<b>Dr. Conrad Murray & diprivan on Michael Jackson - A new street drug? Subpoenas issued.</b>

<p><img src="http://anestheticnews.com/wp-content/uploads/2009/07/diprivan1.jpg" alt="diprivan" title="diprivan" width="250" height="151" class="alignleft size-full wp-image-1300" />Diprivan, the most talked-about drug this week was introduced during the early eighties manufactured by a small German pharmaceutical company called Zeneca. It arrived at a time when almost all surgery was done under general anesthesia using halogenated carbons which were vaporized after the mask was fitted. Halothane was the first of this type of drug after we graduated from chloroform and ether. Such drugs were extremely toxic and balancing oxygen saturation was a test for the best of any anesthetist. Recovery from general anesthesia took longer than the actual operation. <p> <p> Although the move to vaporizers was a giant step for doctors and mankind, the price was high on liver damage to patients as well as anesthesiologists. The daily inhalation unfortunately also took its toll on surgeons who spent hours day after day in the OR. It was in the late seventies that we started to see a move to what is now called "day surgery". One would arrive at the hospital for minor surgery and be back home that afternoon. The dawn of a new area of synthetic opioids which were well tolerated and effective, transformed simple albeit skillful surgical procedures.<p> <p> Research Pharmaceutical companies continued to press on with their commitment to reduce the toxic effect of vaporized solutions. There are only two now in use for general anesthesia under the name of desflurane and sevoflurane (fluorinated methyl ethyl ether brand). Though they vaporizes very readily, it is a liquid at room temperature. <a href="http://wikipedia.org/wiki/anaesthetic_machine">Anaesthetic machines</a> are fitted with a specialized anesthetic vaporizer unit that heats liquid desflurane to a constant temperature.<p> <p> Propofol back in the eighties showed tremendous potential as an anesthetic in combination with nitrous oxide, because of its efficacy, rapid onset, low toxicity and a low tolerance index. Any drug which acts on the CNS (central nervous system) as a relaxant have one thing in common. <b>tolerance</b>. This means an increasing dosage to deliver the same pharmacological effect. When synthetic benezodiazapies, Librium and Valium were introduced to the medical market by the Hoffman La Roche company in the sixties it revolutionized the management of neurotic anxiety complaints but tolerance was and still is the down side.<p> <p> Fentanyl is another synthetic opioids which although synthesized by <a href="http://en.wikipedia.org/wiki/paul_janssen">Dr. Paul Janssen</a> in 1959 following the medical inception of organic morphine several years earlier, and based initially on the chemical starting point of opioid activity. The widespread use of fentanyl triggered the production of fentanyl citrate, which entered the clinical practice as a general anesthetic under the trade name <a href="http://en.wikipedia.org/wiki/sublimaze">Sublimaze</a> in the 1960s. However due to the potential street abuse was and still is classified as a Schedule II drug in north America.<p> <p> The point I am making is that as far back as the eighteenth century when The Andean natives discovered the euphoric action of Erythroxylon coco and Albert Niamey isolated cocaine which was endorsed by Sigmund Freud for its physiological effects and In 1890 Halstead used cocaine for infiltration and conduction nerve block for dental use, nothing much has changed in the search for the euphoric effect other than the source being less ad hoc. Synthetic compounds are easily titrated for precise therapeutic efficacy. Whereas the effect of inhaling the fumes from roots or leaves do not have an FDA standard. What could be more poignant than Bob Marley's song "One love" in which he was in a twilight zone over political dogma. Ref. Bob Marley relics.<p> <p> In the mid 1990s, fentanyl saw its first widespread palliative use with the clinical introduction of the <a href="http://en.wikipedia.org/wiki/duragesic">Duragesic</a> patch, followed in the next decade by the introduction of the first quick-acting prescription formations of fentanyl for personal use. Through the delivery method of transdermal patches. Fentanyl is currently the most widely used synthetic opioid in clinical practice. Fentanyl is classified as a Schedule II drug in the United States due to its high potential for abuse.<p> <p> The general anesthetic Diprivan (propofol) is at the top of the headlines this week as more sweeping of Dr. Conrad Murray's gated house in which he lives continues. This scrutiny has resulted in three subpoenas being served on him. Until Michael Jackson's death Dr. Murray owned and managed thee offices; one in Las Vegas and two in Los Angeles. He was also selected as Michael's personal physician as he would travel as part of the team planning for his grand European tour. News reported that when in Los Angeles Dr. Murray lived at Michael's rented house and house keepers said they would see Dr. Murray come down in the morning with what looked like two empty oxygen cylinders, one in each hand. <p> <p> Propofol was never a controlled substance neither was it indicated for insomnia. Researchers also found that six out of 16 residents (about 38 percent) who abused propofol died from it. While these are small numbers, lead author Dr. Paul Wischmeyer, professor of anesthesiology at the University of Colorado, believes this is indicative of a larger problem. The use of propofol in conjunction of other synthetic narcotics along with nitrous oxide has revolutionized day surgery such as colonoscopies and even more complex surgical procedures. We will have to follow this drug to see if it will be classified under a schedule. Propofol (diprivan) however requires too complex an administration process for it to be targeted as a street drug.<p> <p> <p> Comments to <a href="mailto:localanesthetics@yahoo.ca"><span style="font-size: small;">localanesthetics@yahoo.ca</span></a><span style="font-size: small;"> M.Sc. PharmD. CCPE Please visit </span><a href="http://www.anestheticnews.com/"><span style="font-size: small;">WWW.AnestheticNews.com</span></a></span></span></div> <p> <p> <p> <p> </span> <p> <p> <p> <p> <p> <p> <p> <p> <p> <p> <p> <p> <p> <p> <p> <p> <p> <p> <p> <p></p>