Antidote: The misunderstanding surrounding propofol

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Propofol is an extremely effective anesthetic which is manufactured as an emulsion and is delivered intravenously. AsraZeneca made the first useful version in 1986 (Diprivan), Sandoz now makes another. It is difficult to classify this drug, and it does not appear on the current list of DEA controlled substances. In the hands of a fully trained anesthesiologist it is very safe, but in the wrong hands, it has the potential to stop a patient's breathing.                                                                  

Propofol (Diprovan) has received a lot of attention lately, because by some reports it was found at Michael Jackson's home following his death. Because of this discovery, and because of speculation that it may have been misused or misadministered by an untrained doctor (because it lacked the DEA restriction), propofol has received a substantial amount of negative publicity.         

This makes propofol a prime subject for this column, whose main purpose is to set the record straight about prescription drugs that are misrepresented in the news. And though it has been more than fair to portray propofol as a potent chemical that must be used correctly and cautiously, obscured in translation are all the positive lifesaving uses of the drug.                                            

Not only is propofol regularly used to put patients to sleep before major operations, it is also extremely useful as a standalone treatment for minor procedures. Lost in the flurry of Jackson accusations and fears is the fact that propofol has practically taken over the arena for colonoscopy and endoscopy – sedating many thousands who were formerly afraid of these procedures because they had to experience them while awake. Now patients are put to sleep by a trained anesthesiologist in a surgical suite (often in the gastroenterologist's office), and they skip the discomfort and pain of the procedure. The newer method helps me, as a practicing internist, to improve compliance.       

Known as the “milk of anesthesia,” because of its white color, the makers of propofol emulsions deserve a pat on the back for what the drug has accomplished, not a black eye.       

Marc Siegel, MD, is an internist and professor of medicine at New York University and the author of False Alarm: The Truth About the Epidemic of Fear
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