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Propofol: Acute toxicity

"Much of what was in the search warrant affidavit is factual," said Mr Chernoff. "However, unfortunately, much is police theory. Most egregiously, the timeline reported by law enforcement was not obtained through interviews with Dr Murray, as was implied by the affidavit
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ok, Murray told them this :


"JACKSON remained awake and at approximately 1040 hours, MURRAY finally administered 25mgof PROPOFOL (DIPRIVAN), diluted with LIDOCAINE (XYLOCAINE), via IV drip to keep JACKSONsedated, after repeated demands/requests from JACKSON. JACKSON finally went to sleep andMURRAY stated that he remained monitoring him. After approximately 10 minutes, MURRAY stated heleft JACKSON's side to go to the restroom and relieve himself. MURRAY stated he was out of the roomfor about 2 minutes maximum. Upon his return, MURRAY noticed that JACKSON was no longerbreathing. MURRAY began single man cardiopulmonary resuscitation (CPR) at once. MURRAY alsoadministered .2mg of FLUMANEZIL (ANÉXATE) to JACKSON."

I don't believe they made up the details about " after 10 minutes " he came back .


"Your affiant obtained MURRAY'S cellular telephone records for the early morning hours of June 25,2009. In his statement, MURRAY estimated the time that he noticed JACKSON was not breathing to beat approximately 1100 hours. MURRAY'S cellular telephone records show MURRAY on the telephone,with three separate callers for approximately 47 minutes starting at 1118 hours, until 1205 hours.MURRAY did not mention this to the interviewing detectives."

that's what chernoff is making big deal about, Murray did not tell them at 11.00 oclock but he said I gave him propofl at 10.40 and after 10 minutes I went to relieve myself , so they calculated it and came back with the whole "11.00" chernoff is talking about .
 
aaaaaaarrrrrrrrrrrrrggggggggggghhhhhhhhhhhh!!!! I cant take this anymore!!! What is taking the police so long??????? I am really struggling with all of this now - i thought i would be feeling better but am feeling worse again :-(
 
Lord have mercy. To know MJ was alive that morning and not expecting to go out like this is making me crazy and depress. I hate this doctor with every fiber of my being. This was uncall for. This was Michael year to comeback and he would have done it and to be taken out like this is insane.
 
Loopy said:
aaaaaaarrrrrrrrrrrrrggggggggggghhhhhhhhhhhh!!!! I cant take this anymore!!! What is taking the police so long??????? I am really struggling with all of this now - i thought i would be feeling better but am feeling worse again :-(
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I am with you on this. And to think I would have met him finally face to face. This idoit doctor took that away from me.
 
Loopy said:
aaaaaaarrrrrrrrrrrrrggggggggggghhhhhhhhhhhh!!!! I cant take this anymore!!! What is taking the police so long??????? I am really struggling with all of this now - i thought i would be feeling better but am feeling worse again :-(
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Lawyers that have been following the case have said its taking so long as the prosecution will be working out whether there is enough evidence to charge Murray with second degree murder. Murray will be charged with at least manslaughter but its seeing if they can hit him with a more serious charge that is delaying the case.
 
that what I believe, they want a second degree murder charges not manslaughter , the DA wants to be the star of the century , GOOD FOR HIM.
 
sloride said:
Lawyers that have been following the case have said its taking so long as the prosecution will be working out whether there is enough evidence to charge Murray with second degree murder. Murray will be charged with at least manslaughter but its seeing if they can hit him with a more serious charge that is delaying the case.
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oh God i hope this is true!! Thank you. I truly hope that he gets charged with murder because that is what it is!! Just hope they hurry up!! Hope our dear Michael is ok somewhere :-(
 
williamorange1 said:
yeah , it is used and actually epherdine unlike Ephinephrine influence depth of sedation . epherdine from what I read increases the depth of sedation when propofol is used .
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William can you post proof of this please?

I have seen journal articles where they are using it experimentally, and in reference books where it is used clinically in spinal anaesthesia but not in general anaesthesia.

Pharmacologically I don't get how ephedrine, a stimulant, can increase depth of sedation. It doesn't make sense to me. That's why you're not supposed to take pseudoephedrine decongestants in the evening because it can cause insomnia! Also, the coroner stated it was used in the resus attempt I think not routine admin with propofol.

Has anyone witnessed in clinical practice ephedrine being used in resus?
 
williamorange1 said:
from the search warrant :

"DEA also checked all available computer systems to determine whether DR. MURRAY had prescribed PROPOFOL (DIPRIVAN) toJACKSON and how much of the drug he had purchased and/or ordered. DEA was unable to find a recordof DR. MURRAY purchasing, ordered or obtaining any PROPOFOL (DIPRTVAN) under his medicallicense or DEA number."

so it was obtained illegally.
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I lost the link to an article which stated that Dr Murray didn't have license to buy Propofol in California and even if he had bought it somewhere else it would still be considered illegal.

The more I read about this, the worse it gets. There's a hell lot of wrongdoing in this case.
 
daisydaisy said:
William can you post proof of this please?

I have seen journal articles where they are using it experimentally, and in reference books where it is used clinically in spinal anaesthesia but not in general anaesthesia.

Pharmacologically I don't get how ephedrine, a stimulant, can increase depth of sedation. It doesn't make sense to me. That's why you're not supposed to take pseudoephedrine decongestants in the evening because it can cause insomnia! Also, the coroner stated it was used in the resus attempt I think not routine admin with propofol.

Has anyone witnessed in clinical practice ephedrine being used in resus?
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http://www.anesthesia-analgesia.org/cgi/content/full/97/3/780
 
williamorange1 said:
http://www.anesthesia-analgesia.org/cgi/content/full/97/3/780
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Thanks for the article.

True about depth of anesthesia in this trial but I'd like to point out though that this article refers to a clinical trial only- ie not something that is used in clincal routine practice. This trial was focused on combined general and spinal (epidural) anesthesia and not general anesthesia alone. Also, in terms of the coroner's report, I don't think this is necessarily that relevant since the coroner stated it was from resuscitation. I have scoured the net and health professional resources and cannot come up with any credible sources that state that ephedrine is clincally used for general anesthesia resus. I still have many concerns about why ephedrine was found.....


I found an article from an AP writer and contains input from Dr. David Zvara, anesthesia chairman at the University of North Carolina at Chapel Hill, (apologies mods if this is considered tabloid, but I thought Dr Zvara's input interesting):

http://www.myfoxphoenix.com/dpp/ent...ael_jackson_death_homicide_lwf_082809_3218297

"Doctors were surprised by the coroner's mention of ephedrine, once sold as the controversial diet drug Ephedra and now banned by the federal Food and Drug Administration, though the drug can be used for resuscitation. Zvara said it's unlikely emergency personnel who responded to Jackson's home would have used that drug since epinephrine, otherwise known as adrenaline, is favored."

http://www.myfoxphoenix.com/dpp/ent...ael_jackson_death_homicide_lwf_082809_3218297

Also, related posts in:

http://www.mjjcommunity.com/forum/showthread.php?t=74623&page=4

http://www.mjjcommunity.com/forum/showthread.php?p=2155997#post2155997

I found this data sheet from a reputable source:

http://www.medsafe.govt.nz/Profs/Datasheet/e/Ephedrinesulfateinj.htm

"DBL® Ephedrine Sulfate injection is indicated in the treatment of shock unresponsive to fluid replacement. It is also indicated in the treatment of hypotension secondary to spinal anaesthesia."

Again not licensed for general anesthesia or resus.....
 
I got you , read this :


Original contribution
Admixture of ephedrine to offset side effects of propofol: a randomized, controlled trial
James D. Austin FRCA, MRCPCH, Dip ICM, a, , Registrar and Timothy J. Parke FRCAa, Consultant

aDepartment of Anaesthetics, Royal Berkshire Hospital, Reading, United Kingdom


Received 4 August 2007; revised 23 June 2008; accepted 25 June 2008. Available online 16 February 2009.

Abstract
Study Objective
To determine whether adding ephedrine to propofol is as effective as adding lidocaine at reducing injection pain, and its effects on hemodynamics.

Design
Randomized, double-blinded, controlled trial.

Setting
District general hospital in the United Kingdom.

Patients
156 adult, ASA physical status I, II, and III patients undergoing elective or emergency general anesthesia.

Interventions
Patients were randomized to one of three groups to receive one mL of 1% lidocaine per 20 mL of 1% propofol (Group L), 15 mg of ephedrine per 20 mL of propofol (Group E15), or 30 mg of ephedrine per 20 mL of propofol (Group E30).

Measurements and Main Results
Pain on injection, heart rate, and blood pressure at one-minute intervals for ten minutes were recorded. There was no significant difference in injection pain among groups. Group E30 had the least amount of hemodynamic change.

Conclusion
Adding 30 mg of ephedrine to 20 mL of 1% propofol is as effective as adding lidocaine in preventing injection pain, and it results in a more stable hemodynamic profile.
Keywords: Anesthesia induction; Blood pressure; Ephedrine; Injection pain; Lidocaine
 
and ephedrine was not among the drugs found at MJ's residence nor in Murray's bag .

and yes it makes sense that the paramedics used it since there was no other drug found in mj's body to revive him beside epherdine. we know murray lied about using "flumazenil" to revive mj , because no such drug was detected, but what about the paramedics attempts to revive mj ? they did inject him with something NO DOUBT ABOUT THAT, and it must have been ephedrine
 
Flashback: very interesting article .

Source: Investigators Surprised at Jackson's Health
Saturday, June 27, 2009
By Adam Housley

The body of Michael Jackson, who died Thursday, has been released by the Los Angeles County coroner's office.

Coroner Investigator Jerry McKibben says Jackson's body was returned to the singer's family Friday night and was moved to an undisclosed mortuary.

Jackson's body had been kept in its own crypt at the morgue under lock so that no pictures of the body would be leaked, a source told FOX News. Such a move rarely, if ever, happens
The source told FOX News investigators conducting the autopsy were also surprised at how healthy Jackson was.

While he wasn't necessarily normal, he appeared to be stronger than they expected. Investigators were surprised to see significant scarring on his face, this being the first time they had seen Jackson without make-up.

He had bruises on his chest consistent with someone trying to revive him, but there were no obvious signs of a heart attack, which leads investigators to believe some sort of drug or drug combination caused either the heart to stop beating or the lungs to stop breathing.

Craig Harvey, a spokesman for the Los Angeles County coroner, said Friday there were no signs of foul play in the autopsy and further tests would be needed to determine Jackson's cause of death.

Jackson died Thursday afternoon at the age of 50 after being rushed from the Los Angeles area mansion where he was staying to UCLA Medical Center, where he was pronounced dead at 2:26 p.m.

No funeral plans have been made public.

The Associated Press contributed to this report.
 
"Among the items seized, per the warrant obtained by E! News, were vials of the appetite suppressant phentermine and the muscle relaxant clonazepam, two computer hard drives, the cardiologist's Rolodex, Fed-Ex records, letters from the IRS, pamphlets from a local sleep center, a Medical Board certificate and various other documents, including a notice of suspension from Doctors Hospital, which a hospital employee attributed to "something to do with a chart that needs to be signed."

The warrant also revealed that copies of two emails were recovered sent from Stacie Howe, Murray's secretary at Global Cardiovascular Associates in Las Vegas."

clonazepam was found beside mj's bed but was prescribed by Dr.Metzeger .

Phentermine is an appetite suppersant which affect the nervous system . It is a stimulant similar to amphetamine.

ephedra is considered an amphetamine . ephedra is the herb , it is the natural source of the chemical "ephedrine" which was found inmj's body .

so why did they seize that drug ?

Stacie Howe, was one of the two people in Las Vegas who got a phone call that morning from Murray . we can be sure of that.
 
williamorange1 said:
Flashback: very interesting article .

Source: Investigators Surprised at Jackson's Health
Saturday, June 27, 2009
By Adam Housley

The body of Michael Jackson, who died Thursday, has been released by the Los Angeles County coroner's office.

Coroner Investigator Jerry McKibben says Jackson's body was returned to the singer's family Friday night and was moved to an undisclosed mortuary.

Jackson's body had been kept in its own crypt at the morgue under lock so that no pictures of the body would be leaked, a source told FOX News. Such a move rarely, if ever, happens
The source told FOX News investigators conducting the autopsy were also surprised at how healthy Jackson was.

While he wasn't necessarily normal, he appeared to be stronger than they expected. Investigators were surprised to see significant scarring on his face, this being the first time they had seen Jackson without make-up.

He had bruises on his chest consistent with someone trying to revive him, but there were no obvious signs of a heart attack, which leads investigators to believe some sort of drug or drug combination caused either the heart to stop beating or the lungs to stop breathing.

Craig Harvey, a spokesman for the Los Angeles County coroner, said Friday there were no signs of foul play in the autopsy and further tests would be needed to determine Jackson's cause of death.

Jackson died Thursday afternoon at the age of 50 after being rushed from the Los Angeles area mansion where he was staying to UCLA Medical Center, where he was pronounced dead at 2:26 p.m.

No funeral plans have been made public.

The Associated Press contributed to this report.
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This is what hurts. Michael should be alive.
 
terrell said:
This is what hurts. Michael should be alive.
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Yeah, me too :( If only Murray never came on the scene....


williamorange1 said:
I got you , read this :

Conclusion
Adding 30 mg of ephedrine to 20 mL of 1% propofol is as effective as adding lidocaine in preventing injection pain, and it results in a more stable hemodynamic profile.
Click to expand...

williamorange1 said:
and ephedrine was not among the drugs found at MJ's residence nor in Murray's bag .

and yes it makes sense that the paramedics used it since there was no other drug found in mj's body to revive him beside epherdine. we know murray lied about using "flumazenil" to revive mj , because no such drug was detected, but what about the paramedics attempts to revive mj ? they did inject him with something NO DOUBT ABOUT THAT, and it must have been ephedrine
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Hmm, I'm still not convinced. I mean would paramedics even carry with them ephedrine for resuscitation? It makes no sense to me. Epinephrine, is clinically proven and routine so why would they use something that is not proven or licensed??? This definitely needs investigating by the authorities. I want proof that ephedrine was and is used in resuscitation.

williamorange1 said:
"Among the items seized, per the warrant obtained by E! News, were vials of the appetite suppressant phentermine and the muscle relaxant clonazepam,

Phentermine is an appetite suppersant which affect the nervous system . It is a stimulant similar to amphetamine.

ephedra is considered an amphetamine . ephedra is the herb , it is the natural source of the chemical "ephedrine" which was found inmj's body .

so why did they seize that drug ?
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Yep, and when this article came out about phentermine being seized this phentermine issue was explored to some extent here @ MJJC too. The reason why ephedrine stood out to me as strange when the coroner's report first came out was indeed because of the phentermine found in Murray's office.

Ephedrine is not an amphetamine but is structurally similar. They both are stimulants. Hence they can cause insomnia and suppress appetite

Flomax (tamsulosin) was also on the coroner's report. Ephedrine works by stimulating alpha and beta adrenoceptors which are present in different forms and different systems throughout the body. One of the places where alpha adrenoceptors are found is in the urinary system (these are alpha-1 adrenoceptors), so it is not uncommon for ephedrine to affect urination. Well, tamsulosin is a specific antagonist (blocker) of alpha-1a adrenoceptors and is commonly used for prostate problems (ie begnign prostatic hyperplasia). This means that tamsulosin, although not specifically licenced for use in medicine for this purpose, would theoretically block the alpha adrenoceptors that ephedrine was stimulating in the urinary system.

http://en.wikipedia.org/wiki/Tamsulosin
http://en.wikipedia.org/wiki/Ephedrine
 
Flomax (tamsulosin) was also on the coroner's report
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no , it was not on the coroner's report . it was mentioned in the search warrant as one of the drugs seized from MJ's bedroom on 25th of june , speciffically his bedside and was prescribed to MJ by Murray .
 
williamorange1 said:
no , it was not on the coroner's report . it was mentioned in the search warrant as one of the drugs seized from MJ's bedroom on 25th of june , speciffically his bedside and was prescribed to MJ by Murray .
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Sorry, my bad. But still needs checking out.
 
Nontheless, you make alot of sense , why would the police seize phentermine in the first place ?

by the way Maradona was banned from participation in any international soccer event because they detected Epherdine in his body .

but that means the paramedics and UCLA did not use any drug to revive mj , right ? WHY ?
 
^They could have just collected / seized anything related to MJ as potential evidence.

You raise good questions....why indeed? Timeline is key here. Hopefully the authorities have looked into what, if anything, the paramedics etc did use and why.

Also is it possible that the coroner's report did not include all the meds like flumazenil?

Interesting about Maradona.
 
you said it , anything related to mj , why did they think phentermine was related to MJ?

no, the coroner listed the drugs that caused mj's death propofol and lorazepam , and the other drugs detected in his body . so no if flumazenil was detected , the coroner would have mentioned it . it is not like a bombshell after all.
 
You're right, one would have thought they would have given something as well as CPR. I'm not saying they definitely didn't use ephedrine. If they did I'd like to know why and why not adrenaline (epinephrine). If they didn't then where did it come from?
 
do anyone know how a coroner determine that a drug was injected after someone had died ? do they list the drugs injected in his body before his death? I can't really understand how they did not use any drug to revive him . there is something missing here
 
williamorange1 said:
you said it , anything related to mj , why did they think phentermine was related to MJ?

no, the coroner listed the drugs that caused mj's death propofol and lorazepam , and the other drugs detected in his body . so no if flumazenil was detected , the coroner would have mentioned it . it is not like a bombshell after all.
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Maybe it had his name on the label or something?

ok, so yeah Murray has yet more questions to answer. why lie if he knew the coroner would find out?
 
williamorange1 said:
do anyone know how a coroner determine that a drug was injected after someone had died ? do they list the drugs injected in his body before his death? I can't really understand how they did not use any drug to revive him . there is something missing here
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I don't know if they can tell this. Maybe the coroner just didn't report all of what the paramedics used?
 
ofcourse they think it is related to mj else they would not have seize it . I'm just trying to support your theory about the ehedrine being given by murray not the paramedics , since a very similar drug was siezed from his office although it was not actually detected in mj's system no found at his residence .


but a question remains , why mj was not given any drug to revive him by the paramedics and doctors at UCLZ although they worked on him for hour and half?
 
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