bouee
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Dr White
Walgren
other quotes from White's books/articles
«*because of the profound risk of cardio respiratory depression, propofol should always be administered by anesthesiolgists, not by gastroenterologists, etc (other doctors) …*»
Dr White :the book was published in 1996, things have evolved.
Would agree that propofol has profound a risk of cardio respiratory depression, but can be administered by trained doctors other than anesthesiologists, in a proper setting.
Guidelines for sedation, for non anesthesiologists :
«*even if moderate sedention is intended , the same standard of care should be applied as for deep sedation*»
«*because it's not always possible to predict how a patient will react, the care giver needs to prepare to rescue a patient from deep sedation*»
Dr White agrees that for moderate sedation (when an infusion is used), the patient should receive the same care as for deep sedation.
For mild sedation, you should be prepared in the event that the patient goes into moderate sedation, not deep sedation.
Wouldn't administer propofol in a home, but thinks that these guidelines should be followed with an infusion. Doesn't know if a second person is necessary, assuming the doctor is monitoring the patient, while the propofol is being administered.
What about adminitering benzos + propofol bolus ? in an ideal situation, it would be great to follow the guidelines.
Showing Onnelis model with 25mg propofol over 3 to 5 mn, 25mg fast injection , blood concentration and free propofol in urine levels. Her model is based on a 1998 article.
Dr White has not read the article in detail. Dr White had a conversation with G Onelis at the Flanagans house, a few hours at the end of last week. The models Dr White testified to, were not done by him, he is not an expert in models.
On the model, CM infused 25mg at 10 40, MJ self injection is 11 40. Before the self injection, blood level were near 0.
Showing a zoom of the same graph, zooming on the self injection: :
Dr White believes that self injection occurred later than 11 40.
dr white thinks the scenario is the most likely : consistent with Cms interview, not recvoring the tubing, matches the concentration of free propofol in the urine, matches blood concentration.
Showing another zoom of the same graph, over 10 mn , showing only blood concentration : the circulation stops almost immediately . Dr White says it could have been arrythmia, the cause is unclear.
Walgren brings up the autopsy report : MJ had no heart problem, Dr White says that doesn't preclude an arrythmia.
CM said his heart rate was 122. Dr White said it's unclear what 122 was, it could have been the saturation. Walgren reads the the police interview, CM also reported that he felt a thready pulse. Dr White says that CM might have felt his own pulse, he was under stress. He might not have felt a perfusing pulse. Walgren : «*This fits with you new theory that MJ died instantly*»
Dr White doesn't see any evidence of respiratory arrest, or cardiac arrest, or both combined.
Back to march 8th letter : first cause of death Dr White thought of, is respiratory depression, Dr White corrects «*cardio pulmonary depression*», among other things. Walgren mentions the oral consumption is one of the other things
Showing models of lorazeapm (multiple 4 mg injection, 2 X 2 mg IV +16mg oral) .
The graph shows 0.0013 mg in the stomach, Dr White doesn't know where this number comes from, but it is smaller than the 0.006mg .
The fact that there is free lorazepam in the stomach suggests oral ingestion.
Residual lorazepam is an asumption of 10mg for the past 5 nights.
Shows on the graph where CM would have injected 25mg of propofol, and where MJ would have self injected. When MJ self injected, the lorazepam was a little lower.
Back to Onnelis model with 25mg propofol over 3 to 5 mn, 25mg fast injection , blood concentration and free propofol in urine levels :
Why does it no show the effect site ? Because she was only asked about the free propofol in the urine.
Graph by Dr Shafer ; added effect site concentration to Onnelis'graph : the levels at effect site are the same in both Cms Injection, or the supposed MJ's self injection. Dr White says these numbers are meaningless , because of variability. Dr White would be more interested in the heart concentration.
Afternoon break
Walgren
other quotes from White's books/articles
«*because of the profound risk of cardio respiratory depression, propofol should always be administered by anesthesiolgists, not by gastroenterologists, etc (other doctors) …*»
Dr White :the book was published in 1996, things have evolved.
Would agree that propofol has profound a risk of cardio respiratory depression, but can be administered by trained doctors other than anesthesiologists, in a proper setting.
Guidelines for sedation, for non anesthesiologists :
«*even if moderate sedention is intended , the same standard of care should be applied as for deep sedation*»
«*because it's not always possible to predict how a patient will react, the care giver needs to prepare to rescue a patient from deep sedation*»
Dr White agrees that for moderate sedation (when an infusion is used), the patient should receive the same care as for deep sedation.
For mild sedation, you should be prepared in the event that the patient goes into moderate sedation, not deep sedation.
Wouldn't administer propofol in a home, but thinks that these guidelines should be followed with an infusion. Doesn't know if a second person is necessary, assuming the doctor is monitoring the patient, while the propofol is being administered.
What about adminitering benzos + propofol bolus ? in an ideal situation, it would be great to follow the guidelines.
Showing Onnelis model with 25mg propofol over 3 to 5 mn, 25mg fast injection , blood concentration and free propofol in urine levels. Her model is based on a 1998 article.
Dr White has not read the article in detail. Dr White had a conversation with G Onelis at the Flanagans house, a few hours at the end of last week. The models Dr White testified to, were not done by him, he is not an expert in models.
On the model, CM infused 25mg at 10 40, MJ self injection is 11 40. Before the self injection, blood level were near 0.
Showing a zoom of the same graph, zooming on the self injection: :
Dr White believes that self injection occurred later than 11 40.
dr white thinks the scenario is the most likely : consistent with Cms interview, not recvoring the tubing, matches the concentration of free propofol in the urine, matches blood concentration.
Showing another zoom of the same graph, over 10 mn , showing only blood concentration : the circulation stops almost immediately . Dr White says it could have been arrythmia, the cause is unclear.
Walgren brings up the autopsy report : MJ had no heart problem, Dr White says that doesn't preclude an arrythmia.
CM said his heart rate was 122. Dr White said it's unclear what 122 was, it could have been the saturation. Walgren reads the the police interview, CM also reported that he felt a thready pulse. Dr White says that CM might have felt his own pulse, he was under stress. He might not have felt a perfusing pulse. Walgren : «*This fits with you new theory that MJ died instantly*»
Dr White doesn't see any evidence of respiratory arrest, or cardiac arrest, or both combined.
Back to march 8th letter : first cause of death Dr White thought of, is respiratory depression, Dr White corrects «*cardio pulmonary depression*», among other things. Walgren mentions the oral consumption is one of the other things
Showing models of lorazeapm (multiple 4 mg injection, 2 X 2 mg IV +16mg oral) .
The graph shows 0.0013 mg in the stomach, Dr White doesn't know where this number comes from, but it is smaller than the 0.006mg .
The fact that there is free lorazepam in the stomach suggests oral ingestion.
Residual lorazepam is an asumption of 10mg for the past 5 nights.
Shows on the graph where CM would have injected 25mg of propofol, and where MJ would have self injected. When MJ self injected, the lorazepam was a little lower.
Back to Onnelis model with 25mg propofol over 3 to 5 mn, 25mg fast injection , blood concentration and free propofol in urine levels :
Why does it no show the effect site ? Because she was only asked about the free propofol in the urine.
Graph by Dr Shafer ; added effect site concentration to Onnelis'graph : the levels at effect site are the same in both Cms Injection, or the supposed MJ's self injection. Dr White says these numbers are meaningless , because of variability. Dr White would be more interested in the heart concentration.
Afternoon break
