Pofol: A dangerous kind of rest

The death of Michael Jackson made its expected transition from a celebration of his life and music to an uncomfortable public autopsy of how he died. More than a month after his death, the official coroner's autopsy had yet to be officially released, but various media outlets sniffed out one particular drug that appears in the pop star's toxicology report: the general anesthetic pofol.
Avery Tung, associate professor of anesthesia and critical care for the Medical Center, conducted an NIH-funded research project examining relationships between sleep and anesthesia, and published several papers and scientific abstracts looking at how pofol mimicked the effects of actual sleep. After Tung sat down with ABC News following Jackson's death, we spent a little more time with him discussing the anesthetic and his research.

First of all, what is pofol, and how often is it used?
Pofol is given intravenously to induce anesthesia in surgical patients and to provide sedation for patients in the Intensive Care Unit. It's the most common induction agent of anesthesia in current use. It pretty much has replaced pentothal because it has fewer side effects and it makes people feel better when they wake up.

What side effects does pofol have?
It can cause a decrease in blood pressure, it can depress or even stop breathing, and it can cause pain on injection. And because of those side effects, its use is restricted? The package insert with the drug states that it should only be used by persons trained in the administration of general anesthesia, which in this hospital means an anesthesiologist. In the ICU, it is restricted only for use in intubated, mechanically ventilated patients.

Why restrict it to use under an anesthesiologist's guidance?
Pofol can be deceptively easy to use. Because people recover so quickly, there's a temptation to use it in places which aren't safe. But it's stronger than other drugs, and can clearly destabilize blood pressure and breathing, Users can easily slip over the line from sedation to general anesthesia, develop blood pressure or breathing difficulties, and need specialized resuscitation measures.

Why is it used in non-surgical cases in the intensive care unit?
For a number of reasons. Mechanically ventilated patients can be uncomfortable, or experience pain and anxiety. They might also be a danger to themselves and others due to agitation, or need help to tolerate the ventilator. Not everybody in the ICU needs sedation, and some need to be sedated fairly deeply so that they are only partially responsive to stimulation.

You chose to study the effects of pofol on sleep deprivation. Is sleep deprivation an issue in the ICU?
Sleep deprivation is a huge issue in the ICU, and has been documented since the 1980's. Because of potential pain and anxiety, because the lights are always on, because there is noise always present and nurses are checking on patients on an hourly basis, there is really no quiet time. The circadian rhythms and light cycles that people are normally exposed to aren't as present in an ICU setting either. No one knows whether sleep deprivation adversely affects outcomes in the ICU because there's no way to set up a control for sleep, but many of the effects of sleep deprivation can clearly make care in the ICU more difficult.