Questions about Demerol 關於MJ歌詞中所出現過的Demerol得相關問題 MJJC: Was the amount of Demerol Dr. Klein give to Michael normal or was it too large a dose? Dr. Steve Shafer: I can’t answer without knowing why Demerol was given. Dr. Klein did not testify at the trial. I’m uncomfortable offering any opinion without more information. MJJC: Does your answer change if you consider MJ’s history (burn victim) with the drug? Do you think it was excessive? Dr. Steve Shafer: Again, I apologize, but I don’t want to render an opinion without knowing why Dr. Klein was administering Demerol. This probably reflects my caution as an Editor-in-Chief of a medical journal. Medical editors are reluctant to render a public opinion unless they are confident they understand the facts. MJJC: In your opinion, does Demerol aggravate insomnia as a side effect? Did it play any part in Michael's physical and mental health? What was the best treatment for Michael's insomnia? Dr. Steve Shafer: There are three questions here. I’ll answer them in order: Demerol’s chemical name in the United States is “meperidine.” In many countries it is known as “pethidine.” Meperidine has a metabolite, “ normeperidine”, that is a nervous system stimulant. As a nervous stimulant, I would expect it to exacerbate insomnia. The coroner examined both blood and urine for meperidine (Demerol) and normeperidine. Neither could be detected. Thus, meperidine did not play a direct role in Michael Jackson’s death on June 25th. However, you asked a more general question about “play any part in Michael’s physical and mental health.” It is a good question, and I will again need to apologize for not answering it. I have not read Dr. Klein’s medical records or heard a detailed explanation of Michael Jackson’s care. I am uncomfortable speculating without that information. Sleep disorders are complex, and treating them is a specialized branch of medicine. It is my understanding that any drug that affects the level of consciousness can exacerbate sleep disorders. There is a nice description of sleep disorders, and the treatment of common sleep disorders, at http://www.sleepfoundation.org/artic...s-and-insomnia. Questions about lorazepam, flumazenil, and ephedrine 關於以上這些藥物的相關問題 MJJC: Could the free lorazepam detected in the gastric liquid be explained by the stomach hemorrhage caused by CPR or even by accidental mixing of adjacent blood at the time of autopsy (as it was suggested by the Coroner, Dr. Rogers in the preliminary, though not mentioned again during the trial)? Dr. Steve Shafer: Maybe. However, free lorazepam would be expected simply because molecules like lorazepam would be expected to cross from the blood into the stomach, just like they cross into all tissues. That is how the lidocaine and propofol got into the stomach. Lorazepam should behave just the same way. Additionally, the enzyme beta glucuronidase is secreted by the wall of the stomach into the stomach fluid. Beta glucuronidase is the enzyme that would turn lorazepam glucuronide back into lorazepam. So blood could account for it, but most of it is likely the simple diffusion of lorazepam from the blood into the stomach. MJJC: Is there any other reason for Flumazenil to be administered apart from reversing the effects of benzodiazepines (in this case Lorazepam)? Dr. Steve Shafer: No. MJJC: Does it even make sense to give a person Flumazenil who according to Dr. Murray only received 4 mg of Lorazepam to begin with? Dr. Steve Shafer: The most critical part of any resuscitation is to move air in and out of the patient’s lungs. The problem with giving flumazenil is that it distracted Conrad Murray from the critical task of moving air in and out of Michael Jackson’s lungs. If there were several people were involved in the resuscitation, then giving flumazenil would have made sense. However, since Conrad Murray was alone, any interruption longer than a few seconds was too long. MJJC: Can you explain your consideration of the Lorazepam levels, in more detail? Dr. Steve Shafer: I’ll answer as well as I can, but I’m not sure exactly what you want to know. The lorazepam levels were high enough that you or I would have been very sleepy from them. However, patents become tolerant to lorazepam and related drugs (the “benzodiazepines”). Since Michael Jackson had a fairly high concentration, and according to Conrad Murray that was not enough drug to induce sleep, he must have been tolerant. The defense wanted to attribute Michael Jackson’s death, in part, to oral lorazepam. The problem with this theory is that there was only a minute amount of lorazepam in Michael Jackson’s stomach. To explain this minute amount, the defense alleged that Michael Jackson swallowed lorazepam about 5 hours before the time of death. If that were true, then the lorazepam concentration would have peaked about the time Conrad Murray claims Michael Jackson was pleading for more drug to fall asleep. So that argument doesn’t make sense. MJJC: According to autopsy report there was ephedrine found in Michael's body. It's a drug that aggravates insomnia. How ephedrine goes with benzos and propofol, could it subdue effect of these drugs? Dr. Steve Shafer: There was a bottle of capsules composed of ephedrine, caffeine, and aspirin in the room. Ephedrine is sometimes used in resuscitation. Since there was ephedrine in Michael Jackson’s autopsy urine, as well as the urine that was found at the scene, I would assume that the ephedrine was from oral ingestion, and not from administration as part of the resuscitation. Ephedrine can reduce the effects of propofol and benzodiazepines on blood pressure and heart rate. Chronic ephedrine might aggravate insomnia. -- In a world filled with hate, we must still dare to hope. In a world filled with anger, we must still dare to comfort. In a world filled with despair, we must still dare to dream. In a world filled with distrust, we must still dare to believe. ~~~~By Michael Jackson --

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