According to Huffingtonpost:
The New York City Medical Examiner has finally revealed that lack of oxygen to Joan Rivers' brain caused her death
over a month ago.
According to the medical examiner's report, her death was officially caused by
"anoxic encephalopathy due to hypoxic arrest during laryngoscopy and upper gastrointestinal endoscopy with propofol sedation for evaluation of voice changes and gastroesophageal reflux disease."
I had wondered if the endoscopy center was using propofol, I have admitted several anoxic brain injuries from some area endoscopy centers that used propofol. How many more people must die or have significant brain injury before people wise up that NAPS is not safe. I am not an anesthesia provider, nor do I pretend to be, if you need anesthetics in a procedure get an anesthesia provider.
Oct 16, '14
Joan Rivers Gastroenterologist Lawrence B. Cohen, MD was a supporter of nonanesthesiologist-administered propofol for GI endoscopy
"Lawrence B. Cohen, MD, AGAF, performs endoscopy in an office setting in Manhattan and administers propofol himself (endoscopist-administered sedation [EAS]. " ... see his article: The Extra Cost of Monitored Anesthesia Care
There is no evidence that the presence of an anesthesia provider improves the quality of an endoscopic examination. Although some anesthesiologists believe intuitively that the presence of an anesthesia provider improves the safety of endoscopic sedation in average-risk patients when compared with endoscopist-directed sedation, there is no scientific evidence to support that assumption. An evidence-based assessment indicated unequivocally that the rates of sedation-related complications were comparable for endoscopist-directed sedation (both standard opioid/benzodiazepine sedation and endoscopist-directed propofol) and for MAC.6,7
Wondering if he still feels the same way now. It will come out in NY DOH event review who directed and administered Joan's propofol.
Position Statement: Nonanesthesiologist Administration of Propofol
Propofol for endoscopic sedation: a protocol for safe and
The Propofol Controversy - Medscape
Last edit by NRSKarenRN on Oct 17, '14
Nov 11, '14
Entire CMS report is viewable at Feds slam clinic where Joan Rivers went into cardiac arrest - NY Daily News
Page 6 notes anesthesiologist documented ENT performed 2 nasolaryngoscopies pre and post esophagogastroduodenoscopy procedure.
Page 10-13 lists vital signs and anesthesia notes, 2 code records, dose of propofol inconsistently recorded, first dose of Epi and atropine given 9:38A 10 min after 9:28A arrest, anesthesia record updated at 2:36PM ....
Many lessons to learn from this case.
Last edit by NRSKarenRN on Nov 11, '14