What Is Propofol? The "Michael Jackson Drug" in Anesthesia

Updated on November 2, 2018
TahoeDoc profile image

I am a board-certified anesthesiologist in Lake Tahoe, California. I write from the perspective of both a doctor and a patient.

What does Propofol Look Like?

Some of the intravenous medications that may be used during general anesthesia. Propofol is shown in the white syringe. Because of its color and ability to induce unconsciousness, it is has been given the nickname "milk of amnesia."
Some of the intravenous medications that may be used during general anesthesia. Propofol is shown in the white syringe. Because of its color and ability to induce unconsciousness, it is has been given the nickname "milk of amnesia." | Source

What Is Propofol?

Propofol is a sedative/hypnotic drug used every day as a routine part of anesthesia practice. When administered properly by skilled practitioners, it is usually very safe.

Recently, it has become infamous as the "Michael Jackson Drug." In his case, propofol was inappropriately used as a sleep aid—which, in combination with other sedatives, led to his death.

Even now that time has passed since the superstar's death, we anesthesiologists still get asked about the "Michael Jackson Drug" with some frequency.

So what is propofol?

What are the guidelines for the safe use of this medication?

Who should administer it?

And, what role does it play in the administration of anesthesia?

Is Propofol Safe?

Propofol is a milky white fluid used in anesthesia. Its color and effect has led to its nickname, "milk of amnesia."

The levels of anesthesia can be thought of as a continuum from conscious, awake and alert through various stages of sedation to unconsciousness with general anesthesia.

Many of the same agents are employed in increasing amounts to achieve and sustain the desired level of anesthesia. Propofol is a very versatile drug in this regard. It can also be very dangerous and takes a high level of training and skill to titrate correctly and, most importantly, respond to the physiologic changes caused by propofol administration. For this reason, the use of propofol is restricted to medical facilities where appropriate personnel are available, along with sophisticated monitors to record vital signs and emergency rescue medications and equipment to deal with any severe events related to propofol use.

Like all medications capable of inducing profound changes in the body, there are risks and dangers with propofol use. But, in the hands of skilled anesthesia providers, it is quite safe and provides reliable and comfortable anesthesia.

Who Should Be Allowed to Administer Propofol?

This is actually a topic of some debate. Anesthesiologists, obviously, should be able to administer propofol. They are the experts, not only in giving this type of medicine, but also in rescuing patients from any serious, unintended effects. They are highly trained to deliver oxygen, either by mask or breathing tube, or through other emergency techniques in case that is needed.

But, which other physicians should be able to do this? It's a good question. Just as I (as an anesthesiologist) am not trained to perform surgery or optimally manage someone's diabetes over time, some physicians are not adequately trained to give drugs capable of inducing anesthesia or to manage the airway of patients, especially high risk patients, who might need that type of rescue.

Some emergency room doctors (who are trained properly to use it) can use propofol for sedation for brief procedures. Sometimes, propofol is used by GI doctors (gastroenterologists) during endoscopies or colonoscopies. Gastroenterologists are not specialists in airway management or resuscitation, so this may be less safe, although most gastroenterologists disagree. Procedures in other settings have also been done with propofol under less than ideal conditions.

A cardiologist administering propofol in a private home with no monitoring or rescue equipment is NOT a gray zone, however. This cannot be justified.

How is Propofol Used for Anesthesia?

Propofol is a sedative/hypnotic drug. In anesthesia, that means that a main effect of the drug is to change the level of consciousness.

Propofol acts at specific receptors in the brain, changing their activity and affecting brain function. It does this in a dose-dependent fashion, meaning the more medication you give, the more brain function changes. With propofol, it is possible to give a very small amount and you wouldn't even realize it was given. At the other end of the spectrum, a large dose can rapidly induce unconsciousness and even cause a "flat-line EEG," meaning brain activity has stopped.

Because propofol is short-acting, all of these effects rapidly terminate as the drug is metabolized in the body. The effects of lower doses go away the most quickly, but even after a bigger dose in the operating room, most people will be awake from propofol in about half an hour.

As a sedative: Propofol can be used during procedures where sedation is the intended effect. It can be given as small, divided doses or as a continuous infusion at a low dose during the procedure.

During general anesthesia: Propofol is the most commonly used drug for the initiation, or induction, of anesthesia. In this regard, it is given through an intravenous line. The dose is determined by weight and then adjusted for other factors like age and health status. It can sting or burn as it is injected, but you will be asleep in about 30 seconds, so it doesn't last long.

Expected Effects of Propofol: What It Does and Doesn't Do

In addition to the sedative or anesthetic effects of propofol, there are other consequences of propofol use that are not necessarily the desired effect, but can be expected.

  • Blood pressure: Propofol causes dilation of blood vessels, which leads to decreased blood pressure.
  • Heart rate: Heart rate usually goes down with propofol administration, but could potentially also be increased in certain circumstances.
  • Breathing: Propofol slows and can stop breathing. The amount of air inhaled with each breath is decreased, as is the rate of breathing. This can, and often does lead to decreased oxygen levels.
  • Myoclonus: Propofol can cause a temporary stiffening or involuntary movement of body parts as the patient is going to sleep. This is not terribly common or consequential.
  • Anti-emetic: Propofol can help to prevent or treat nausea and vomiting. This is a big advantage over other anesthetics that cause nausea and vomiting.
  • Other: Propofol may cause vivid or unusual dreams, usually of a pleasant variety (seems to me a lot of patients dream about food- maybe because they weren't allowed to eat before surgery, not scientific, just my observation).

Propofol does not, however, have any pain-preventing or pain-relieving properties.

Blood Pressure
can become dangerously low in patients with risk factors (trauma, taking blood pressure medicines, poor overall health, etc)
Heart Rate
usually decreases
May go up in bleeding or dehydrated patient as a response to low blood pressure
decreases or stops
Oxygen and practioners, such as anesthesiologists, skilled in 'airway management' must be present
Pain Relief
Use in combination with pain medicines if not under general anesthesia

Risks of Propofol

The risks are essentially related to the changes in vital signs highlighted above. There are other potential risks with propofol use, but they are beyond the scope of this article and are either rare or aren't life threatening in most cases, unless a true allergy is present.

But, as you can tell from reading about the effects of propofol on the breathing, heart rate, and blood pressure, propofol should NEVER be used in a situation like it was for Michael Jackson. Not only were his vital signs not monitored, he was not being cared for by a physician who is skilled at placing breathing tubes or supporting respiration until the propofol wears off. And, even if he was, it seems there was no emergency equipment or medications nearby.

To use propofol in the manner that it was for the singer was extremely dangerous—and, in my opinion, either stupid or arrogant.

Quick Quiz- Propofol Basics

view quiz statistics

This content is for informational purposes only and does not substitute for formal and individualized diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed medical professional. Do not stop or alter your current course of treatment. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.


    0 of 8192 characters used
    Post Comment
    • profile image

      Arthur Robey 

      12 months ago

      My anesthesiologist (also a lady) gave me propofol. It never stung. I woke feeling preturnaturly blissful.

      Another time I was given a valium and sent to bed when all my muscles siezed up painfully. Again I woke to preternatural bliss.

      I threw away the second tablet. Way too dangerous.

    • profile image


      2 years ago

      Had propothal for endoscopy yesterday. Bladder was frozen for 6 hrs and had to self cath.

      Now doc is recommending Gastro Emptying Test. Egg with radiation. What effects will this have on the body...also have IC and have gone on anti biot after bladder freeze feeling infection coming on.

    • TahoeDoc profile imageAUTHOR


      7 years ago from Lake Tahoe, California

      Hi Superanxious. There are many ways that a MAC/sedation anesthesia can be done. Propofol is often, but not always, part of the combination.

      The specific drugs to be used wouldn't be decided until that day. The anesthesiologist will choose them based on your needs- health history, allergies, length of procedure, pre-surgery status (in pain=more pain meds used, anxious=more anti-anxiety agents used, unable to hold still= more propofol). Those are examples only and each anesthesiologist will have their own reasons for choosing specific medications. Let them know what you fears are so they can best help you get through this.

      Good luck!!

    • profile image


      7 years ago

      Is propofol what is used in MAC anesthesia?

    • Mmargie1966 profile image


      7 years ago from Gainesville, GA

      I have felt that burn and remember it well. The last surgery I had, I told the anesthesiologist this fact. I believe I was given something local so I wouldn't feel it again.

      This was very interesting, Doc. Thanks for sharing!

      I voted up and interesting.

    • Pamela99 profile image

      Pamela Oglesby 

      7 years ago from Sunny Florida

      If you are having a procedure done this is a wonderful drug as you wake up in a very short time totally refreshed. I was given this drug for an endoscope but a anesthesiologist it in my case. I also had a bronchoscopy where they used Versed and some other drug and I never was completely put to sleep. That was a miserable test. I think an anesthesiologist should probably be the only doctors administering this drug from all the information you have provided. Interesting and useful hub.

    • Nettlemere profile image


      7 years ago from Burnley, Lancashire, UK

      Very informative and great to hear the information from an actual anaesthetist rather than a journalist's take on the drug, which is what I've had from the newspaper coverage of MJ's death.

    • TahoeDoc profile imageAUTHOR


      7 years ago from Lake Tahoe, California

      Propofol, especially as a sedative, really provides a comfortable "sleep" and a smooth, usually happy wake-up. I think it's an amazing medication when used properly and it makes my job a lot better to have it in my arsenal of drugs.

      Thank you for taking the time to read and comment.

    • mperrottet profile image

      Margaret Perrottet 

      7 years ago from San Antonio, FL

      I've had propofol twice when I've had colonoscopies, and felt great when I woke up both times. That's the good part of the drug. Voted up and interesting!


    This website uses cookies

    As a user in the EEA, your approval is needed on a few things. To provide a better website experience, healthproadvice.com uses cookies (and other similar technologies) and may collect, process, and share personal data. Please choose which areas of our service you consent to our doing so.

    For more information on managing or withdrawing consents and how we handle data, visit our Privacy Policy at: https://maven.io/company/pages/privacy

    Show Details
    HubPages Device IDThis is used to identify particular browsers or devices when the access the service, and is used for security reasons.
    LoginThis is necessary to sign in to the HubPages Service.
    Google RecaptchaThis is used to prevent bots and spam. (Privacy Policy)
    AkismetThis is used to detect comment spam. (Privacy Policy)
    HubPages Google AnalyticsThis is used to provide data on traffic to our website, all personally identifyable data is anonymized. (Privacy Policy)
    HubPages Traffic PixelThis is used to collect data on traffic to articles and other pages on our site. Unless you are signed in to a HubPages account, all personally identifiable information is anonymized.
    Amazon Web ServicesThis is a cloud services platform that we used to host our service. (Privacy Policy)
    CloudflareThis is a cloud CDN service that we use to efficiently deliver files required for our service to operate such as javascript, cascading style sheets, images, and videos. (Privacy Policy)
    Google Hosted LibrariesJavascript software libraries such as jQuery are loaded at endpoints on the googleapis.com or gstatic.com domains, for performance and efficiency reasons. (Privacy Policy)
    Google Custom SearchThis is feature allows you to search the site. (Privacy Policy)
    Google MapsSome articles have Google Maps embedded in them. (Privacy Policy)
    Google ChartsThis is used to display charts and graphs on articles and the author center. (Privacy Policy)
    Google AdSense Host APIThis service allows you to sign up for or associate a Google AdSense account with HubPages, so that you can earn money from ads on your articles. No data is shared unless you engage with this feature. (Privacy Policy)
    Google YouTubeSome articles have YouTube videos embedded in them. (Privacy Policy)
    VimeoSome articles have Vimeo videos embedded in them. (Privacy Policy)
    PaypalThis is used for a registered author who enrolls in the HubPages Earnings program and requests to be paid via PayPal. No data is shared with Paypal unless you engage with this feature. (Privacy Policy)
    Facebook LoginYou can use this to streamline signing up for, or signing in to your Hubpages account. No data is shared with Facebook unless you engage with this feature. (Privacy Policy)
    MavenThis supports the Maven widget and search functionality. (Privacy Policy)
    Google AdSenseThis is an ad network. (Privacy Policy)
    Google DoubleClickGoogle provides ad serving technology and runs an ad network. (Privacy Policy)
    Index ExchangeThis is an ad network. (Privacy Policy)
    SovrnThis is an ad network. (Privacy Policy)
    Facebook AdsThis is an ad network. (Privacy Policy)
    Amazon Unified Ad MarketplaceThis is an ad network. (Privacy Policy)
    AppNexusThis is an ad network. (Privacy Policy)
    OpenxThis is an ad network. (Privacy Policy)
    Rubicon ProjectThis is an ad network. (Privacy Policy)
    TripleLiftThis is an ad network. (Privacy Policy)
    Say MediaWe partner with Say Media to deliver ad campaigns on our sites. (Privacy Policy)
    Remarketing PixelsWe may use remarketing pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to advertise the HubPages Service to people that have visited our sites.
    Conversion Tracking PixelsWe may use conversion tracking pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to identify when an advertisement has successfully resulted in the desired action, such as signing up for the HubPages Service or publishing an article on the HubPages Service.
    Author Google AnalyticsThis is used to provide traffic data and reports to the authors of articles on the HubPages Service. (Privacy Policy)
    ComscoreComScore is a media measurement and analytics company providing marketing data and analytics to enterprises, media and advertising agencies, and publishers. Non-consent will result in ComScore only processing obfuscated personal data. (Privacy Policy)
    Amazon Tracking PixelSome articles display amazon products as part of the Amazon Affiliate program, this pixel provides traffic statistics for those products (Privacy Policy)
    ClickscoThis is a data management platform studying reader behavior (Privacy Policy)