The Oregon Clinic Involved in Landmark Study Involving a New Way to Use the Surgical Anesthetic Propofol

Tuesday, November 3, 2009

The Oregon Clinic

Drug implicated in the death of pop star Michael Jackson can be safely administered by non-anesthesiologists, study finds

Doctors with The Oregon Clinic participated in a revealing new study on the safety of the surgical anesthetic propofol. The report, “Endoscopist-Directed Administration of Propofol: A Worldwide Safety Experience,” was published in the October issue of Gastroenterology, the official journal of the American Gastroenterology Association.

The study examined 646,080 cases at 28 medical centers around the world in which propofol was administered without the presence of an anesthesiologist.  It included 14,181 procedures performed at The Oregon Clinic, and concluded that the drug was just as safe as other commonly used sedatives.

The report is the first to demonstrate on a large scale that trained gastroenterologists can safely administer propofol, without an anesthesiologist present.  The most commonly used agents are the combination of a narcotic and a benzodiazepine like Versed.  To date, the only way propofol has been used (with the exception of the groups contributing to the study) is in the presence of an anesthesiologist, adding an extra person and an extra charge to the procedure.

The results challenge previously issued recommendations that the drug only be administered by anesthesiologists, concluding that the use of anesthesia specialists to deliver propofol would have had “high costs relative to any potential benefit.”

“What the study basically says is, ‘Here’s more than half-million people where it’s been used very successfully with at least comparable if not better safety record than the traditional medications,” said Dr. Rodger Sleven, a specialist from The Oregon Clinic, West Hills Gastroenterology division who contributed to the study.

Dr. Viju Deenadayalu, a physician with The Oregon Clinic, Portland Gastroenterology division, was also involved with the study.

Propofol was in the news recently, after it was identified as a contributing factor in the homicide of pop star Michael Jackson, who died from a combination of propofol and three other sedatives, according to autopsy reports. Those involved with the propofol study say the Jackson case represents a set of completely different circumstances in which there was likely not sufficient medical monitoring. Sleven stressed the fact that The Oregon Clinic uses oxygen monitoring, electrocardiograms and other monitoring devices and follows the highest safety protocols.

“We’ve had a number of patients that have come in and said, ‘Isn’t this the same medication that killed Michael Jackson?’” Sleven says. “After we explain our safety protocols, they are reassured and we haven’t had anyone refuse propofol because of the Michael Jackson case.”

The study sites an increase in the use of propofol in recent years as compared with traditional endoscopic sedation with benzodiazepines and opioids and concludes that the safety record of propofol administration by endoscopists is superior to the published safety record of traditional medications used by endoscopists for gastrointestinal endoscopy.

Some of the reasons for using propofol include faster response and less grogginess on the part of patients. Patients tend to move around less during surgery and wake up more quickly afterwards. Propofol has been in use at The Oregon Clinic since 2004.

“My hope is that more people will see propofol is a better sedative,” Sleven concluded.