance to these drugs and they just stop working for them.
Propofol will always work even on the most hardcore drug addicts and there is no known tolerance to it's effects (or it has never been studied).
 
When people take narcotics and sedatives regularly they develop tolerance to these drugs and they just stop working for them.
Propofol will always work even on the most hardcore drug addicts and there is no known tolerance to it's effects (or it has never been studied).

Ah, yes ... makes sense. I didn't think of the unknown tolerance of propofol...

thanks.
 
Apparently Jackson had an anesthesiologist as his tour physician during the 1997-98 HIStory. Dr. Ratner...

http://www.cnn.com/2009/SHOWBIZ/Music/07/03/jackson.wrap/

the plot thickens...

There's an interesting quote from this article:

"The anesthesiologist who accompanied Jackson during the 82-date world tour in 1996 and 1997 was Dr. Neil Ratner, the sources said.

They said Ratner would keep medical equipment in his hotel room, which he used to monitor Jackson's vital signs when the singer was asleep or "under," as one source put it."

Sounds like he was receiving 'MAC naps' during his tour. What lunatics....
 
this will keep propofol from being approved for use by non-anesthesiologists as the public will be scared of it now

that is a good thing
 
As a new EM resident (I'm asking from a position of ignorance):
What exactly can go wrong with propofol titration if the EM person is the one maintaining the airway? Is the anesthesiologist's fear just that the patient would stop breathing and the EM attending would encounter a difficult airway that he would not be able to intubate, or are there other potential complications that we'd be ill-equipped to deal with?

And are there any other medications that you feel are better-suited for an EM doc to use that have lower risk than propofol for use in procedures?
 
As a CA-3 and having done hundreds of MAC cases using propofol, precedex, ketamine, you name it, I'm still learning the art of sedation and the great variabilities you will encounter b/w patients, doses, boluses, infusion rates, apneic threshold, etc. Where I agree with my anesthesia colleagues, is ER docs and any other doc will never accumulate the experience and feel for propofol and can run into trouble they wouldn't have imagined. Is this fracture reduction NPO? Are you sedating with propofol or are you inducing GA with loss of airway reflexes? There's a host of problems that accompany this drug that you need to be prepared for and the best person for that job is an anesthesiologist.
 
What if there was no procedure performed, as appears to be the case here? What if administration of propofol for sleep WAS the procedure? Do you justify that?

Would you do that?

as long as proper staff and equipment was available at the house and standard monitoring used. tough to argue that. Do you need a hospital to use propofol safely?
 
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