The King of Pop and Propofol

Death Valley - photo by JoAnn Sturman

Scott Sturman
fliesinyoureyes.com

Elizabeth Taylor once remarked Michael Jackson was the most normal person she knew. It would be interesting to meet her other friends. The King of Pop and his bizarre behavior filled the tabloids with material, but with few real friends and plenty of pretenders, who could deal with a lifetime of fame and fortune and be considered normal by anyone other than Liz Taylor? There’s a line from Jersey Boys where Frankie Valle tells the audience: When you’re rich, famous, on the road, and have been given a dozen cocktail napkins with women’s phone numbers on them who all want to shack up, don’t assume you could resist unless you’ve been in that position.

Propofol revolutionized anesthesia. It works quickly with few side effects, and even huge doses wear off so fast that it rarely delays a patient’s emergence from anesthesia. A white liquid that looks like it could be sold in the dairy section of a supermarket, propofol it is nicknamed “the milk of amnesia.” The favorable traits which make the drug appealing for anesthesia also confer a misuse potential. It is the most abused drug in anesthesia training programs, not because of the pleasure of putting oneself to sleep but by titrating the drug to establish a euphoric state hovering on the knife’s edge between consciousness and unconsciousness. It’s a delicate pharmacokinetic line; not enough and the pleasure is not there, too much and it’s off to sleep with the risk of not awakening if someone is not present to assist with ventilation.

It’s doubtful Michael used propofol as a treatment for insomnia, and more probable he preferred teetering on the edge between the worlds of dreams and reality. Normal sleep is restorative and relieves the symptoms of sleep deprivation; there is a distinctive REM-nonREM sleep pattern associated with it. Propofol drastically alters the EEG of patients, preventing normal REM states; it is sleep without the salutary effects.

In Jackson’s case just going to sleep with propofol would have done nothing to free him of the irritability, languor, and torment of sleep deprivation. The more likely scenario would be to start an IV and adjust the drug dosage for the desired and extremely addictive effect. Overdoses are treated easily provided a person skilled in airway management is at the bedside. Turn off the infusion and ventilate with oxygen by mask until breathing resumes. If food is in the stomach, aspiration could be a problem when playing the propofol game. However, for as much as Michael’s physician was paid, certainly this technicality would have been considered.

Most physicians who routinely use propofol in their practice have a story or two to tell about the drug and how quickly matters can go awry if prompt action is not taken to resuscitate the patient. This is particularly the case if the patient has received other sedatives or narcotics. Good equipment and fast action save the day. It is just another reason why propofol is not recommended for use at home, in a dimly lit room, and without monitors or the ability to provide life support.