Following the unexpected death of Joan Rivers, I am once again inundated daily with questions from concerned patients about the safety of anesthesia. Everybody comes in with wide eyed fears while family members produce a list of questions about how likely their loved one will die during a routine outpatient procedure.
This hysteria is similar to the events five years ago when Michael Jackson was found dead in his rented mansion after being sedated by an inattentive cardiologist. At that time patient anxiety was actually far more intense because of Mr. Jackson's notoriety and the widespread news of propofol's involvement.
However, my answer to questions about both Mr. Jackson's and Ms. Rivers's deaths are quite similar--in both cases an anesthesiologist was not present to give the sedation. We know for a fact that MJ was overseen by Dr. Murray in a private bedroom with absolutely no evidence of any anesthesia resuscitation equipment available, not even oxygen. Ms. Rivers's case is still under investigation so we only have gossip and heresay to tell her story. However all evidence point to Dr. Cohen, her gastroenterologist, as the primary procedurist in the room. He has strongly voiced his opinion that the use of propofol by a non-anesthesiologist is just as safe as when an anesthesiologist is giving the sedation. With such a strong advocate of DIY anesthesia as Dr. Cohen, it is unlikely that he let any anesthesiologist sedate his patients, especially for a procedure as "benign" as an EGD.
As you can see, in both tragic cases there was no anesthesiologist in the room when a crucial airway emergency occurred. When patients ask about these sensational events, they must be firmly told that an anesthesiologist would most likely have prevented the untimely deaths of these two celebrities. No amount of PR material from the ASA about physician anesthesiologists (how I hate that term) can compare to a face to face bedside education that an anesthesiologist can give to his patient about the safety of our craft. This is another golden opportunity to inform our patients about the frequently misunderstood practice of anesthesiology. Out of tragedy anesthesiologists can really shine and demonstrate to the public the indispensable skills we possess to safely guide a patient through his most vulnerable period.