pendell
2009-08-25, 06:41 AM
While this touches current events and so we have to be leary not to step on the minefields of religion and politics, I've been reading up a bit on the pharmacological reports surrounding Michael Jackson's departure and wonder if there's anyone here with a background in pharmacy who has any thoughts on the matter.
Full Timeline (http://www.people.com/people/article/0,,20300182,00.html)
June 25: At about 1:30 a.m., Murray again tried to get Jackson to sleep without propofol and gives the singer a 10-milligram tablet of Valium, but Jackson is unable to sleep.
• Around 2 a.m.: Murray injects Jackson with two milligrams of lorazepam, pushed slowly into the singer's IV. But again, Jackson can't sleep.
• Around 3 a.m.: Murray then gives two milligrams of midazolam to Jackson, also pushed slowly into the IV. Jackson remains awake.
• Around 5 a.m.: Murray gives the singer another two milligrams of lorazepam but Jackson still can't sleep.
• Around 7:30 a.m.: Murray administers another two milligrams of midazolam. Murray claims he is continuously at Jackson's bedside, monitoring the singer with a pulse oximeter [connected to Jackson's finger] and measuring his pulse and oxygen statistics. But Jackson remains awake.
• Around 10:40 a.m.: Murray gives Jackson 25 milligrams of propofol diluted with lidocaine to keep Jackson sedated after repeated demands for the drug by the singer. Jackson finally falls asleep, and Murray continues to monitor him.
• After 10 minutes: Murray states he left Jackson's bedside to use the restroom and is gone for no more than two minutes. Upon his return, Murray finds Jackson not breathing. Murray begins CPR, and gives Jackson 0.2 milligrams of flumazenil, an antidote for certain overdoses. Using his cell phone, Murray calls Jackson's personal assistant, Michael Amir Williams, and asks him to send security upstairs for an emergency.
Murray continues CPR – and before security arrives – he leaves Jackson and runs to the hallway and downstairs to the kitchen, where he asks the chef to send up Jackson's 12-year-old son, Prince Michael I. Murray continues CPR. The boy arrives upstairs and summons security.
• At 12:21 p.m.: Jackson staff member Alberto Alvarez dials 911, and the Los Angeles Fire Department responds on the scene shortly thereafter. Murray waits for the ambulance while conducting CPR, and later accompanies Jackson to the hospital.
Further note (http://abcnews.go.com/Entertainment/WireStory?id=8402022&page=2)
Jason Hymes, an assistant clinical professor at the University of Southern California who is not associated with the case, said the drug [propofol] was a true anesthetic. "You administer it to somebody and then operate on them ... This concept of giving somebody a general anesthetic for sleep disturbance strikes me as just bizarre and astoundingly inappropriate."
Other comment (http://www.mtv.com/news/articles/1619374/20090824/jackson_michael.jhtml)
The very potent drug, also known as Diprivan, is administered intravenously as a general anesthetic used to sedate patients for surgery and is only available to medical personnel.
"This is only meant for use in anesthesia and [administering it as a sleep aid]. It's like giving someone chemotherapy so they don't have to shave their head," veteran anesthesiologist Dr. John F. Dombrowski — who has not treated Jackson and has no information about the case, but has used propofol often in his practice — told MTV News last month. "It's one purpose is as an anesthetic, to induce that sleepy feeling, and when I run it as an IV drip, I can keep you asleep, and when I turn it off, you are quickly awake. It works in 30 seconds or so, and it is out of your system quickly when I turn it off."
Dombrowski said the drug is so powerful that it is critical to have someone in attendance who has the ability to rescue you should your breathing cease or some other critical failure occur, which is why the drug is only used in operating rooms and in doctor's offices where providers are on hand to support patients and intervene should something go wrong. "It is never used outside a medical setting during a procedure," he said. "And it is never used as a sleeping aid. I've never heard of that in my 16 years of practice."
Still more doctor's comments (http://news.yahoo.com/s/ap/20090824/ap_on_en_mu/us_michael_jackson_investigation)
"There's no surprise there" that death could result from such a combination, said Dr. David Zvara, anesthesia chairman at the University of North Carolina at Chapel Hill.
"All those drugs act in synergy with each other," Zvara said. Adding propofol on top of all the other sedatives "tipped the balance."
Besides the propofol and two sedatives, the coroner's toxicology report found other substances in Jackson's system but they were not believed to have been a factor in the singer's death, the official told the AP.
...
The 25 milligrams of propofol Murray told police he gave Jackson the day he died "is not a whopping amount," said Lee Cantrell, director of the San Diego division of the California Poison Control System. But by combining propofol with a cocktail of the other sedatives, known as benzodiazepines, it "may have been the trigger that pushed him over the edge," Cantrell said.
Cantrell said it's perplexing that someone would give various benzodiazepines if one was found not to be effective.
"This is horrible polypharmacy," he said, referring to the interaction between the various drugs. "No one will treat an insomniac like this."
Respectfully,
Brian P.
Full Timeline (http://www.people.com/people/article/0,,20300182,00.html)
June 25: At about 1:30 a.m., Murray again tried to get Jackson to sleep without propofol and gives the singer a 10-milligram tablet of Valium, but Jackson is unable to sleep.
• Around 2 a.m.: Murray injects Jackson with two milligrams of lorazepam, pushed slowly into the singer's IV. But again, Jackson can't sleep.
• Around 3 a.m.: Murray then gives two milligrams of midazolam to Jackson, also pushed slowly into the IV. Jackson remains awake.
• Around 5 a.m.: Murray gives the singer another two milligrams of lorazepam but Jackson still can't sleep.
• Around 7:30 a.m.: Murray administers another two milligrams of midazolam. Murray claims he is continuously at Jackson's bedside, monitoring the singer with a pulse oximeter [connected to Jackson's finger] and measuring his pulse and oxygen statistics. But Jackson remains awake.
• Around 10:40 a.m.: Murray gives Jackson 25 milligrams of propofol diluted with lidocaine to keep Jackson sedated after repeated demands for the drug by the singer. Jackson finally falls asleep, and Murray continues to monitor him.
• After 10 minutes: Murray states he left Jackson's bedside to use the restroom and is gone for no more than two minutes. Upon his return, Murray finds Jackson not breathing. Murray begins CPR, and gives Jackson 0.2 milligrams of flumazenil, an antidote for certain overdoses. Using his cell phone, Murray calls Jackson's personal assistant, Michael Amir Williams, and asks him to send security upstairs for an emergency.
Murray continues CPR – and before security arrives – he leaves Jackson and runs to the hallway and downstairs to the kitchen, where he asks the chef to send up Jackson's 12-year-old son, Prince Michael I. Murray continues CPR. The boy arrives upstairs and summons security.
• At 12:21 p.m.: Jackson staff member Alberto Alvarez dials 911, and the Los Angeles Fire Department responds on the scene shortly thereafter. Murray waits for the ambulance while conducting CPR, and later accompanies Jackson to the hospital.
Further note (http://abcnews.go.com/Entertainment/WireStory?id=8402022&page=2)
Jason Hymes, an assistant clinical professor at the University of Southern California who is not associated with the case, said the drug [propofol] was a true anesthetic. "You administer it to somebody and then operate on them ... This concept of giving somebody a general anesthetic for sleep disturbance strikes me as just bizarre and astoundingly inappropriate."
Other comment (http://www.mtv.com/news/articles/1619374/20090824/jackson_michael.jhtml)
The very potent drug, also known as Diprivan, is administered intravenously as a general anesthetic used to sedate patients for surgery and is only available to medical personnel.
"This is only meant for use in anesthesia and [administering it as a sleep aid]. It's like giving someone chemotherapy so they don't have to shave their head," veteran anesthesiologist Dr. John F. Dombrowski — who has not treated Jackson and has no information about the case, but has used propofol often in his practice — told MTV News last month. "It's one purpose is as an anesthetic, to induce that sleepy feeling, and when I run it as an IV drip, I can keep you asleep, and when I turn it off, you are quickly awake. It works in 30 seconds or so, and it is out of your system quickly when I turn it off."
Dombrowski said the drug is so powerful that it is critical to have someone in attendance who has the ability to rescue you should your breathing cease or some other critical failure occur, which is why the drug is only used in operating rooms and in doctor's offices where providers are on hand to support patients and intervene should something go wrong. "It is never used outside a medical setting during a procedure," he said. "And it is never used as a sleeping aid. I've never heard of that in my 16 years of practice."
Still more doctor's comments (http://news.yahoo.com/s/ap/20090824/ap_on_en_mu/us_michael_jackson_investigation)
"There's no surprise there" that death could result from such a combination, said Dr. David Zvara, anesthesia chairman at the University of North Carolina at Chapel Hill.
"All those drugs act in synergy with each other," Zvara said. Adding propofol on top of all the other sedatives "tipped the balance."
Besides the propofol and two sedatives, the coroner's toxicology report found other substances in Jackson's system but they were not believed to have been a factor in the singer's death, the official told the AP.
...
The 25 milligrams of propofol Murray told police he gave Jackson the day he died "is not a whopping amount," said Lee Cantrell, director of the San Diego division of the California Poison Control System. But by combining propofol with a cocktail of the other sedatives, known as benzodiazepines, it "may have been the trigger that pushed him over the edge," Cantrell said.
Cantrell said it's perplexing that someone would give various benzodiazepines if one was found not to be effective.
"This is horrible polypharmacy," he said, referring to the interaction between the various drugs. "No one will treat an insomniac like this."
Respectfully,
Brian P.