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I practice anesthesia. My most significant change so far has been to drastically reduce the amount of ketamine I give. It is a very interesting drug. Very sta
by adasound 3y ago
I practice anesthesia. My most significant change so far has been to drastically reduce the amount of ketamine I give. It is a very interesting drug. Very stable re. cardiovascular concerns. Maintains blood pressure nicely. We use it to induce anesthesia and for pain, but others use it for depression, chronic pain, borderline personality disorder.
It's fine for pediatrics. Adults not so much. We dose ketamine quite a bit higher as an induction agent at the start of operations than what would be considered a recreational or psychotherapeutic dose/"K hole".
In opposition to kids, adult patients have frequently found themselves in a very bad place on emergence from anesthesia and in the recovery room. They sometimes endorse reliving trauma and confronting themselves in a dark region of their minds that they possibly have never known about. This is why it has promise as a therapeutic agent in psychotherapy, however it is often the case that patients are cared for by one recovery room nurse who is run off her feet/has more than one patient. I have learned that "K hole" context is everything.
Kids are just fine with ketamine. I think it's because their brains are much more plastic & the variation of experience in their waking lives is higher than adults. I think that experiencing the moods and expressiveness and novel situations as a 3 year old for a day would be an incredible hallucinogen or psychedelic.
- basch 3y agoI have nothing to base this on, but I suspect kids do better because they lack experience, so there is nothing to resurface. Their lack of memories prevents any sort of introspective reevaluation of their life.
- bbor 3y agoI think this is a little uncharitable to kids. Do you not remember the stressors and ruminating thoughts of childhood? To say nothing of children who have experienced trauma. Perhaps this could apply to pre-object-permanence infants, but by the time they're undergoing surgery (hopefully...) they've had years of conscious experience. Hopefully I'm not being too uncharitable, your idea is certainly plausible. I'm also just musing which feels disrespectful to the terribly interesting expert take in the ancestor comment, but I cringe whenever I hear arguments that I can reduce down to "being a child is not at all like what it is to be me", as it's been used for centuries to suppress their behavior and excuse abuses
- basch 3y agoMaybe it’s more like a volume thing. Ketamine causes a reboot and the core memory table has to reindex.
- svnt 3y agoI wonder if this will continue to be the case as generational effects work their way through, or if it is purely developmental and a universal part of becoming an adult.
- bobowzki 3y agoI'm also an anesthesiologist. Would be interesting to hear what you are working on.
- devilbunny 3y agoThere are four of us! (bookofjoe is an anesthesiologist as well) I've only seen one really bad reaction to ketamine, but it was rather haunting. Still, it's a magnificent drug.
- adasound 3y agoI am but a lowly senior anesthesia resident in Canada. I can't even bill people or governments / buy a lambo yet. Don't make fun of me for saying 'I practice anesthesia' because I do truly only 'practice' it. I studied pain and autonomic dysfunction in grad school. My supervisor: "To test your your own patience and attention span ask somebody about their research" I don't do anything specifically re. bench science or rats / electrophysiology now like I did then. I was bitten by the decentralized network infrastructure / digital identity / blockchain applications bug. Here's my first protocol that I'm legitimately proud of (quietly posting it today in a few places) -- https://violet.adasound.io/ https://violet.adasound.io/ TL;DR- I am working on nothing that people who work in hospitals are generally interested in or seeking to hear a grown man rattle on about for very long :), and what I've made public is still somewhat cryptic and lacks an advertising push..