Death by Propofol

James Diaz, MD, Dr. P.H.; Alan David Kaye, MD, PhD 

Since its introduction in 1986, propofol (2, 6-diisopropylphenol), an intravenous sedative-hypnotic agent, has been utilized for the induction and maintenance of general anesthesia and conscious sedation in over 80% of cases; largely replacing thiopental (sodium pentothal) over a decade ago. Unrestricted as a controlled substance, propofol’s abuse potential emerged quickly and was highlighted by the death of pop singer, Michael Jackson, in 2009. In order to assess the epidemiological features of fatal propofol abuse, a descriptive analysis of the scientific literature was conducted using Internet search engines. Well-documented cases of fatal propofol abuse were stratified as unintentional or accidental deaths and as intentional deaths by suicides or homicides. Continuous variables were compared for differences by unpaired, two-tailed t-tests with statistical significance indicated by p-values less than 0.05. Of 21 fatal cases of propofol abuse, 18 (86%) occurred in healthcare workers, mostly anesthesiologists and nurse anesthetists (n=14, 67%). One case occurred in a layman who purchased propofol on the Internet. Seventeen deaths (81%) were accidental; two were suicides (9.5%) and two were homicides (9.5%). Blood levels in intentional death cases were significantly greater than in accidental death cases (p < 0.0001); all of which reflected initial therapeutic induction-level doses in the ranges of 2.0-2.5 mg/kg. Though lacking in analgesic effects, the abuse of propofol by young healthcare professionals, particularly operating room workers, has been significant; and likely underreported. Propofol is a dangerous drug with an evident abuse potential which often results in fatalities.

 

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