Shafer
Walgren
Lorazeapm : when given IV , some of it goes into the stomach. This has nothing to do with post mortem distribution.
There is no to differentiate MJ taking oral lorazepam, or CM giving MJ oral lorazeapm
About his 100 ml infusion over 3 hours simulation : doesn't show when MJ died, it was not necessarily at 12, the goal was just to show that MJ died with an infusion running.
IV setup : controlling the rate via the clamps is commonly done with certain medication, when you don't need to precisely set the rate (example antibiotics), so it is possible, but is not done with propofol (a pump would be used)
Lidocaine levels : his 100 ml infusion over 3 hours simulation is not inconsistant with levels found at autopsy .You can mix lidocain in the bottle, you just have to take some propofol off
Risk of propofol : the main risk of propofol is the failure to breath. It's the lack of oxygen in the heart that kills the heart.
Unchanged propofol in the urine : has researched the litterature : 1988 article says that very little unchanged propofol is found in the urine, so little that they didn't know if it was free propofol or its metabolite. They said it was less than 0.30% , but that's only the upper limit. It could be 0.3 to 0.
There are multiple articles published on the subject, the clearest is a 2002 article : confirmed the 1988 article, in 2002 they actually measured the unchanged propofol. The actual figure is between 0.002% to 0.004%
Autopsy urine propofol : 0.15 mg/ml . 500 ml of the urine = 82.50 micrograms of propofol .
Shows a table from the 2002 article :
the average found is 70.71 micrograms of propofol in the urine, it corresponds to a dose of 2000 mg .
It absoultely rules out Dr White's theory, actually suggests that MJ received more propofol that what Dr Shafer thought.
Standard of care : anesthesiolgist providing care in a remote location (ex :radiology suite, etc..), in a remote location , you have less tolerence for error, because you have no back up. You take no short cut. If there was such a thing as bedroom based anesthesia, if you have an error, you have mortality. So the standards of care would actually be higher.
Flanagan :
Argues about something in Dr Whites report, about lidocaine : Flanagan says that Dr Shafer wrote that 5 cc lidocaine is consistent with the autopsy report, Dr Shafer doesn't agree, Flanagan asks Dr Shafer to read a paragraph from his report
25 mg propofol is a subanesthetic dose : In most patients it's a sub anesthetic dose, it depends on what other medication is on board. Flanagan is trying to say that the article didn't mention sub anesthetic doses .
Walgren :
About the article and the use of sub anesthetic dose : the use of a larger doses makes the result more precise, that's all
Stipulation : peoples 52 actually reflects the accurate phone numbers
prosecution and defense rest.
recess until thursday 3rd november, 9 am.