There is no propofol antidote, so the only response when the sedative stops a patient breathing is immediate breathing support, an anaesthetist said, as authorities examine drugs found in singer Giorgos Mazonakis’ blood.
Investigators are looking at three substances found in the singer’s blood: midazolam, flumazenil and propofol. Experts are examining the order, the doses and the conditions in which Dr Ioanna Gaka, 56, one of two doctors accused in the case, gave them.
Gaka and her husband, Dr Ilias Theodoropoulos, 58, ran the practice on Karneadou Street, in central Athens, where Mazonakis died. Both are in pre-trial detention and deny wrongdoing.
Anaesthetist Dimitris Manikis spoke about the drugs in a television interview. He said that midazolam and propofol can both cause apnoea, which means breathing stops, as their main side effect.
No propofol antidote
While midazolam has an antidote, there is no propofol antidote, Manikis said. As a result, he said, the only option in a case of apnoea is to support the patient’s breathing at once with specialist equipment.
Manikis said that when he sees the risk of breathing stopping, he does “two things”. He gives the antidote, when one exists, and replaces the patient’s breathing.
Without a propofol antidote, he said, that second step depends on the skills of an anaesthetist. “I give you air with positive pressure from outside,” he said.
He also said there is no propofol antidote for a drug whose effect lasts five to 10 minutes.
Combined sedatives
When midazolam and propofol are combined, the effect becomes much stronger, Manikis said. “It doesn’t just add up, it multiplies,” he said.
In that case, he said, apnoea is a given. According to Manikis, giving such drugs outside a hospital, or without an anaesthetist present, is extremely dangerous.
Propofol is an intravenous anaesthetic used for sedation and to start general anaesthesia, according to the US National Library of Medicine’s StatPearls reference.
Greek City Times reported on 5 October that toxicology tests had found propofol in the singer’s system. Later, on 9 October, authorities froze the assets of doctors held over his death.
The couple face charges of homicide with possible intent by omission. No court has ruled on the case, and the investigation is continuing.
Source: Ta Nea
