An anesthesiologist answers: “How Safe is Propofol?”
It is quite likely that if you or a family member has had a recent diagnostic, endoscopic or surgical procedure, the drug propofol was a part of the anesthetic. Since approval by the FDA in 1993, this liquid drug, which is administered through the vein (IV), has been safely used as a sedative or anesthetic for millions of people worldwide.
In trained hands, propofol offers many advantages over other drugs used for sedation and anesthesia. Those advantages include having a rapid onset of action and wearing off quickly, which allows patients to wake up, recover, and return to normal activities and diet sooner than other anesthetics. An additional benefit is its anti-nausea effect, making it especially popular for outpatient, same-day procedures.
As with many drugs, for all its positive benefits and good safety profile, propofol is not without risk. First and foremost, propofol only should be administered by a trained medical practitioner, such as an anesthesiologist or nurse anesthetist (CRNA), who is familiar with the dosing of this powerful drug; can closely monitor the patient with the help of sophisticated machines which track vital signs and oxygen levels; and provide airway assistance in the form of a breathing tube, if needed. This drug only should be administered in an accredited healthcare facility such as a hospital or surgicenter.
Sadly, in untrained hands, propofol can be dangerous, even deadly. Profound changes can occur rapidly, as evidenced in the Michael Jackson case. It will be interesting to note what authorities determine are the facts around that case. Jackson apparently died while being given propofol along with several other powerful sedatives in his own home. The physician who was caring for him and treating his insomnia was not a trained specialist in anesthesiology. An anesthesiologist, in an accredited healthcare facility, is thoroughly educated and prepared to diagnose and treat such an emergency situation.
Anesthesiologists are physicians who have taken an additional 4-6 years of training in the field of anesthesiology. This training allows them to care for patients in the intensive care unit (ICU), render surgical patients unconscious and insensitive to pain during surgery, and recognize and treat side effects and complications resulting from the surgery. In addition, hospitals, such as Verde Valley Medical Center (VVMC), utilize an “anesthesia care team” that consists of an anesthesiologist and a nurse anesthetist who is an advanced practice RN and has completed 2-3 years of training in anesthesia care.
In the late 1970s, The American Society of Anesthesiologists (ASA) undertook a massive effort to improve the safety of anesthesia by determining the causes of adverse anesthesia-related outcomes and focusing attention on avoiding those causes. By 1985, the Anesthesia Patient Safety Foundation was created to raise the levels of consciousness and knowledge of patient safety issues. In 1986, ASA became the first medical specialty to adopt standards of care for its members.
A 1999 report by the Institute of Medicine noted that anesthesia care “was now performed 50 times more safely than in the early 1980s.” At the time few professional societies or groups could demonstrate that kind of visible commitment to reducing errors in healthcare and improving patient safety.
Anesthesiology is an exciting and intriguing field of medicine involving physics, pharmacology and high-tech gadgetry. More than 20 years ago, however, when entering the specialty, little did I realize the most gratifying part of an anesthesiologist’s work. It is simply the powerful relationships which are developed with patients while they experience such important and stressful moments in their lives.
Fortunately, while none of us have the riches or resources that Michael Jackson possessed, we all are entitled to expect a trained physician, anesthesiologist or nurse anesthetist to be at our side, focusing solely on our comfort, safety and well-being during a surgery or procedure using powerful medications such as propofol.
Sadly, that is the one thing the “King of Pop” apparently didn’t have before his death.
Brian W. Launius, M.D., joined VVMC’s Medical Staff in 2009. He is certified by the American Board of Anesthesiology and is a member of several professional societies including the American Society of Anesthesiologists.