T & T is pleased to offer guest commentary from KZ. KZ, a practicing nurse anesthetist, has offered knowledgeable commentary regarding the use of propofol and correct medical techniques. This is the first of two write-ups.
I agree with everything medically that Selma Calmes enumerated. I have some issues with how she portrayed "other" anesthesia providers in her commentary, but that is another long discussion! I think, if anything, she did not elaborate enough about a number of issues. Her comment: "It is not known whether trained medical personnel were continuously observing the decedent while propofol given" could actually help the defendant. He could claim to be a trained medical person continuously observing the decedent, but I think he'll lose that one with the phone records.
Medical Evidence Analysis Summary:
See my comments in the IV technique document I sent earlier (Caligirl9 note: This will be posted later today or tomorrow; there are visuals that go with that excellent write-up). That explains why propofol was not found in the remaining bag or tubing. (And may I comment that the senior criminalist was a bit light on the details of what size IV bags, what crystalloid they contained, and what size needles and syringes he documented in the autopsy report?! How about the brand name of the IV tubing, and mini or maxi drip, needle-less, etc. Nothing documented. But maybe there are other evidence docs with this that we don't have access to.)
Summary of Positive Toxicological Findings:
The propofol in the vitreous humor and the propofol and lidocaine in the gastric contents is a VERY small amount. I believe 70cc of dark fluid stomach contents were described. With the specimen scale noted as ug/ ml or ug/g at the top of the chart, it is difficult to interpret the gastric contents. Is it 0.13mg propofol PER ML of stomach contents, or 0.13mg total volume?
Gastric Propofol: Propofol comes 10mg/ml. 0.13mg, which is 0.013ml of propofol, and extremely tiny amount. Taking stomach contents into account, it is possible that result is some kind of diffusion from the arterial or vascular system. If that is so (and I'm no toxicologist!), all that says is that MJ's arterial and venous system was saturated with propofol to the extent that passive diffusion into avascular fluids (gut and eye) occurred! (The DRUG molecules only, not the lipid delivery system, the white stuff. The drug molecules are what is measured in the vitreous, also.) Still looking for a journal article comparing venous concentration with vitreous and gastric concentrations by diffusion. Don't know if I'll find one, though. If MJ had consumed a portion of propofol orally close to his time of death, it would have been visually noted in the gastric fluid recovered, or in the duodenal contents. The ME would have recorded "white liquid" or something like that, in the narration of stomach contents. Instead, the narration says "70g of DARK fluid." (My emphasis.) Remember that propofol is a lipid (fat) suspension, and the white liquid lipid portion would likely not break down until bile acids had acted upon it. So I think the oral ingestion hypothesis (ie, MJ woke up and drank some propofol) is not a very likely scenario, IMO.
Gastric Lidocaine: Lidocaine 1% is 10mg/ml, which is the most common preparation available for admixtures, and likely what Murray had. So 1.6mg of lidocaine is 0.16cc of 1% lidocaine. That is a TINY amount that could possibly be attributed to some kind of diffusion, like the propofol.