"The Michael Jackson Drug and the Dental Office"
In This Issue
Michael Jackson Drug
Diprivan
OSHA Regs
Join The List
Join Our Mailing List
Web Links
Diprivan

Dr. Ronald Davies is medically trained in Anesthesiology and double Board Certified in his field.  He has an unsurpassed 30 year safety record.
  • General Anesthesia Evaluator for the Dental Board
  • Past Associate Professor in Anesthesia at LLU, UCLA and USC
  • Past President: American Society of Dentist Anesthesiologists, California Society of Dentist Anesthesiologists
  • Member: ADA, CDA, OCDS, OCDA, JADE, ASDA, ADSA, CSDA
Issue: #8   August 2009
Dear Dr. :

You just can't get away from the media's coverage of the death of Michael Jackson. Some patients are worried and have been asking if dentists use the drug "that killed him".  It is a question that needs answering.  Diprivan (Propofol) is safe when delivered by trained professionals for the proper reasons. To my knowledge it is used by most, if not all, General Anesthesia Permit holders in California dental offices.
diprivan
Recent news reports suggest that Dr. Murray (a reported cardiologist) used the drug Propofol "off label" in combination with benzodiazepines, without proper monitoring and without the necessary emergency equipment such as an EKG, pulse oximeter and airway support.  I have not read whether or not Jackson's  blood pressure was monitored.  As a General Anesthesia Evaluator for the Dental Board I can tell you that this is far below the standard of care for anesthesia in dental offices.
The Propofol Package Insert
dip-insert

Newspapers have reported that Jackson requested Diprivan as a sleeping aid.

Diprivan (Propofol) has no approved use as a sleeping aid, ie it appears to be used "off label"  in the Michael Jackson case.

Diprivan is approved for:
  • Initiation and maintenance of Monitored Anesthesia Care (MAC) sedation
  • Combined sedation and regional anesthesia
  • Induction of General Anesthesia
  • Maintenance of General Anesthesia
  • Intensive Care Unit (ICU) sedation of intubated, mechanically ventilated patients
Under "WARNINGS" it says:
"For general anesthesia or monitored anesthesia care (MAC) sedation, DIPRIVAN Injectable Emulsion should be administered only by persons trained in the administration of general anesthesia and not involved in the conduct of the surgical/diagnostic procedure. Patients should be continuously monitored, and facilities for maintenance of a patent airway, artificial ventilation, and oxygen enrichment and circulatory resuscitation must be immediately available."

(It may be appropriate to ask those you refer your patients to for anesthesia if they are using this drug against the WARNING section.)
Coming Soon to An Office Near You?
 At Least Dr. Murray was a Physician

According to the AP August 8, 2009, "Propofol is extremely powerful, and even a small miscalculation in a dose can cause a dangerous drop in breathing and heartbeat.  Some benzodiazepines also affect breathing rate, making the combination potentialy deadly, according to several anesthesiologists...(who) describe balancing the dose of several drugs as an art...People not properly trained in such nuances are playing within a small margin for error...Nonspecialists may view it as 'Well, it should be pretty straightforward', and they get caught with their pants down."

Imagine the upcoming danger when dental assistants with only 110 hours of training begin labeling syringes, drawing up medications, injecting propofol and Versed (among other drugs) and then "monitoring" patients in a dental office that is ignoring the Driprivan "Warning" label. Compare the training between a cardiologist and a dental assistant and you begin to see the danger California dental patients will be exposed to when AB 2637 is fully implemented in January.  See my last Newsletter Dangerous Anesthesia Law.
 
Red Flag Rule Delayed Again
The Federal Trade Commission (FTC)  announced  they are further delaying enforcement of the Red Flags Rule until November 1, 2009.  Details here.
More Regulations
 New Cal OSHA Regulation Targets Aerosol Transmissible Diseases.

The regulation is effective August 5.  It can be found in Title 8 of the California Code of Regulations Section 5199 (link above).

Basic rules and exemptions are covered at the CDA web site here.
 
logo
Safe Anesthesia is Affordable

  • NO Set-up, Front Loaded Charges
  • NO Pharmacy/Equipment Charges
  • NO Minimum Charges (South Orange County)
  • NO Travel Charges
We Match Most Percent Discounts You Offer Your Patient
We Accept VISA, MC, Amex and Care Credit.
Previous Newsletters
Click Here to access previous newsletters

I WOULD LIKE MORE INFORMATION ON....

Anesthesia Services                        Local Anesthesia                
Fees and Scheduling                       General Anesthesia Laws

Ronald O. Davies, DDS
949-362-9690
Discover/VISA/MasterCard/Amex/CareCredit
creditcare credit