Propofol, Michael Jackson and vet medicine...things you just wish you never knew

Yes, I’ll write about [just about] anything as long as it reminds me of veterinary medicine. Today’s post is proof. It’s to do with the most salacious, creepy kind of medicine there is (or was): Michael Jackson’s personal brand.

Michael Jackson never was much of a hot topic for me until he succumbed to some IV propofol, served straight, allegedly sans direct observation. That’s when his deadly tragedy got me to thinking about propofol and how we veterinarians use it.

Why? Because propofol (AKA, “milk of amnesia”) is a great drug. But it’s not for every person or for every pet...not under all circumstances or in identical doses, anyway. Also because sometimes we get to feeling so comfortable with our anesthetics that we forget to get back to the basics.

Too bad the reminder came via news we wish we never knew anything about. Case in point, this blurb from the NY Daily News (yes I did):

The Los Angeles County coroner released autopsy results Wednesday which confirmed that the King of Pop was the victim of a homicide and revealed other details of his death.

The 51-page report backed the coroner's determination made last August the Jackson died from "acute propofol intoxication."

Jackson's personal doctor, Conrad Murray, told investigators he gave the entertainer the powerful sedative to help him sleep.

Dr. Selma Calmes, the outside consultant who reviewed the coroner's findings, said propofol is not supposed to be used for "insomnia relief, to my knowledge."

"The only reports of its use in homes are cases of fatal abuse (first reported in 1992), suicide, murder and accident," Calmes wrote.

Also, the "recommended equipment for patient monitoring, precision dosing and resuscitation was not present."

"The standard of care for administering propofol was not met," Calmes wrote.

***

No, I’ll hasted to add that even the barest minimum standard was NOT met, not even for veterinary medicine, which specifically requires that appropriate resuscitation and ventilation equipment be present. Which would only make sense given that the drug’s commonest side effect is––get this––respiratory arrest.

Yep, whenever a drug comes attached to a 50% risk of apnea even at standard doses, you’d think intubation would be a distinct possibility. Indeed, there’s never a good reason to use an anesthetic induction agent like propofol without an endo-tracheal tube handy. Anyone who uses this drug (as I do, daily) knows this and expects some respiratory compromise.

So what was this harebrained, overpriced version of a doc doing while Mr. Jackson was dying? For his sake, I hope he can claim his own drug dependency rendered him insane. If I were on the jury, it’s the only explanation I might muster some sympathy for. Because you’d have to be out of your right mind to use propofol as a sleep aid. It’s just plain suicidal––or rather, homicidal, depending on your point of view.