a question: ephedrine was not brought up during lopez' testimony or did i miss it?
re flumazenil:
accordign to what i read flumazenil should normally not be used if a patient had a high lorazepam dose unless it’s an emergency, because
flumazenil can cause seizures.
there is another problem with flumazenil, it has a different half-life than lorazepam and if a patient had a high lorazepam dose there is the
risk of resedation: the patient wakes up, but gets sleepy again!
i believe this could be the reason why mj was (probably?) still unconscious at shortly before noon.
I think murray had to wait until mj showed signs to get out of the lorazepam sedation on his own before he gave him the flumazenil to wake him fully up: this reduced both the risk of a seizure and the risk of resedation.
in addition, murray gave mj ephedrine to make him more alert to counter remaining resedation effects.
I think murray could have used flumazenil as a "quick detox" agent under anesthesia, and he used propofol as the anesthetic.
this website explains how a quick detox works, and they say they DO NOT do it for lorazepam:
http://www.rapiddrugdetox.com/detox-facts--drugs/benzodiazepine-addiction.html
to me, one of the key questions is whether or not mj was conscious at the time of death, when he received the fatal propofol bolus (or drip if you are ready to believe murray was able to give propofol by drip WITHOUT AN IV PUMP).
i can see two scenarios of what happened at time of death:
scenario 1
at the time murray called sade anding, mj was finally coming out of his lorazepem sleep. murray noticed this too late, mj was already moving, maybe trying to get up and murray had to be quick to give the propofol bolus (before administering flumazenil), and he gave the propofol too fast.
scenario 2
mj did not wake up at all, murray realized something was wrong (low oxygen levels?) at the time he called anding. he droped the call and rushed to mj’s side. He gave the flumazenil FIRST (before the propofol bolus) and waited until mj was coming out of the lorazepam sedation. mj came out of sedation fast, it was a rough awakening and murray THEN gave him the propofol bolus - he hadn’t yet prepared the scene and needed more time (+ propofol has amnesic potential, murray possibly hoped mj would not remember the incident afterwards?).
mj was moving (was he possibly going into a seizure??) and murray messed up the propofol bolus, he gave the bolus too fast.
^can the medics here please comment on this, what do you think? thanks
--
below some links with information about flumazenil and some other helpful info:
here are some studies on flumazenil and benzos:
http://www.druglib.com/druginfo/romazicon/abstracts/ (index)
http://www.druglib.com/abstract/mi/mintzer-mz_psychopharmacology-berl_20050300.html
http://www.druglib.com/abstract/gi/girdler-nm_anaesthesia_20020900.html
http://www.druglib.com/abstract/co/coulthard-p_br-dent-j_20000325.html
http://www.druglib.com/abstract/sa/saxon-l_psychopharmacology-berl_19970500.html
^note what the studies say about psycho motoric effects
flumazenil info:
http://www.drugs.com/sfx/flumazenil-side-effects.html
http://www.drugs.com/pro/romazicon.html
antidote info:
http://www.inchem.org/documents/antidote/antidote/ant01.htm#PartNumber:3
^note that this guide says flumazenil can be detected in blood (or that’s what i understand). during prelim the coroner(?) said they (at their labs i guess) cannot test for it in blood. defense was paying close attention to this to my recollection
mj had a high amount of lorazepam in his blood at tod. question is, was he conscious?
s. here for sedation scores, lorazepam is on p6:
http://www.mc.vanderbilt.edu/surgery/trauma/Protocols/SedationAnalgesiaGuidelines.pdf
^can a medic please comment on this. to me it looks like mj must either have been tolerant to lorazepam (very high tolerance?!), or he must still have been sedated.
murray gave valium in the days before mj died.
s. here how valium is used to treat benzo withdrawal symptoms:
http://www.benzo.org.uk/manual/bzsched.htm
^note how murray prescribed valium: he did not say use once at bedtime, but take every 6 hours
here is a document on the controversy about propofol by bolus (mac sedation) used for endoscopy:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1614218/
The Great Debate On Nurse-Administered Propofol Sedation (NAPS)
someone on this board recently posted a study (it was conducted last year) how efficient propofol is to treat insomnia, the outcome of the study was positive:
http://www.springerlink.com/content/q1383124j665v845/
note, that these patients received propofol under safe conditions!