For many years, a white, milky drug called propofol has been quietly doing its job. Patients waking up after surgery may not even bother to ask their doctors what drug was used to knock them out. Then, everything changed when celebrities got into the picture. Propofol gained notoriety overnight.
First, it was Michael Jackson. The superstar was put on a propofol drip. He was left to sleep on his own and he never woke up. As if things are not bad enough, a local doctor, while performing liposuction on a local patient, accidentally created fatal perforations in the latter’s intestines. This patient was sedated with propofol during the procedure. All this got me a bit worried, not so much about propofol, but the public’s interpretation of these unfortunate incidents.
My concerns are not unfounded. All of a sudden, patients start changing their minds about undergoing sedation. And for deep sedation, which drug do we use? Propofol.
“Eeee… don’t want. Wait I die like Michael Jackson or that CEO how?”
I don’t know whether the same occurs in other countries, but in Singapore, the propofol equation can work in the following illogical way:
1. Michael Jackson died while he was on propofol.
2. A CEO died after liposuction. He was also on propofol.
Conclusion: propofol kills you. Avoid. Avoid. Avoid.
Had enough of equations? Let’s now take a look at the drug in complete sentences. Looking like milk, Propofol is a short-acting, intravenously administered hypnotic agent. What does that mean? It means that first of all, an intravenous line must be set up before propofol is administered. It is a highly potent hypnotic agent. At a low dose, the patient feels drowsy and will not remember the procedure. At high dose, an anaesthetist can safely achieve a deep level of sedation close to general anaesthesia. We often call in an anaesthetist to administer the drug to nervous patients so that these patients can sleep through the surgery without all the inconvenience and adverse effects of general anaesthesia.
However, propofol is a very short-acting drug. This means that to maintain the depth of sedation, it must be injected continuously into the body. To make it convenient for the anaesthetist, we have a syringe infusion system in our clinic. This allows the infusion to go on “auto-pilot”. Once you stop injecting the drug, the patient recovers rapidly. Most are able to stand up and walk within 30 minutes. We’ve been using propofol for more than 6 years. Many surgeons out there have been using it for even longer and far more frequently. As far as we know, there wasn’t a single case of adverse effects due to propofol alone. More often than not, recovering patients feel wonderful. Some even hug the anaesthetist.
More complete sentences. How did Michael Jackson die? The court may have ruled that Dr Conrard Murray has been grossly negligent and the autopsy report may have stated that the cause of death was “acute propofol intoxication”, but it should also be noted that in addition to propofol, the examiner also found traces of lorazepam (a benzodiazepine drug used to treat anxiety and insomnia); midazolam (another benzodiazepine, indicated for insomnia and medical sedation); lidocaine (a local anesthetic often included with propofol to relieve injection pain); diazepam (a benzodiazepine to treat anxiety, insomnia and alcohol withdrawal); and nordiazepam (a benzodiazepine-derived sedative, often used to treat anxiety) in Jackson’s bloodstream.
No responsible anaesthetist will put such a cocktail in your bloodstream without personally supervising the administration. With the drug dosage, the patient’s airway, blood oxygen saturation, constantly monitored and with supplemental oxygen provided, deep sedation is safe for patients with dental phobia or even those who are just a little anxious/nervous/jumpy.
All surgical procedures do carry some risks. But sedation has many benefits. In some cases where the patient is unable to cooperate, it would have been impossible for us to carry out the necessary procedures without sedation. Just a week ago, we removed 3 badly decayed wisdom teeth from an adult male with the IQ of an 8-year-old. It would have been impossible without propofol. He is now recovering very well and not waking his parents up in the middle of the night, no longer complaining of toothache. Propofol is a safe drug when used responsibly. Just because you were involved in a car accident doesn’t mean you’re not going to get into a car anymore. Just because someone else has died in a car accident certainly doesn’t mean you should avoid them. Might as well avoid crossing the road, riding a bicycle, swimming and eating fishballs. Let’s hope the public can put matters in perspective and let us get on with business.
