Jackson Sleep Aid Is 'Only For Expert Use'

2:41pm UK, Tuesday January 04, 2011

Robert Nisbet, US correspondent

The powerful anaesthetic propofol has been identified as a key factor in Michael Jackson's death.

Propofol 'should always be used in a clinical setting'

:: Michael Jackson's Doctor Faces Death Charge

Sky News asked Dr John Dombrowski, from the Washington Pain Centre, to explain more about the drug.

What is it?

Propofol is the generic name for a milky, anaesthetic liquid used to make patients comfortable when undergoing surgeries or procedures.

Before this, medical professionals used sodium pentathol, also known as truth serum, which has been around since the 1940s and left patients feeling "hungover".

It is very fast-acting, yet also very quick to wear off, so you usually have to administer this using an infusion device: it drips into a patient via a vein to give them the medication.

The minute you stop the infusion, they will wake up and go about their day.

How does it work?

It puts the patient to sleep, slowly shutting the body down so you can observe blood pressure lowering.

This is why propofol needs to be administered by an anaesthesiologist or at least a physician who's trained on how to not only administer the medication but, more importantly, how to rescue that patient.

That is really the key thing: rescuing patients. So you can say: 'OK, we overshot with this medication, let's get you back'. And that is why you need that certain level of training.

How should you monitor the patient who is receiving propofol?

Always carefully. Firstly, you should have an electrocardiograph telling you what is going on with the patient's heart, secondly a blood pressure cuff and thirdly a pulse oximeter, which tells the physician the saturation of the drug in patient's system.

Of course all those machines and gadgetry are great, but nothing replaces the skill-set of the physician observing the patient while he or she is "under".

The other thing you always need to give the patient is supplemental oxygen because these drugs slow down the body. The patient will not breathe as much and will need some extra oxygen.

Is it rare to use propofol at home?

I would never administer it in a home setting to help someone sleep. This is not an appropriate use of this medication.

It is always used in a clinical setting to help people undergo surgery or to have procedures done, so that they are comfortable. It is not the kind of medication you can apply and then leave.

The guidelines from the American Society of Anesthesiologists make it clear that a medical professional should be in attendance at all times.

Can you become addicted to the drug?

It is very unusual. Number one, propofol can be hard to get. Number two, it puts you to sleep and then immediately you are awake, so there is really no addiction potential as far as I understand it.

What can happen with medication used to bring relief from pain and to induce sleep is that patients become used to the effects. They can start to rely on it.

If a combination of heavy sedative medications are not doing the job and then a medicine is introduced which succeeds in giving a patient several hours of restful sleep, it becomes a crutch.

I am aware of certain instances where some anaesthesiologists have self-administered the medication. They will jerry-rig an IV, put the needle in their arm and run this medication. Unfortunately this can end in tragedy.