There are a couple of very clear take away messages from this incident.

1. Propofol is a substance of abuse- We have known this from the pre-marking animals studies that clearly and unequivically demonstrated that animals will self administer the drug because of it'spositive rewarding effects on midbrain reward pathways.
2. This is a drug with an incredibly narrow therapeutic index meaning that the range between the effective hypnotic dose and a toxic dose that impairs breathing is extraordinarily narrow.
3. This is clearly a drug that should ONLY be administered by qualified anesthesia providers such as CRNAs and anesthesiologists in settings where advanced airway management and full resucitative capabilities are immediately available!

The whole world is talking about propofol being the cause of MJ's death, and the doctor administering it shortly before.

We still don't KNOW. Nothing has been confirmed by the authorities.

What surprises me in this case is that each and every rumour starts to lead its own life and people mistake it for hard fact. The media have their "sources"; up comes another fable. First it was demerol. Now it's propofol.
Another example: Michael is/is not/cannot be the biological father of his three children. (O, but he has a fourth in Norway).
This goes on.

I wouldn't be surprised if there was no evidence found of poisoning by any external substance whatsoever. Not after the first, nor after the second autopsy. Huge problem, there is no story, no explanation....

...he just died, for God's sake.

In Tennessee, where I am licensed this question often arises as new skills are added for Paramedics. Paramedics must get training (usually through CEUs) prior to being able to carry out that skill in the field?

I can only imagine an addiction to the affect of Propofol – guarantied coma or state of unconsciousness, but please don’t confuse that with sleep or rest.

As was pointed out earlier in this blog, there are so many substances in a hospital, that if used wrong, will lead to certain death – start with the compounds used to put criminals to death, I don’t believe they are scheduled, most substances on the heart revival cart would kill you if used in sufficient doses, like perhaps atropine, or your eye doctor, I believe frequently uses the poison originally used in the Amazon delta for poisonous arrows (curare), or get the blood pressure through the roof with a large dose of an explosive (nitroglycerin), and with some luck, you might cause a brain aneurism, or perhaps just a simple overdose of insulin. I’m sure there is a great deal of other examples, but I will leave those to authors of crime novels, or perhaps for a other episode of

We have been blessed (according to my faith by God) with these compounds, to be used in competent hands of doctors, who take an oath to serve their fellow beings (I make the assumption here that they really take the oath with a continued intent to keep it). There will unfortunately always be a bad apple in the barrel, and then we need to identify it as soon as possible, hoping you get rid of it before it causes great damage. But leave it in the capable hands of the DEA to figure out truly needs restricted in a reasoned and scientific manner instead of running amok over a single drug, that when used appropriately is a blessing for those undergoing surgery, just because Michael Jackson makes the lethal unfortunate choice, assisted somehow by a doctor, who gave the drug to him, when he clearly shouldn’t have done so. Don’t mess with the medical professions toolbox in a rash reaction to an unfortunate incident.

I was very enlightened and grateful for the entry made by “Jessica MD from Boston” whose entry explained in a very logic fashion why the proper use of it is so restricted in a hospital environment – namely because of the lack of a “reversal agent”. It won’t keep me from letting trained well equipped doctors anesthetize me again with Propofol, but I will certainly ask him/her about his experience with using Propofol, a legitimate question to anybody who is about to assume responsibility for your life.

Go fourth doctors and use Propofol in a responsible fashion, in the service of mankind, and let the law enforcement (DEA) review this and all other drugs, as I’m sure they routinely do. This is about an eccentric pop star who tragically got access to a prescription medication, possibly from a careless doctor (in fairness, that remains to be determined, the autopsy report and the criminal investigation isn’t done yet), and took the medication in a manner that appear to have lead to his death. Please de-emphasize this focus on Propofol, it could have been a dozen other agents he could have used, and that fact shouldn’t make us jump to the conclusion that we need to restrict or ban the drug.

While mj never meant a great deal to me, it certainly seems to have inspired a lot of artists I like. To the fans of mj, I understand and appreciate your feeling of loss, but don’t lash out against a perfectly legitimate drug, which has done so much good for so many people. I’m not familiar with any trend related to the misuse of this medication. On the contrary, one of the MDs who submitted an entry to this blog, mentioned that it is in fact Fentanyl (a much used painkiller), that far and away is the most misused and addictive medication in OR, and I would assume in other areas of the hospital. And while it appropriately is highly controlled, it is frequently used by terminal cancer patients, and quite frankly, we should care too much if they get addicted or not, as long as it takes away their pain.

I think I’ve approached this in several different ways, but I just don’t see how you can make the case for outlawing or further restricting the use of Propofol. Sure a few hospitals may review there fluid disposal after an operation, to make sure that Propofol, Fentanyl, and other such substances are appropriately removed and destroyed, but that review should be undertaken regardless of the mj case.

Thank you for reading my entry.

Henrik from Denmark

"People can intentially kill themselves with almost anything, tylenol, aspirin, shirts, lamp cords, light sockets i ti is possible that MJ intentionally killed himself with propofol. People can unintentionally kill themselves with tylenol, whiskey, cars. paint. They can unintentionally kill themselves with propofol it seems more reasonable to publicize widely that prpofol is an anesthetic, not a drug to treat insomnia, and allow medical professionals to use it in their settings where they can monitor it’s’ proper use. Do we have to regulate and control everything.?Can’t we allow our citizens to exercise some risk, and accept some responsiblity?: