Dancing with the White Rabbit
Carly Turner English 102 Polliard May 5th, 2011 Dancing With The White Rabbit People go under sedation all the time. They jump into the rabbit hole to receive colonoscopies, plastic surgery, dental work and other various medical procedures. Today’s world has become accustomed to regular use of sedation drugs however they do not realize just how dangerous they can be. There are many factors to be taken into account when someone is put under. Proprofol (Diprivan), a drug that is used to induce sedation, which is the cause of many medical malpractices and deaths, is not supervised enough in the medical community.
Propofol is one of the most widely used forms of anesthesia (Nytimes. com). It was invented 20 to 25 years ago (News Week). It has multiple benefits over general anesthesia. Unlike general anesthesia, propofol has rapid onsets. "If you try to count backward from 100 after it's injected, you don't get to 97,” says Dr. Wischmeyer, a University of Colorado Anesthesiologist (Wall Street Journal). It also allows patients to recover and return to baseline activities such as eating and breathing on their own faster. In addition, it can result in less nausea and vomiting in patients (Ismp. rg). Because of this many practioners feel a false sense of security when using propofol. It can be harmful and even deadly if the person who is administering it is not trained in drugs that cause deep sedation and general anesthesia. On the labeling of Diprivan (Propofol), it is intended “for general anesthesia or monitored anesthesia care sedation”, meaning that that drug should only be administered by people trained in general anesthesia and not involved in the procedure being done. Propofol is an exact science. Dosing needs to be based on the patient’s tolerance to the drug.
A number of factors including the age, weight, and how hydrated the person is factors into the efficiency of the drug (News Week). The tolerance can vary and can change easily. Also, for a patient who uses it the first time, it’ll be much more potent but for a patient who uses it often it stays in the tissues and creates a tolerance to the drug (Inside Surgery). The possible side effects, are changes in moods and emotions, dizziness, drowsiness, and a lack of coordination (Drugs. com). The harsher effect is that a patient can go from breathing normally to being in respiratory arrest in seconds, even at what seems like a low dose.
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There are also no reversal agents to propofol, which means that the drug’s adverse effects have to be treated while the drug is being metabolized in the body (Inside Surgery). Considering all of these variables this makes working with propofol difficult and somewhat unpredictable, even for a trained professional. If a patient isn’t monitored closely enough by a person trained in sedation while on propofol then they can quickly go into respiratory arrest and thus get brain damage or die from not enough oxygen to the organs and brain (Ismp. rg). During a procedure, a nurse who was trained in moderate sedation, assisted a gastroenterologist in surgery by giving the patient propofol. The nurse gave too high of a dosage of propofol to the patient and the patient started experiencing respiratory arrest. In another case, a physician thought it would be safe to administer propofol himself while performing a breast augmentation surgery. According to a poll, eighty-three percent of people thought it was wrong for a surgeon to administer the propofol himself (Survey. com).
The young patient died from not getting enough oxygen to the brain because there was no one there to supervise her. Nurses have been asked to give “a little more” of the propofol if a patient moved. Anesthesiologists have been known to leave the room and leave the syringe filled with propofol and a needle in the IV port so that the nurses can monitor the patient alone themselves. This has been brought to the attention of some hospital’s leaders however no laws have been enacted about this. Additionally, money is an issue when deciding the safety of the patient.
There is sometimes an unwillingness of insurers to reimburse anesthesiologists for their care and thus nurse-administered propofol happens quite often and untrained nurses may be caught in the middle of such a debate and feel pressures to administer the propofol themselves. States in the U. S. all have different views on propofol and whether or not it needs to be administered by a trained anesthesiologist or if a nurse should be allowed to do it (Kathy Dix). On an online survey seventy-eight percent of people believe that a trained anesthesiologist should be in control of the propofol and not a nurse (Survey. om). It usually comes down to that health care facilities board and is not decided by the state. In a recent survey, it stated that ninety-six percent of the people thought that every hospital and healthcare facility should have set rules on the matter (Survey. com). In addition, American Society of Anesthesiologists, American Association of Nurse Anesthetists, and American A ssociation for Accreditation of Ambulatory Surgery Facilities believe that the only persons trained in administering general anesthesia should administer propofol to non-ventilated patients.
The American Society of Anesthesiologists suggests that if that is not possible then non-anesthesia staff who do administer the drug should be qualified to rescue the patients if their level of sedations becomes deeper than intended (Ismp. org). Along with the issue of propofol not being safely administered, it is also abused in the medical community itself. This can be done easily because it is not listed as a “controlled substance” by the Food and Drug Administration.
The drug is likely to be liked by abusers because it induces relaxation or sleep and can cause euphoria and also leaves the bloodstream so fast that it is difficult to detect (Nytimes). Anesthetists and abusers of propofol say that it can bring a brief but captivating high as the sedation wears off. It has been referred to as “dancing with the white rabbit” (referring to the white color of the drug) and “pronapping” because the drug induces a short sleep that many practioners and medical personnel use between their long shifts (Wall Street Journal). Many practioners do not feel that propofol should be a more controlled substance.
However, according to a poll, eighty-seven percent of people think that propofol should be listed as a controlled substance (Survey. com). Naming propofol a controlled substance under the Drug Enforcement Agency’s rules would require the hospitals to track their inventory, account for all the propofol vials, list all of it’s users, and lock it up with the hospital’s narcotics. If these actions were taken doctors and nurses seeking rehabilitation for their abuse of propofol might cost them their licenses and lead to them having criminal charges because they would have been abusing a Drug Enforcement Agency controlled drug.
Michael Jackson’s young death is the most well-known case of propofol abuse and has rekindled the propofol controversy the last two years. Detectives found large quantities of propofol and oxygen tanks in his home. Along with this they found that he had a personal physician that allegedly admitted to administering the drug to Jackson the day the singer died. Jackson reportedly had insomnia and was seeking aid from the drug. It seemed that his dance with the white rabbit caused his death, and may be the cause of many others if not taken into control. ’It enters your bloodstream fast, and even highly trained anesthesiologists can't control it, and die. They don't even have seconds to pull out the needle,’ said Art Zwerling, a registered nurse anesthetist and counselor with the Association of Nurse Anesthetists” (Wall Street Journal). When the drug is being used properly there should be strict procedures enforced regarding the supervision of vital signs and oxygen saturation to assure that the patient is safe. Health care facilities should inform all the staff working around propofol how dangerous it is.
Today’s standards on the administration of Diprivan (Propofol) are too lenient and need to be reformed. In conclusion, the distribution and handling of this drug needs to be strictly supervised. Work’s Cited “What the Heck is Proprofol? More Info On the Drug That May Have Killed Michael Jackson” News Week. Web. 29 Jul. 2009. <http://www. newsweek. com/blogs/the-human-condition/2009/07/29/what-the-heck-is-propofol-more-info-on-the-drug-that-may-have-killed-michael-jackson. html> “How to use Diprivan” Drugs. com. Web. 18 Mar. 2011. <http://www. drugs. om/diprivan. html > “Propofol (Drug)” Web. 7 Aug. 2009. <http://topics. nytimes. com/topics/news/health/diseasesconditionsandhealthtopics/propofol/index. html> “Michael Jackson’s Death From Propofol” Inside Surgery. Web. 24 Aug. 2009. <http://insidesurgery. com/tag/diprivan/> “Practical Guide to Moderate Sedation/Analgesia” Odom-forren. Donna Watson. 2005. Mosby Inc. “Propofol (A Drug Used For Sedation)” Carly Turner. Survey ages 18-50, 23 surveyors. Web. 4 May. 2011. Survey. com <http://www. survey. com/cgi-bin/pollxt. pl? poll=PM2U1AR9U9G8>
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