Propofol: How Safe is it?

| November 23, 2014 | 11 Comments

Propofol has recently been in the news for all the wrong reasons. It started with the Michael Jackson tragedy, and has continued with the unfortunate events surrounding the death of Joan Rivers.

The use of propofol has been implicated in both celebrity deaths. And because of the media coverage surrounding these events, there has been a swell of concern in the public about the use of propofol.

Is it safe?

Patients come into the hospital or surgery center now, and ask specifically about the use of propofol. Naturally, they are concerned. So let’s examine this anesthetic drug a little closer. After reading this, my hope is that you will know a few key things about propofol that will ease any anxiety about this drug.

What is it used for?

Here are some of the more common, legitimate uses for propofol:

  1. General anesthesia: propofol is used to induce general anesthesia thousands of times every day for all sorts of surgical procedures
  2. Sedation for procedures/studies: propofol is also used for endoscopic procedures (upper endoscopy, colonoscopy, Trans-esophageal echocardiogram, etc) and various imaging studies (MRI– in children that can’t hold still or adults that are claustrophobic or disabled)
  3. ICU: to provide sedation for patients that are intubated (have a breathing tube) and on mechanical ventilation in the ICU

What is it not supposed to be used for?

Propofol is NOT indicated for use as a sleep aid, as seems to have been the case for Michael Jackson.

This drug is not supposed to be used outside of a hospital type setting. It is a very potent drug and should only be given for the appropriate reasons, in the proper setting, with vital sign monitoring, by the proper personnel (more on this later).

Important Effects of Propofol

There are a few important effects of propofol that are key for the public to know and understand.

  1. This drug produces respiratory depression (and possibly the complete stopping of breathing) very quickly.
  2. The administration of this drug can also be accompanied by a drop in blood pressure.
  3. Many people experience some kind of pain/burning sensation within the IV when propofol is given. Anesthesiologists will try to minimize/prevent this pain by giving lidocaine beforehand, but it may not completely block the pain. Although uncomfortable, this pain is “normal”, passes quickly, and is not indicative of something dangerous happening.

Allergies

Propofol is an intravenous anesthetic medicine that can contain egg lecithin, glycerol, and soybean oil. This brings up the issue of whether propofol can be used in patients with an egg allergy.

Definitely tell your anesthesiologist about any allergies you may have.

Usually propofol can be given to those with egg allergy. Most egg allergies come from egg whites (egg albumin) while egg lecithin is derived from the egg yolk.

Who Should Administer this Drug?

We’ve already discussed the important effects of propofol that give it the potential to be dangerous. This includes its rapid onset of slowed/stopped breathing, as well as its effects on blood pressure. This is why an anesthesiologist is the safest and most qualified person to administer this drug.

In Michael Jackson’s case, a cardiologist was giving him propofol at home to aid with sleep.

He had the wrong person (not an anesthesiologist) in the wrong environment (at home, without proper monitoring) and for the wrong reasons (propofol is not a sleep aid). We are all aware of the tragic outcome.

Many of the details surrounding Joan Rivers’ death have yet to be revealed. From the little information available, it appears that there were several issues with the care she received. And just like Michael, to my knowledge an anesthesiologist was NOT involved in her care (even though she also appears to have been given propofol).

Anesthesiologists safely give propofol to thousands of people every day for all kinds of surgeries and procedures. Because we use it so often, we are very familiar with the various potent effects of this drug and use our skill and experience to keep the patient in a safe zone.

Occasionally, a patient may have an exaggerated reaction to the medicine. Perhaps they stop breathing at a much smaller dose. Or maybe their blood pressure is more significantly impacted than one might expect. Your anesthesiologist is diligently watching all these effects and treating whatever is necessary.

We are ready to treat the blood pressure changes quickly, and should it become necessary, we are capable and ready to manage a patient’s airway and “breathe for them until they are again capable to breathe on their own”.

The key question to ask: Is the person giving me propofol trained and capable of doing these things?

It’s OK to ask questions when undergoing procedures. More and more, patients ask me if I am going to use propofol. If I am, I let them know. I also explain why propofol is safe for them in their particular case.

And if one of my family members were to require the use of propofol, I would insist it be provided by an anesthesiologist.

***

What about you? Do you have any questions about propofol? Any experiences you’d like to share? I look forward to your comments.

What General Anesthesia Side Effect have you experienced, if any?

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    Category: Anesthesia Medicines, Anesthesiologist, General Anesthesia

    Comments (11)

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    1. Catherine says:

      I am wondering if you could comment on the use of propofol for endoscopy using MAC. Is the patient still have sensation of the procedure? What is the difference between MAC and conscious sedation for these procedures? Thanks.

      • David Draghinas says:

        Hi Catherine,

        Terms such as MAC (monitored anesthesia care) and conscious sedation can be very confusing, even for hospital personnel that are not anesthesiologists.

        This post by Dr Joe may help: http://www.anesthesiamyths.com/types-of-anesthesia/

        Briefly, you can think of MAC as a continuum of sedation, from light sedation to deep sedation and bordering on general anesthesia.

        Conscious sedation is not a very good term and is not typically used by anesthesiologists.

        Propofol is generally a great drug for endoscopy. If works very fast and wears off fast as well. But it is a very potent drug that can easily stop a patient’s breathing.

        If I were having an endoscopic procedure, I would want propofol, BUT I would insist on having an anesthesiologist administer it and personally perform the anesthetic (ie. be at my side the entire time).

        I hope this helps.

        Dr Dave

    2. Sandra Cox says:

      I had propofol for ERCP to remove biliary stent. Nurse anesthetist administered it. How do I know if she was with me throughout? My heart rate and blood pressure dropped during extubation and I suffered a TIA. How will I ever know if someone is at fault? I had propofol in the past and did ok. I had no risk factors other than being 66. Now I’m on a blood thinner and a statin, even though my blood labs are normal.

      • David Draghinas says:

        Sandra,

        I’m so sorry to hear about your outcome.

        While I can’t comment on your specific situation, one place you can take a look at is the anesthesia record for your procedure.

        Dr Dave

    3. Physician on FIRE says:

      It seems the Michael Jackson drug questions have subsided, but a lot of patients were anxious about the drug back when it was in the news every day. You’ve described the proper use quite nicely. As with any powerful drug, it can be safe when used by properly trained physicians in appropriate clinicial settings on appropriate patients.

      Best,
      -PoF

    4. Gina says:

      I am supposed to be having my wisdom teeth removed with IV general anesthesia. They said they will be using Propofol, Versed an anti nausea med and some pain med as well in the IV. However, I will not have a breathing tube or anything during the surgery. The oral surgeon is a board certified anesthesiologist and there will also be an RN in the room, and her only job is monitoring me. I am EXTREMELY nervous about doing this. I have read horror stories online about Propofol and how easy it is to stop breathing with this medication. This will not be done in a hospital, but in the Oral Surgeon office, with monitoring equipment, etc. Can you ease my fears ? Is this safe ?

      Thanks

      • David Draghinas says:

        Gina,

        Unfortunately, I can’t ease your fears too much.

        I highly doubt your oral surgeon is a board certified anesthesiologist. He may be board certified for oral surgery, but that is different.

        What often happens in these cases is that you have a sedation nurse that administers the anesthesia under the direction/supervision of the oral surgeon.

        Although oral surgeons do a few months of anesthesia during their surgical residency, I would personally not be OK with this set up for myself or my family.

        This actually happened to me when I was in the Navy. I had to have my wisdom teeth removed prior to deployment.

        I insisted that we use an anesthesiologist instead of a sedation nurse. I’m very glad I did.

        My opinion is that it’s too much for the oral surgeon to have his/her attention divided between performing the surgery AND the anesthesia.

        I would want an anesthesiologist who is focused on my anesthesia the whole time (especially with a drug like propofol).

        All the best. Please come back and let us know how things went.

        Dr Dave

        • Gina says:

          Thank you for your reply. I have decided to go to a different oral surgeon who uses IV sedation instead of general. They will use versed and fentanyl and I will not be totally under which I feel some better about. My consult is in May. Is this a better scenario? I feel like it is already.
          Thanks!

        • Gina says:

          Also Dr Dave, I currently started taking Lexapro, 5mg for the anxiety I am having due to this upcoming procedure. Is there any danger of receiving versed / fentanyl while taking this drug? I have seen things online referring to Seratonin Syndrome? Sorry for all the questions but I am terrified of everything to come. My new Oral Surgeon took out my Niece and Nephews wisdoms as well as my best friends wisdoms and entire top teeth. They all had IV sedation and were fine, but I am still just terrified.

          Thanks

          • David Draghinas says:

            Serotonin syndrome can occur when antidepressants and opioid medications are being used concurrently.

            Every medicine has a risk and benefit associated with its use. Anesthesiologists train a long time to take patients safely through this process.

            This is why I think it’s safest to have one by your side if you are going to have anesthesia.

            I wish you all the best for your procedure. Please come back and share your experiences with us.

            Dr Dave

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