Propofol is a common drug used by anesthesiologists. But it found grim notoriety in the days and weeks after Michael Jackson’s untimely death in 2009.

Reports indicated that the pop star was using the powerful anesthetic as a sleep aid to treat insomnia, and the combination of excessive propofol and other drugs in his system led to his death at only 50 years old. Many experts were critical of Jackson’s doctor for using the anesthetic as a sleep aid. But propofol isn’t only dangerous when used in off-label ways.

Propofol is a short-acting drug, which means it sedates patients quickly but wears off rapidly as well once it’s no longer being administered. That’s why it’s commonly used for minor outpatient procedures such as colonoscopies and epidural steroid injections. Typically, patients receive the drug through an IV drip rather than intubation.

However, propofol is a strong medication and it doesn’t have a reversal agent. This means that although its effects are short-lived, there is no way to counteract the drug if a patient has an adverse reaction.

Propofol can cause respiratory depression, which is why anesthesiologists must be vigilant about how they administer the drug and to whom. They must verify that a patient has no underlying health conditions that could cause complications from the propofol. Even then, they should monitor the patient closely because of the risk of respiratory arrest.

Adverse Effects and Poor Reaction Protocols

Unfortunately, there are many cases in which patients react badly to propofol but doctors and nurses don’t notice until the situation becomes critical. Ill-prepared surgical teams may be caught off-guard if they’ve done a routine procedure many times without incident. They’ve never learned to cope with an emergency, so they are slow to react when problems arise.

When they do notice the crisis, many surgery center staff members lack proper training on how to respond. Oftentimes, staff members don’t have access to a crash cart or even know what one is. A crash cart is of little use if no one can use it or if the drugs are out of date, but that is the case at many surgery centers. If the patient doesn’t die from such ineptitude, they still may suffer severe anoxic brain damage or long-term health problems.

In Michael Jackson’s case, reports indicate that a doctor was administering the drug to him. But his physician likely did not have access to a crash cart and other instruments that would have helped the singer recover, and Jackson was reportedly taking a number of other medications that exacerbated his health troubles.

While his doctor was found guilty of involuntary manslaughter and the tragic story highlights the risks of propofol overdose, it’s important to maintain perspective for more common cases. Although it’s tempting to put the responsibility for propofol injuries and deaths at the feet of the anesthesiologists, the problem is broader than that.

An anesthesiologist can do their job perfectly and a patient might still unexpectedly react badly while in the operating room. At that point, the entire medical team should be capable of responding instantly, and they should have the equipment to do so. Yet the opposite is true at an alarming number of surgery centers.

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A Call for Greater Responsibility

Vigilance and early intervention save lives. That’s why the American Society of Anesthesiologists issue guidelines for rapid resuscitation and emergency response protocols. At a bare minimum, surgical teams should include personnel who have Advanced Cardiac Life Support certification and they should have access to a fully stocked, up-to-date crash cart.

Without these precautions, avoidable tragedies occur. A team might bungle the code and not resuscitate the patient quickly enough, resulting in death or devastating brain damage. Propofol side effects can also include an irregular heartbeat and ongoing respiratory problems that deteriorate a patient’s quality of life.

Surgery centers see high volumes of patients, and propofol does not present an issue in many of these cases. However, one complication-free surgery does not guarantee that the next one will be the same.

The question we often hear is, “Is propofol safe?” Unsatisfying though it seems, the answer is that it depends. Many people come through surgeries with no complications, and anesthesiologists take precautions where they can to limit risks.

But things go wrong during even the most routine procedures, and surgical centers are responsible for ensuring that they have a well-trained staff and accessible, fully stocked crash carts to prevent tragedies. No one should die during a routine colonoscopy or outpatient surgery, especially not due to sheer negligence.