It is unknown where the propofol physically came from. It would have been difficult for the patient to administer the drugs (others besides propofol were administered) to himself, given the configuration of the IV-set-up. The IV catheter was in the left leg. The injection port of the IV tubing was 13,5 cm from the tip in the catheter. He would have had to bend his knee sharply or sit up to reach the injection port and push the syringe barrel, an awkward situation, especially if sleep was the goal. If only bolus injections via syringe were used, sleep would not have been maintained, due to the short action of propofol. Someone with medical knowledge or experience would have started the IV. Anyone could have drawn up and administered the medications after the IV was started.
What is an anesthiosolgist’s view point on the toxicology screen results?
The level of propofol found on toxicology exam are similar to those found during general anesthesia for major surgery (intra-abdominal) with propofol infusions, after a bolus induction. During major surgery a patient with these levels of propofol would be intubated and ventilated by an anesthesiologist and any cardiovascular depression would be noted and treated. Anesthesiologists would also comment on the presence of other sedative drugs in the toxicology screen. Lorazepam, a long-acting benzodiazepine, is present at a pharmacologically significant level and would have accentuated the respiratory and cardiovascular depression from propofol.
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