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Propofol dose

March 7 2010 at 5:14 PM
Steve Harris  (Login StevenHarris)
Registered User


Response to Organ Procurement and Propofol Dose

 
Maxim: "The reason there's usually "no mortuary person around when a heart or kidney needs to be removed" is because the donors are not in a mortuary, since their respiration and circulation must be maintained, until the procurement team, (comprised of medical professionals, not laymen), arrives. Comparing medical professionals performing organ procurement, to laymen performing surgical procedures on dead people for Alcor or Suspended Animation, is pointless."

COMMENT: It's hardly pointless if it bears on the legality of the procedure, which it does. The law really doesn't care whether people procuring organs for study or dissection are "professionals." There are no licensing requirements, for example. If the organs aren't to be transplanted into another human, the law doesn't care about the educational "qualifications" of the people obtaining them. Perhaps this is a hole in the law which will one day be filled. Or perhaps not. Either way, it's very relevant to the question of whether anything illegal is being done here.

Maxim: Steven Harris MD writes: "I don't know where the "25 mg" of propofol figure which everyone is using, came from." The dose was 20mg, and it came from SA's CI-81 case report:http://suspendedinc.com/cases/CaseReport2_fin.pd

COMMENT: Okay-- that's easily cleared up. It's a typo or simple error in the report, and should be corrected. The standard propofol bottle supplied with the kits is 20 mL (10 mg per mL), and all of it is to be given, according to longstanding instructions. So that should read "20 mL" not "20 mg". It would be quite difficult to actually administer 20 mg, as it would involve drawing just 2 mL from a 20 mL bottle, giving the 2 mL, and discarding the rest (18 mL). That's never done, and it wasn't done in this case, either.

Maxim: The three laymen who performed that case didn't know to ask Dr. Harris, (the "Consulting MD" for that case), about heparin dosing, so I think it's safe to assume they also didn't know to ask question the propofol dosing. Or, maybe they'll come back and say it was a typo, after one of their employees defended the 20mg dose, for three months.

COMMENT: The reason kits are packaged around unit dose vials is to avoid this very problem. Much the same happens in Advanced Cardiac Life Support kits, where some of the same problems are encountered, and mistakes are made. In this case, the patient got the correct dose of propofol, and heparin dose that was also fine, given the other backup anticoagulants.

Maxim: "Regardless, I don't think a 200 mg bolus of propofol is much more significant than a 20mg bolus, in the grand scheme of things."

COMMENT: Oh, really? Is that why you devote two paragraphs to the fact that it's not enough in this "Cryonics Meets Medicine" blog post of yours? http://cryomedical.blogspot.com/

This really deserves to be quoted.

From "Cryonics Meets Medicine" (March 3, 2010) "Recently, when I questioned cryonics organizations allowing laymen to have free access to, transport, and administer the drug propofol, Steve Harris, along with SA employee Mathew Sullivan, and "FD" an anonymous poster on the Cold Filter cryonics forum, argued that the 25mg of propofol in question was necessary so Alcor and/or SA could administer CPR to patients who had just died, without causing them pain, or waking them up. Nonsense. Propofol has an extremely short duration of action, (minutes), and a conservative dosing of propofol, for a 70kg (154lb) man, for the purposes of maintaining unconsciousness would be 140mg for induction, followed by 7mg per min (420mg per hour).https://online.epocrates.com/u/1011979/Diprivan/Adult+Dosing"

Comment: if you don't think the dosing is important, why the rant about underdosing? A conservative dose of propofol is 140 mg, you say. We give 200 mg. There you are. If there are any signs of awareness later, such as eyelid movement or even shivering (not a sign of awareness but certainly a sign of CNS activity), another equal dose is held in reserve. This is probably not likely to be necessary, given the fact that the patient is being cooled and not normally perfused for the duration of action of a single induction dose of propofol (at least 15 minutes and probably more). All your arguments for why propofol isn't needed in the first place, apply more effectively after 15 minutes of CPS and cooling, so it's ridiculous for you to argue, at the same time, that [A] propofol isn't needed, and [B] that we're not giving enough.

Which way do you want it? We can argue about propofol pharmacokinetics and duration of action, but you won't get much out of it. I have a lot of research experience with propofol and a published paper on the topic of its duration of action in the veterinary field (PMID: 16948589), and I also hold a novel propofol formulation patent in several countries, with more to come. You seem to have a gift for identifying topics on which I actually am an expert, cited in both the scientific and patent literature, and you yourself know nothing except what you read. How do you do it?

Maxim: "As for the rest of the post, while it may not be illegal, I think most physicians would call it "unethical" for a physician to write prescriptions that would enable laymen, (probably sometimes people the physician doesn't even know, well, if at all), to have access to, transport and administer certain medications, (regardless of whom, or what, they are administering the drugs to)."

Again, if you can actually find a physician who understands this particular topic and circumstances, and is willing to criticize me, trot him or her out, and let that doctor post here. Set them up. His hypothermia, resuscitation, and propofol research cites first. Then we'll get to the philosophical question of why he or she thinks he can teach me medical ethics. As for your own opinion in these matters, as usual I give it all the consideration it is due.

Steve Harris, MD

 
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