Physicians and the public are concerned about the safety of the drug propofol in hospital emergency departments.
Since the death of performer Michael Jackson in 2009 from the drug propofol, many medical professionals and the public have questioned the drug's use in hospital emergency departments. Propofol is a sedative that is given intravenously in the health care setting. Even before Jackson's death, several studies were being conducted to determine the safety of the drug and its place in emergency medicine.
Propofol Studies
Propofol is frequently used when someone breaks a bone.
According to an article in the Journal of Emergency Medicine, the use of propofol has been gaining in popularity over the last several years. Because of Jackson's death, however, propofol has come under increased scrutiny concerning its safety when a patient is not monitored by an anesthesiologist. Anesthesiologists typically do not monitor patients in emergency room treatments.
Its Use
Patient's pulses are carefully monitored in the emergency room.
The drug is usually administered to combat pain in brief, painful procedures such as a bone fractures or dislocations. Physicians like using the drug because it has a short half-life, that is, it leaves the body swiftly and it has no residual effects afterward. In 2010, a group of emergency room physicians and nurses petitioned the federal Centers for Medicare and Medicaid Services (CMS) to allow the use of propofol as a procedural anesthesia.
Study Results
None of the patients in the studies needed intubation to increase oxygen flow.
The group argued that emergency departments are staffed with highly trained physicians and medical personnel who are trained in airway management. Past studies, such as one published in the International Journal of Emergency Medicine, reported that the effects of using propofol were no different from other powerful analgesic anesthesia. The article in the Journal of Emergency Medicine reported that the only complication from the drug's use was decreased oxygen pressure in the blood.
Doctors' Input
Some emergency room personnel fear a change in propofol policy will change treatment.
In December 2009, the CMS had classified the drug under the heading "deep sedation/analgesia" which means an anesthesiologist had to be on hand to monitor the patient. In 2010, the president of the American College of Emergency Medicine, Dr. Howard Blumstein, told the CMS, "A lot of emergency physicians feel that propofol is the best drug to use for sedation because it is safe, has rapid onset and wears off quickly." Because of the classification changes, Blumstein said he feared that hospitals would make policy changes on the use of propofol in emergency rooms and "patients will suffer."
Cost Considerations
In addition to quality of care diminishing, emergency room physicians and nurses fear that limiting the use of propofol will drive up already expensive emergency department costs. Dr. Angela Gardner, president of the American College of Emergency Physicians, told members of the CMS that having to keep an anesthesiologist present for emergency room procedures "would add millions of dollars to health care costs unnecessarily, and there are not enough anesthesiologists to do that."
Tags: emergency room, emergency departments, Emergency Medicine, Journal Emergency, Journal Emergency Medicine