“That Michael Jackson Drug:” Propofol and the Conrad Murray Trial

More than two years have passed since Michael Jackson’s death shook the pop world. His eccentric behavior through the past decades has been fodder for late-night talk shows and tabloid magazines. His life after death has been no different, albeit with a much more devastating twist.

Recently, Jackson’s personal physician, cardiologist Dr. Conrad Murray, began his trial facing a charge of involuntary manslaughter. As week two of the trial wraps up, I would like to clear up some confusion about the agent that ultimately led to Jackson’s demise: the anesthetic drug propofol.

As a medical student working in various hospitals and clinics in New Orleans, I have heard many patients refer to propofol as “that Michael Jackson drug.” In fact, an anesthesiologist once told me that he has spent a lot of time since Jackson’s death reassuring patients who need to be administered the drug that it is generally safe when used correctly. The buzz surrounding the Murray trial has not only spurred conspiracy theories around Jackson’s death, but also fueled unsubstantiated fear surrounding a drug that is generally approved to be safe if administered correctly.

Murray is accused of administering the drug propofol as a sleep aid to Jackson, who suffered from insomnia and who supposedly wanted help with sleep and anxiety problems leading up to his comeback tour. Propofol, however, is not approved as a sleep aide.

According to the coroner’s report, Jackson died of “acute propofol intoxication.” Jackson also had significant levels of other sedative drugs in his system, including benzodiazepines such as Ativan, Versed and Valium. The coroner ultimately determined that the manner of death was homicide.

Propofol is an intravenous anesthetic used for induction and maintenance of general anesthesia for surgery. It is also used in the ICU setting for sedation of critically ill patients who are usually intubated and closely monitored. The drug has many favorable properties that make it useful in a surgical setting, including a rapid onset of sedation, a generally predictable duration of action, and rapid return to consciousness post-anesthesia. The drug, however, also has the potential to cause respiratory and cardiovascular depression, which may be aggravated by other drugs, such as the benzodiazepines found in Jackson’s body.

Additionally, propofol has a very narrow safety margin between mere sedation and general anesthesia. It can lead to a situation that can lead to a loss of a patient’s ability to breathe alone without intubation and ventilation. For this reason, propofol should be administered with an infusion pump that can provide close dose control, and doctors should continuously monitor the patient with proper equipment.

The American Society of Anesthesiologists has stated that “non-anesthesia personnel who administer propofol should be qualified to rescue patients whose level of sedation becomes deeper than initially intended and who enter a state of general anesthesia.” Rescue, in this case, means the medical personnel should be qualified to correct physiological consequences such as hypoventilation, hypoxia and hypotension. Since propofol does not currently have an appropriate reversal agent, as do benzodiazepines and other sedatives, it is of the utmost importance that the person administering the drug monitors the patient appropriately and be appropriately trained in advanced life support.

In the coroner’s report, an anesthesiologist confirmed that “the standard of care for administering propofol was not met” in Jackson’s case. According to the consulting anesthesiologist, there was no evidence of an infusion pump to control the IV administration and no appropriate monitoring equipment was found at the scene. Furthermore, the amount of propofol found in Jackson’s body was equivalent to that found during general anesthesia in an intra-abdominal surgery where a patient would be intubated and ventilated and cardiovascular depression would be expected to occur and be treated.

The circumstances that caused Jackson’s death because of inappropriate propofol administration were ultimately dangerous and irresponsible. If you or a family member ever needs surgery and your anesthesiologist brings up propofol in the discussion, don’t let it alarm you. The drug is not just “that Michael Jackson drug.” Remember that if it used in the right way, correctly monitored and supervised by trained medical personnel, the drug will most likely not cause any harm.