Propofol found in Weston Medi Spa patient

New details have now emerged regarding the tragedy which occurred in south Florida, following liposuction surgery at an unlicensed medispa, which we discussed in an earlier chapter of the blog (here).

According to an October 30, 2009 article in the Sun-Sentinel (here), the patient was not having the liposuction surgery performed with just local anesthesia (numbing with lidocaine), but she also was given the anesthesia drug Propofol for intravenous sedation. Propofol is a safe drug in the trained hands of an anesthesiologist, but, as Michael Jackson found out, it can be lethal in the hands of an amateur.

This discovery makes a huge legal and regulatory difference. It's giving anesthesia without a trained anesthesiologist or nurse-anesthetist being present.

Receiving any sort of intravenous sedation automatically defines the procedure, according to existing Florida regulations, as a "level II office surgery" at a minimum. The level II category mandates significantly more stringent requirements than a procedure performed with local anesthesia only, such as:
- a well-defined list of safety equipment present in the office
- certain monitoring standards for the patient's vital signs and oxygenation
- completion of inspection of the surgery center by either the State of Florida or one of the national accreditation agencies
- hospital privileges for the surgeon
- a standing hospital transfer agreement in case of emergency.

None of these regulations were being followed by the Weston Medi-spa. The physician who performed this surgery was not board-certified in a surgical specialty, and reportedly did not have hospital privileges to perform liposuction in any hospital.

The Board of Medicine is now looking at a new rule, which would require all Medi Spas where surgical procedures are performed to follow the same regulations as surgery centers. I think this is an excellent idea, that would enhance patient safety.

However, these rules have to have some "teeth". It's one thing to write a good law, but another thing altogether to insure that the law is followed. Currently, it is the enforcement of existing regulations that is lacking. There are some good people working for the Board of Medicine - but they are stretched thin, in terms of manpower and funding.

Diprivan - not for home use!

Apparently, Diprivan has been found at the former home of the late Michael Jackson. This story is becoming more tragic by the day.

Diprivan, also known generically as propofol, is a powerful intravenous anesthestic agent. In the right hands, it is a useful drug, permitting anesthesia with a low incidence of postoperative nausea and vomiting. In the wrong hands, however, it can be dangerous.

In small doses, diprivan causes sedation. In larger doses, it can induce unconsciousness, and a state of general anesthesia. And a distinct lack of breathing, which can permanently ruin your day.

Sometimes, the same dose in one person will give a different response in another person. Or a slight increase in the dose can push the patient from mere sedation to complete unconsciousness. So, the physician administering propofol needs to know how to monitor and maintain the patient's airway - which might include intubating the patient. This is everyday stuff for a trained anesthesiologist or nurse anesthetist.

There is no way that this drug has any legitimate use outside of a controlled medical setting like the OR or ICU, and certainly no way it should be in a private residence.