A different take on Dr. Treacy's comment

[alexwithmj]

During the interview with Dr. Drew, Dr. Treacy gave a comment which was not really based on currently medical and scientific knowledge and evidences. I think he should be more cautious to avoid confusion and false assumption. For Dr. Drew, he is a phony in my opinion.

“OK, if we look at the facts... why is propofol so popular with anesthesiologists? Treacy asked. ”If you give injection of it, there is no antidote, but it only last four minutes and it wears off. So, if he took a 20 mil syringe himself, the most he can give himself a shot of is 200 milligrams, which would only keep him asleep for four minutes and he would wake up again. So, it is almost physically impossible that Michael Jackson could have killed himself.”

There are many good scientific reviews and research articles about this specific subject, you can search on pubmed and get quite comprehensive information. For example, there is one recent review titled Clinical effects and lethal and forensic aspects of propofol. J Forensic Sci, January 2011, Vol. 56, No. S1.

quot
"Propofol-related Deaths
Propofol abuse and recreational use often lead to death because of the rapid onset of unconsciousness and apnea following injection(3). Thirty-seven percent (37%) of the 38 published cases of abuse between 1992 and 2007 were fatalities (3) The majority of these propofol-related deaths were the result of accidental overdose or intentional suicide. Recently, however, the first case of first degree murder with the use of propofol was reported (3). Of interest, blood levels of propofol in the majority of propofol-related deaths were within or below the therapeutic range (1.3–6.8 ug⁄ mL) ，indicating that the mechanism of death was likely because of respiratory depression with subsequent hypoxia (3,33). It is important to also recognize that perimortem and postmortem metabolism and redistribution may occur (34). Thus, blood and tissue toxicological analysis must be interpreted carefully in these cases (3). Furthermore, as with other drugs of abuse, a specific ‘‘lethal level’’ may not be necessary to conclude that death was caused by propofol injection. "

The full text of this paper is http://onlinelibrary.wiley.com/doi/10.1111/j.1556-4029.2010.01583.x/full, it's open source, you should be able read the full text.

 

[PaceMioDolceCuore]

At this point I admittedly listen more closely to those who have reason to call themselves anesthesiologist. At this point I've seen a number of physicians riding their favorite horses if you will. Pinsky is pushing his 'opiate addiction' like a shopping cart in front of him and other physicians are offering their opinions as well.

I recall one 'panel' on Pinsky's show and the only I learned was that 6 different physicians had 6 different opinions.

I listened to the Dr. Treacy's take but all of them are offering what they consider the truth. If you have ever a physician tell you it's "impossible for x, y to occur"- while the package insert indicates that x,y, z MAY occur- these absolutes are rarely helpful.

 

[lemon662]

During the interview with Dr. Drew, Dr. Treacy gave a comment which was not really based on currently medical and scientific knowledge and evidences. I think he should be more cautious to avoid confusion and false assumption. For Dr. Drew, he is a phony in my opinion.

“OK, if we look at the facts... why is propofol so popular with anesthesiologists? Treacy asked. ”If you give injection of it, there is no antidote, but it only last four minutes and it wears off. So, if he took a 20 mil syringe himself, the most he can give himself a shot of is 200 milligrams, which would only keep him asleep for four minutes and he would wake up again. So, it is almost physically impossible that Michael Jackson could have killed himself.”

There are many good scientific reviews and research articles about this specific subject, you can search on pubmed and get quite comprehensive information. For example, there is one recent review titled Clinical effects and lethal and forensic aspects of propofol. J Forensic Sci, January 2011, Vol. 56, No. S1.

quot
"Propofol-related Deaths
Propofol abuse and recreational use often lead to death because of the rapid onset of unconsciousness and apnea following injection(3). Thirty-seven percent (37%) of the 38 published cases of abuse between 1992 and 2007 were fatalities (3) The majority of these propofol-related deaths were the result of accidental overdose or intentional suicide. Recently, however, the first case of first degree murder with the use of propofol was reported (3). Of interest, blood levels of propofol in the majority of propofol-related deaths were within or below the therapeutic range (1.3–6.8 ug⁄ mL) ，indicating that the mechanism of death was likely because of respiratory depression with subsequent hypoxia (3,33). It is important to also recognize that perimortem and postmortem metabolism and redistribution may occur (34). Thus, blood and tissue toxicological analysis must be interpreted carefully in these cases (3). Furthermore, as with other drugs of abuse, a specific ‘‘lethal level’’ may not be necessary to conclude that death was caused by propofol injection. "

The full text of this paper is http://onlinelibrary.wiley.com/doi/10.1111/j.1556-4029.2010.01583.x/full, it's open source, you should be able read the full text.

Well based on what I've read about Propofol and dosages, 200mg of Propofol given by a direct IV bolus would be a lethal dose.

The dosage is based what the doctor is trying to achieve: full general anesthetic or sedation, and it's based of course on the patient's weight. If MJ was 136 lbs that's 62kg. Based on this page below and the dosing info there, IF he was to have received 20mls (or 200mg of Propofol as the concentration of it is 10mg/ml), that would be a lethal dose:

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=13430#df8296f2-61df-4ba0-9828-4337053a2231

It's also indicated that if it's given by direct IV bolus (as opposed to a continuous IV infusion), it must be injected slowly; over a period of 3-5 minutes for if given too quickly can basically cause blood pressure to drop too low or lack of oxygen in the blood.