Basically, Murray was charged with manslaughter by the Los Angeles court system, to which he plead not guilty.  If convicted, he could serve four years in prison.   He was charged based on evidence the district attorney’s office presented that indicated Murray acted “without due caution and circumspection.”  Basically – he is charged with accidentally killing MJ by performing a medical procedure without the proper knowledge or training to do so.

Should he be charged?  Absolutely!  He had no idea what he was doing.  Anesthesiologists spend years learning to administer these drugs in controlled settings, with appropriate monitoring devices and support staff.  It cannot be done in the home, and it must not be done by those who have not undergone the proper training.  I wouldn’t go perform a heart catherization on somebody just because I could get a hold of the equipment.  Let Murray stick to cardiology, and the anesthesiologists will stick to anesthesia.

You can comment and blog all you want on Nancy Grace’s blog too.  Medical Barista’s own Double Shot has appeared on Nancy’s program several times regarding the Michael Jackson case.

It appears that reality TV star Heidi Montag went under the knife to make a few improvements on her already flawless face.  She apparently had 10 plastic surgery procedures at one time!  That’s quite efficient.  She may have saved herself some recovery time and maybe some money by having to pay for only one anesthetic; however, she did not save on public criticism.

Heidi, a star of MTV’s Laguna Beach, The Hills, and other reality-esque shows, was interviewed by The Early Show on CBS.  She claims that she is not addicted to plastic surgery since she’s only had two surgery sessions in her life, despite having stacked several procedures into each session.  She also claims that plastic surgery does not contradict her belief in strong Christian values, nor is a promotion for her new album ironically titled “Superficial.”

A couple of her comments bother me.  She claimed in an interview with Access Hollywood that plastic surgery really had a negative effect on her health.  She even thought she was going to die.  She said, “I had too much demerol like Michael Jackson did.  And my breathing was five breaths per minute.”  Her doctors naturally refute this claim.  I tend to believe them.  She also claims to continue to be a role model for girls, saying that “beauty is really within.”  Please.

Read more on Popeater.com

It has been reported in the British newspaper The Sun that Brittany Murphy may have succombed to an addiction to pain killers, something we’ve heard before in the news this year.  Apparently Murphy has had a few plastic surgery procedures that have resulted in prescriptions for pain killers including Vicodin, a drug also known to be abused by Michael Jackson.  Murphy was rumored to have been fired from a recent movie production due to her erratic behavior, and friends of Murphy have made statements substantiating an addiction to pain meds and have expressed concern that something like this would happen.

Could something as innocent as a Vicodin overdose have caused Brittany’s death?  Sure.  All we know is that she was found in a state of cardiac arrest when paramedics arrived at her home.  Cardiac arrest can happen after a respiratory arrest, which can be caused by an overdose of these type of pain killers.  Vicodin also contains acetaminophen (Tylenol), which in large doses can cause metabolic derangements that can lead to electrolyte imbalance, cardiac arrhythmias, and cardiac arrest.

I guess we’ll just have to wait for the autopsy report and toxicology analysis to find out — sounds like something we heard this summer…..

I know the whole Michael-Jackson-death-by-propofol thing is no longer making the news, but I just wanted to share my experience today.  This is what’s happenning to anesthesiologists everywhere (I presume) now that propofol has become a household word.

Today, on three separate occasions, during my shift in the preoperative evaluation clinic, I had the pleasure of educating patients about the common and proper use of propofol after they had expressed some desire to not end up like Michael Jackson.

1. A 40-something woman coming for evaluation before bariatric (gastric bypass) surgery asked me what I thought about how MJ died.  I told her it was tragic, shouldn’t have happened that way, and was the result of a negligent doctor.

2. A 70-something woman called to ask about the anesthesia for her colonoscopy and was concerned that she would be getting the same drug as MJ.

3. And finally a 40-something woman coming for evaluation before a gynecologic procedure, who even brought in a tabloid article underlined in certain parts where propofol was explained.  She even went as far as claiming to have an allergy to propofol so that it wouldn’t be given to her for her procedure.

Well, I will take this opportunity to educate the public (or the minority that will actually read this post) about the history of this newly popularized, but not really new drug.

Propofol has been around since the 1970s.  It was first synthesized and tested in 1977 by Imperial Chemical Industries.  It’s first formulation resulted in allergic reactions due to the solvent it was prepared in; however, it was reformulated and gained widespread use.  It’s advantages over other widely used intravenous anesthetics at the time was that it was very short-acting (meaning that patients fell asleep quickly after administration and woke up quickly after discontinuation) and had some anti-nausea effects.  Propofol has been a popular anesthetic ever since.  Annual sales in the U.S. is somewhere between $350 million and $400 million, and worldwide annual sales are around $700 million.

So, propofol is not some new experimental drug; it has been around for over 3 decades and is quite popular among anesthesiologists and intensive care doctors for the reasons mentioned above.  These doctors are trained in using the drug safely, as opposed to the one who is responsible for Michael Jackson’s death.  Although most doctors have some knowledge of the drug, most do not use it on a daily basis, and therefore shouldn’t.  It is also important to stress where the drug is to be used -  a place where a patient’s vital signs can be monitored regularly (i.e. not for home use).  Rest assured, it can be and has been provided to patients for sedation and general anesthesia in a controlled, monitored setting (such as an operating room) for over 30 years.

Several sites are now reporting the findings of the search of Michael Jackson’s home.  In addition to multiple vials of the anesthetic propofol and bottles of sedatives, there is word of “tar heroin” and marijuana.  Sounds like MJ dabbled in everything.  It turns out that the “tar heroin” didn’t test positive for heroin, but the medication list becomes a little more interesting with the finding of Benoquin in the master bathroom.

What’s Benoquin?  It’s the brand name for a drug called monobenzone, a depigmentation agent used for various skin disorders, including vitiligo (presumed to be the autoimmune depigmenting disease having affliced Michael Jackson). Although its exact mechanism of action is unknown, it works by destroying or modifying the melanocytes in the skin – the cells that produce the pigment melanin that gives skin a dark color.   Typically, it is used to bleach the skin around areas of depigmentation to give it a uniform color.  This may be a contributing explanation as to why Michael Jackson was so uniformly pale!

Check out these links more information on what was found in MJ’s house, Benoquin, and vitiligo.