PTT偶像團體區 / KingofPop (麥可傑克森 - Michael Jackson)

Re: [情報] Dr. Shafer 回答MJJC歌迷問題

看板KingofPop (麥可傑克森 - Michael Jackson)作者ChesterB (很難想)時間14年前 (2011/12/29 06:35)推噓0(0推 0噓 0→)

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Questions about propofol in general 關於Propofol的一般問題 MJJC: Do you feel that your testimony helped alleviate patient concerns about Propofol or are things more or less the same? Dr. Steve Shafer: It may have helped, but only a little. On the Friday that Paul White testified I was working at the “Allen Pavilion,” a regional hospital run by Columbia University that serves a low-income area of Manhattan and the Bronx. I was caring for an elderly man who asked what drug he would get. I told him “propofol.” As usually happens, he asked if that was the drug that killed Michael Jackson. I told him that propofol didn’t kill Michael Jackson, Conrad Murray killed Michael Jackson. I also said that propofol was very safe drug. He said “I heard that doctor say that at on television, but I don’t believe him.” I told him I was the doctor he saw on television. He thought that was hilarious: the doctor in blue scrubs, wearing a surgical hat, with a stethoscope around his neck working in this clinic for poor patients might be the “famous” doctor he saw on television. “Yea, right” was his answer. He didn’t believe me for a second. However, he was reassured by my “joke” about being the doctor he saw on television, and everything went well. MJJC: Can a person become dependent or addicted to propofol? If yes what kind of dependency is it physical or psychological? Dr. Steve Shafer: There is not much data about this, because propofol must be given intravenously, and it really burns, which discourages abuse. However, there have been a number of deaths of anesthesiologists and other health care personal from propofol abuse. Based on this, I am reasonably confident that it is addictive. MJJC: Why would someone even have the idea to use Propofol as a sleep aid? If it is only to be used for surgery then why would anyone suggest giving it someone to get some sleep? Dr. Steve Shafer: The mechanism of action of propofol is the same as drugs like Ambien that are commonly used to induce sleep. This is a reasonable research question. However, it should never be put into practiced until it has been studied in a proper research setting. After that work has been done, it should only be used with appropriate documentation and precautions. MJJC: Are the drug companies who make Propofol looking into testing Propofol for sleep? Do you think there will be more research studies about Propofol being used for sleep? Dr. Steve Shafer: Yes to both questions. MJJC: What are the known effects on the nervous system & the brain of long term Propofol use? Dr. Steve Shafer: Not a lot, because it is rarely used for long term use. I have been able to find one report of a patient who received propofol in the intensive care unit for 51 days. This is from the conclusion of the article: “To our knowledge, this report represents the first documentation of propofol use for long-term sedation in a mechanically ventilated pregnant patient and the longest duration of continuous infusion propofol published in the medical literature. Propofol was used for 51 days with no documented maternal adverse events.” (Tajchman SK, Bruno JJ. Prolonged propofol use in a critically ill pregnant patient. Ann Pharmacother. 2010;44:2018-22) This patient was weaned from propofol over several days without adverse consequences. So administration for 2 months appears to not have long term consequences, at least based on this example, and the fact that Michael Jackson continued to function at rehearsal. However, those are just two data points. More research needs to be done if one contemplates development of propofol for long term use. MJJC: Does one get a "restful sleep" from Propofol? We have heard experts contradict each other on this. Dr. Steve Shafer: The contradiction reflects the state of the science. I received propofol for anesthesia about a year ago, and I have given propofol to thousands of patients. There is often a feeling of having slept well after awakening from propofol. However, studies suggest that propofol sleep it is quite different from normal sleep, and is not “restorative” the way that normal sleep is restorative. For example, dreams are important in brain function. Patients don ’t dream on propofol, except at the time of awakening. My interpretation of the data is that propofol might be OK for getting a patient off to sleep, but that maintaining a patient on propofol for sleep (as we sometimes do in intensive care units) probably is denying patients restorative sleep. MJJC: Do you agree that Propofol should be re-classified as a controlled substance? Dr. Steve Shafer: No. I think this will hurt patients. In emergencies we need propofol immediately, and in large quantities. I am opposed to placing obstacles in the way of doctors caring for patients, unless there is clear benefit. Conrad Murray could have still obtained propofol for Michael Jackson, because doctors can order controlled substances. Since most propofol abuse is by doctors, making it controlled won’t limit the ability of doctors to abuse it. It will just impair their ability to care for emergency patients. This has been the subject of an issue of Anesthesia & Analgesia. Here is the cover of that issue: http://www.aaeditor.org/HWP/Covers/0710.cover.jpg. MJJC: Do you think now the anesthesiology community will be more careful in how they promote and teach one to use Propofol? Dr. Steve Shafer: We already take this very seriously. We are very involved in teaching the safe use of sedatives to our medical colleagues. This will continue. Perhaps they will be more receptive to the importance of safe sedation. However, nothing we can do will reach a doctor who does not put patients first. MJJC: Do you think the medical community has learned from Michael’s death in regards over prescribing to a powerful wealthy person and wrong doing by a doctor? Dr. Steve Shafer: Absolutely. I mentioned this above. I am aware of this because I occasionally see this in my practice. Doctors serve patients by acting as doctors. That is a message for doctors and patients alike. MJJC: Can you explain “Propofol lollipop” a little more? Dr. Steve Shafer: Propofol absorbed from the stomach never reaches the brain, because it is all removed by the liver. However, the blood supply to the mouth and esophagus (above the diaphragm) does not return directly to the liver. Instead, it just goes to the heart, and from there goes everywhere including the brain. So a propofol lollipop would provide propofol to the venous blood, and from there to the brain. Paul White and I discussed this at one of the breaks prior to his testimony. It is a reasonable idea, provided the dose was adequately controlled. Should this ever become available, then I would reconsider my position on classifying propofol as a controlled substance. My current view is highly influenced by the fact that it only works when given intravenously, and that really burns! MJJC: What does Propofol taste like? Dr. Steve Shafer: It has the consistency of skim milk, and tastes like a very medicinal salad dressing. 居然有人問他喝完Propofol之後喝起來味道怎樣~~ MJJC: Beagle Propofol experiment done by the Defense has made PETA and MJ fans angry. We don’t expect that you have any direct information about the Beagle experiment but as the humans weren’t affected by drinking Propofol, is it safe to assume that the Beagles were unharmed as well? Dr. Steve Shafer: I think it is very unlikely that any harm came to the beagles. There should be no effect from drinking propofol. However, I am uncomfortable that neither the experimental protocol nor the results of the experiment were presented in court. I believe that when animals or humans participate in trials, there is an ethical obligation to write up and publish the research to add to the body of knowledge. It is the increased knowledge that morally justifies the research. I wrote our human study up for publication, asked Paul White to review it, and gave it to the defense. I believe they should have done the same with their beagle study. MJJC: We heard the theory of some of the Benzos or/and Propofol that were given to MJ by Murray can be used for people with drug addiction to help them off their addiction to other drugs such as Demerol, Is this true? Can you comment on this? Dr. Steve Shafer: There is a technique of rapid detoxification that involves placing patients under general anesthesia for a long period of time (hours to days) and pharmacologically reversing opioids with “opioid antagonists”, drugs that chemically block the effects of Demerol and similar drugs. This is controversial, but it probably works in some patients. -- In a world filled with hate, we must still dare to hope. In a world filled with anger, we must still dare to comfort. In a world filled with despair, we must still dare to dream. In a world filled with distrust, we must still dare to believe. ~~~~By Michael Jackson -- ※ 發信站: 批踢踢實業坊(ptt.cc) ◆ From: 71.179.164.112