Newswise — Recent questions about the death of Michael Jackson have focused media attention on the commonly used intravenous anesthetic propofol. In the April 2009 issue of Anesthesia & Analgesia, the leading clinical journal for anesthesiologists, Robert R. Kirby, James M. Colaw and Michael M. Douglas reported on a 24-year-old woman whose 2005 death was attributed to propofol toxicity.
The article "Death from Propofol: Accident, Suicide, or Murder?" has enough intrigue to satisfy anyone who follows "Law and Order." The woman who died had no history of drug abuse and no evidence of such behavior at autopsy. The possibility of suicide was remote because the injection site for the propofol was in the woman's elbow. The medical examiner and police investigators felt that she died from probable homicide. Attention turned to a male registered nurse acquaintance who had acquired propofol in the course of his regular duties in a surgical intensive care unit.
A follow-up investigation of the propofol national drug code lot numbers on the bottles at the crime scene revealed the drug had been obtained from an automated OmnicellÂ® dispenser by a male registered nurse who worked in the surgical intensive care of Shands Hospital at the University of Florida, Gainesville. The most recent propofol had been dispensed to him on November 3, 2005. On or about the day of the woman's death (between November 8 and 9, 2005), he left the area and fled the U.S. to Ireland. He was later apprehended in the West African republic of Senegal and returned to the United States. He was tried and convicted of first-degree murder and was sentenced to life in prison without the possibility of parole in May 2008.
"All intravenous sedatives have similar risks of depressing breathing, blood pressure, and protective reflexes. Propofol is not intrinsically more dangerous than other intravenous sedatives," stated Dr. Steven L. Shafer of Columbia University, Editor-in-Chief of Anesthesia & Analgesia. "We have known since the days of Paracelsus that it is the dose that renders a drug toxic. Propofol is dispensed in doses intended to produce general anesthesia. Administration of an anesthetic dose of any hypnotic by an untrained individual, or in a setting in which general anesthesia cannot be properly managed, is a recipe for disaster."
Propofol has been used in anesthesiology since 1986. Although its clinical properties are well known to anesthesia providers, knowledge concerning its abuse potential and more complex issues, such as its use in suicide, are less commonly appreciated. Before 1992, clinicians and the manufacturer were convinced that such abuse was rare to nonexistent. Since 1992, however, reports have been published " largely in forensic medical journals " concerning abuse, accidental overdose, and suicide. In the October 2007 issue, for example, Anesthesia & Analgesia included several papers on drug diversion, including one on propofol. The journal has reported on the use of propofol since 1986.
About the IARS
The International Anesthesia Research Society is a nonpolitical, not-for-profit medical society founded in 1922 to encourage, stimulate, and fund ongoing anesthesia-related research and projects that will enhance and advance the anesthesiology specialty. The IARS has a worldwide membership of 15,000 physicians, physician residents, and others with doctoral degrees, as well as health professionals in anesthesia-related practice. In additional to publishing the monthly scientific journal Anesthesia & Analgesia, the IARS sponsors an annual clinical and scientific meeting, funds anesthesia-related research, and sponsors the SAFEKIDS research initiative in conjunction with the FDA. Additional information about the society and the journal may be found at www.iars.org/journal and www.anesthesia-analgesia.org.
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