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episode 42: Episode 42 - Part 1 - Special Guest Dr. Gary Andolfatto - A Chat About Ketamine [transcript]


Our first ever Guest Speaker! Dr. Gary Aldolfatto, a well-known Ketamine researcher, talks to us about everything we ever wanted to know about Ketamine. In fact, we chatted so much we split to split it into two podcasts! Part One discusses dosing, myths, pain control and procedural sedation. Part Two discusses intubation, behavioural control, physiologic effects and other trendy bits. Don't miss both episodes!

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 2018-07-01  33m
 
 
00:00  Speaker 1
Hey
00:01
Landon
00:01
here,
00:02
episode
00:02
42.
00:03
God
00:03
a
00:03
little
00:04
long,
00:04
but
00:04
it's
00:04
fantastic.
00:05
So
00:05
we
00:05
split
00:06
it
00:06
into
00:06
two
00:06
parts.
00:08
Part
00:08
one
00:09
is
00:09
going
00:10
to
00:10
be
00:10
about
00:10
Ketamine
00:10
dosing,
00:11
procedural
00:12
sedation
00:12
and
00:12
pain
00:13
control,
00:13
and
00:13
in
00:14
part
00:14
two
00:14
we're
00:14
going
00:14
to
00:14
talk
00:15
about
00:15
intubation,
00:16
behavioral
00:16
control,
00:17
the
00:17
effects
00:17
on
00:18
physiology
00:18
and
00:19
some
00:19
of
00:19
the
00:19
trend
00:19
to
00:19
use
00:20
this
00:20
for
00:20
it.
00:21
So
00:21
make
00:21
sure
00:21
you
00:21
listen
00:22
to
00:22
both
00:22
and
00:22
we
00:22
know
00:22
you'll
00:23
enjoy
00:23
our
00:23
first
00:23
guest
00:24
speaker
00:24
ever
00:24
on
00:25
the
00:25
podcast.
00:33  Speaker 2
Hi,
00:34
it's
00:34
landon.
00:34
Hey,
00:35
it's
00:35
money
00:36
and
00:36
we're
00:36
kind
00:36
of
00:37
excited
00:37
today.
00:38
We're
00:38
not
00:38
in
00:38
my
00:39
kitchen
00:39
of
00:39
knowledge,
00:40
different
00:41
kitchen
00:41
of
00:41
knowledge.
00:41
We
00:41
are
00:42
definitely
00:43
and
00:43
we
00:43
have
00:43
our
00:43
very,
00:43
very,
00:44
very
00:44
first
00:45
yes
00:45
speaker.
00:46
Yup.
00:47
Say
00:47
Hi.
00:47
Hello.
00:49
Oh,
00:50
uh.
00:50
So
00:50
we're
00:50
honored
00:51
today
00:51
to
00:51
have
00:54
Dr
00:54
Gary
00:54
Dull
00:54
Fado
00:54
on
00:54
our
00:55
podcast
00:55
as
00:55
our
00:55
first
00:56
ever
00:56
guest.
00:57
Gary,
00:57
why
00:57
don't
00:57
you
00:57
tell
00:58
us
00:58
a
00:58
little
00:58
bit
00:58
and
00:58
we're
00:59
gonna
00:59
talk
00:59
about
00:59
Ketamine
00:59
today
01:00
and
01:00
tell
01:00
us
01:00
why
01:01
you
01:01
are
01:01
interested
01:01
in
01:02
ketamine
01:02
and
01:03
kind
01:03
of
01:03
what
01:03
your
01:04
deal
01:04
is
01:04
with
01:04
ketamine.
01:05
Awesome.
01:06
We'd
01:06
be
01:06
happy
01:06
to.
01:06
First
01:07
of
01:07
all,
01:07
thanks
01:07
very
01:07
much.
01:09
Always
01:09
fun
01:09
to
01:09
see
01:10
you
01:10
guys.
01:10
Oh,
01:11
thank
01:11
you.
01:11
Can,
01:11
I
01:12
mean,
01:12
is
01:13
far
01:13
and
01:13
away
01:13
my
01:13
most
01:14
favorite
01:14
drug,
01:16
Doug,
01:16
of
01:16
choice.
01:16
Not
01:17
just
01:17
recreationally,
01:19  Speaker 3
but
01:19
uh,
01:19
no,
01:20
we
01:20
use
01:20
ketamine
01:21
on
01:21
a
01:21
daily
01:21
basis.
01:22
I
01:22
don't
01:23
think
01:23
there's
01:23
been
01:23
a
01:23
day
01:24
that's
01:24
gone
01:24
by
01:24
in
01:25
the
01:25
past
01:25
15
01:25
years
01:26
where
01:26
I
01:26
hadn't
01:26
just
01:26
kidding
01:27
me.
01:28
So
01:28
we
01:28
use
01:28
it
01:28
for
01:29
all
01:29
sorts
01:29
of
01:29
things
01:29
from
01:30
Analgesia,
01:31
sedation,
01:32
agitation,
01:32
control,
01:33
you
01:33
name
01:33
it.
01:34
Um,
01:35
I
01:35
got
01:35
an
01:35
interest
01:35
in
01:35
using
01:36
ketamine
01:36
really
01:37
because
01:37
I
01:38
became
01:38
an
01:38
accidental
01:39
researcher
01:40
about
01:40
15
01:41
years
01:41
ago
01:43
where,
01:43
um,
01:43
we
01:44
were
01:44
looking
01:44
for
01:44
different
01:44
ways
01:44
of
01:44
sedating
01:45
people
01:45
and
01:46
we,
01:47
um,
01:47
we
01:47
thought
01:48
it
01:48
might
01:48
be
01:48
a
01:48
good
01:48
idea
01:48
to
01:49
start
01:49
mixing
01:50
ketamine
01:50
and
01:51
fall
01:51
together
01:52
and
01:52
started
01:53
playing
01:53
around
01:53
with
01:53
that
01:54
and
01:54
found
01:54
it
01:54
worked
01:54
really
01:54
well.
01:55
And
01:55
then
01:55
when
01:55
I
01:55
went
01:56
to
01:56
look
01:56
at
01:57
what
01:57
literature
01:58
there
01:58
was
01:58
on
01:58
that
01:59
subject,
01:59
I
01:59
realized
02:00
there
02:00
was
02:00
none.
02:01
And
02:01
so
02:02
that's
02:02
how
02:03
I
02:03
first
02:04
became
02:05
a
02:05
researcher
02:05
with
02:06
Ketamine,
02:06
was
02:07
actually
02:07
in
02:07
the
02:07
sedation
02:08
field
02:08
where
02:09
we
02:09
were
02:09
mixing
02:09
ketamine
02:10
and
02:10
profile
02:10
together
02:10
for
02:11
fall.
02:11
After
02:12
that,
02:13
realized
02:14
that
02:14
ketamine
02:14
is
02:14
just
02:15
a
02:15
really,
02:15
really
02:16
interested
02:16
in
02:16
dragging.
02:16
I
02:16
became
02:17
more
02:17
fascinated
02:18
with
02:18
different
02:18
ways
02:18
of
02:18
using
02:18
it
02:19
and
02:20
we
02:20
eventually
02:21
came
02:22
to
02:22
the
02:22
point
02:22
where
02:23
I
02:23
kind
02:23
of
02:23
thought
02:23
that
02:24
we're
02:24
doing
02:24
sedation
02:24
pretty
02:25
well
02:26
and
02:26
there
02:26
was,
02:26
there
02:27
was
02:27
less
02:27
to
02:27
gain
02:27
and
02:27
the
02:28
sedation
02:28
field
02:28
and
02:29
Analgesia
02:30
was
02:30
something
02:30
we
02:31
did
02:31
really,
02:31
really
02:31
poorly,
02:32
so
02:33
I
02:33
thought
02:33
there
02:33
was
02:33
more
02:33
to
02:34
gain
02:34
by
02:34
focusing
02:35
on
02:35
analgesia
02:36
and
02:36
so
02:36
with
02:36
my
02:37
experience
02:37
with
02:38
ketamine
02:38
and
02:39
the
02:40
poor
02:40
experience
02:41
we
02:41
were
02:41
having
02:41
with
02:41
Analgesia,
02:42
I
02:42
thought
02:43
the
02:43
two
02:43
went
02:43
well
02:44
together,
02:44
which
02:45
has
02:45
really
02:45
been
02:45
the
02:45
case.
02:46
So
02:46
that's
02:46
where
02:46
I
02:46
become
02:47
really
02:47
a
02:48
ketamine
02:49
researcher,
02:49
more
02:50
than
02:50
eight
02:50
Kenneth
02:50
Fall
02:50
researcher
02:51
these
02:51
days.
02:52
Excellent.
02:53  Speaker 2
Like
02:53
the
02:53
Ketamine
02:54
goober.
02:55
Yeah.
02:56
In
02:56
our
02:56
minds
02:57
I
02:57
was
02:58
once
02:58
coined
02:58
as
02:58
the,
03:01  Speaker 4
you
03:01
are
03:01
Italian,
03:02
so
03:02
I
03:03
got
03:03
all
03:03
this
03:03
shit
03:03
be
03:04
the
03:04
appropriate
03:05
thing,
03:05
but
03:05
I
03:05
think
03:05
if
03:06
anybody
03:06
has
03:06
read
03:06
anything
03:07
on
03:07
ketamine
03:08
research,
03:08
you
03:08
will
03:09
have
03:09
seen
03:10
Dr
03:10
Gary
03:10
Autos
03:10
name
03:11
and
03:11
a
03:11
lot
03:11
of
03:11
those
03:12
research
03:12
papers
03:12
and
03:13
we'll
03:13
probably
03:13
put
03:14
a
03:14
lot
03:14
of
03:14
that
03:14
on
03:15
our
03:15
website
03:15
so
03:16
that
03:16
you
03:16
can
03:16
look
03:16
at
03:16
those
03:17
links.
03:18
Totally.
03:18
Um,
03:18
I
03:18
think
03:19
we
03:19
probably
03:19
have
03:19
some
03:19
questions
03:20
and
03:20
you
03:21
probably
03:21
have
03:21
a
03:21
way
03:22
of
03:22
getting
03:22
to
03:23
all
03:23
the
03:24
points
03:25
that
03:25
you
03:25
want
03:25
to
03:25
make
03:25
about
03:26
ketamine.
03:27
And
03:27
so
03:27
maybe
03:28
we
03:28
should
03:28
start
03:29
with
03:29
you
03:29
talking
03:29
about
03:31
doses.
03:31
I
03:31
think
03:31
that
03:32
that's
03:32
probably
03:32
the
03:32
easiest
03:33
because
03:33
I
03:33
know
03:33
that
03:34
right
03:34  Speaker 2
where
03:34
this
03:34
all
03:35
came
03:35
from
03:35
was
03:35
we,
03:35
we
03:36
came
03:36
to
03:36
your
03:36
presentation
03:37
that
03:37
Canadian
03:40
Association
03:40
of
03:40
Emergency
03:40
Physicians
03:40
Conference
03:40
and
03:41
you
03:41
just
03:41
had
03:41
a
03:41
way
03:42
of
03:42
making
03:43
the
03:43
ketamine
03:43
dosing
03:44
a
03:45
reality
03:45
for
03:46
me
03:46
that
03:47
a
03:47
light
03:47
bulb
03:47
came
03:48
on
03:48
and
03:48
that's
03:48
when
03:49
I
03:49
turned
03:49
to
03:49
many
03:50
and
03:50
said
03:51
he
03:51
has
03:51
to
03:51
be
03:51
on
03:51
our
03:51
podcast.
03:52
And
03:52
so
03:53
why
03:53
don't
03:53
you
03:53
tell
03:53
us
03:54
about
03:54
Ketamine
03:55
dosing
03:56
and
03:57
the
03:57
ranges
03:57
and
03:58
in
03:58
the
03:58
way
03:58
that
03:59
you
03:59
do
03:59
so
03:59
that,
04:00
uh,
04:00
because
04:00
it
04:00
was
04:01
really
04:01
clear
04:01
for
04:01
me.
04:01
Yeah.
04:02  Speaker 3
Yeah,
04:03
that's
04:03
a
04:03
great
04:03
way
04:03
to
04:03
start
04:04
because,
04:05
because
04:05
with
04:05
ketamine
04:06
it's
04:06
all
04:06
about
04:06
the
04:07
dose
04:08
and
04:08
kill
04:08
me.
04:08
And
04:08
it's
04:08
really
04:09
particular
04:09
that
04:09
way
04:10
that
04:11
it
04:11
behaves
04:11
differently
04:12
depending
04:13
on
04:13
the
04:13
dose
04:13
you'd
04:13
pick.
04:14
And
04:14
that's
04:14
really
04:14
the
04:14
special
04:15
thing
04:15
about
04:15
ketamine.
04:16
And
04:17
so
04:17
what
04:18
I
04:18
always
04:18
tell
04:19
people
04:19
is
04:19
that
04:19
when
04:19
you're
04:20
going
04:20
to
04:20
use
04:20
ketamine,
04:21
what
04:21
you
04:21
need
04:21
to
04:21
have
04:22
in
04:22
your
04:22
mind
04:22
is
04:22
a
04:22
clear
04:23
idea
04:23
of
04:23
what
04:23
you're
04:23
trying
04:24
to
04:24
achieve
04:25
because
04:26
what
04:26
you're
04:26
trying
04:27
to
04:27
achieve
04:27
determines
04:28
the
04:28
dose
04:28
that
04:29
you're
04:29
going
04:29
to
04:29
pick.
04:30
Knowing
04:30
the
04:30
dosing
04:31
ranges,
04:31
this
04:31
is
04:31
the
04:32
easy
04:32
part.
04:33
The
04:33
difficult
04:33
part
04:33
is
04:33
for
04:34
people
04:34
to
04:34
be
04:34
organized
04:35
about
04:35
their
04:35
intent.
04:36
So
04:37
for
04:37
instance,
04:37
if
04:38
I
04:38
walk
04:38
up
04:38
to
04:38
a
04:38
patient
04:39
and
04:39
I
04:39
want
04:40
to,
04:41
I
04:41
just
04:41
wanted
04:41
to
04:41
provide
04:42
some
04:42
analgesia
04:43
than
04:43
I
04:43
know
04:44
I'm
04:44
going
04:44
to
04:44
pick
04:44
a
04:45
certain
04:45
dose
04:46
of
04:46
ketamine,
04:46
which
04:46
you
04:46
will
04:47
to
04:47
be
04:47
the
04:47
low
04:47
dose.
04:48
Whereas
04:48
if
04:48
I
04:48
walk
04:49
up
04:49
to
04:49
a
04:49
person
04:49
and
04:49
say,
04:50
I
04:50
want
04:50
this
04:50
person
04:51
completely
04:51
unconscious
04:52
so
04:52
I
04:52
can
04:52
reduce
04:53
their
04:53
fracture,
04:54
I
04:54
know
04:54
that
04:54
I'm
04:54
going
04:55
to
04:55
pick
04:55
a
04:55
high
04:55
dose
04:55
of
04:55
ketamine.
04:57
And
04:57
so.
04:58
So
04:58
those
04:58
things
04:58
is
04:58
a
04:58
great
04:58
structure
04:59
to
04:59
start
04:59
on.
05:00
So
05:01
I
05:01
guess
05:01
starting
05:01
from
05:02
the
05:02
bottom
05:02
up,
05:03
ketamine
05:03
isn't
05:03
analgesic
05:04
that
05:04
has
05:04
been
05:05
well
05:05
established
05:06
and
05:07
it's
05:07
analgesic
05:07
in
05:07
a
05:07
very,
05:08
very
05:08
low
05:08
doses.
05:09
When
05:09
you
05:09
look
05:09
at
05:10
human
05:10
studies
05:10
doses
05:11
as
05:11
low
05:12
as
05:12
zero
05:12
point
05:13
one
05:14
milligrams
05:14
per
05:15
kilogram.
05:16
There
05:16
are
05:16
human
05:16
studies
05:16
on
05:17
that
05:17
dose
05:18
and
05:18
no
05:18
question
05:19
that
05:19
it
05:19
does
05:19
provide
05:19
analgesia.
05:21
When
05:21
you
05:21
see
05:21
people
05:22
using
05:22
it
05:22
in
05:22
the
05:23
Ed
05:23
to
05:24
the
05:24
usual
05:24
analgesia
05:25
range
05:25
is
05:25
anywhere
05:26
from
05:26
zero
05:27
point
05:27
one
05:28
to
05:29
zero
05:29
point
05:29
five
05:30
milligrams
05:31
per
05:31
kilogram.
05:32
When
05:32
you
05:32
get
05:32
above
05:33
zero
05:33
point
05:33
five,
05:34
that's
05:34
when
05:34
people
05:34
start
05:35
to
05:35
become
05:35
disconnected
05:36
from
05:37
reality
05:38
and
05:38
that's
05:38
where
05:39
Kevin
05:39
even
05:39
gets
05:39
its
05:39
name
05:40
as
05:40
a.
05:40
it's
05:40
called
05:40
a
05:41
dissociative
05:41
anesthetic.
05:42
Basically
05:43
you're
05:43
disconnecting
05:44
the
05:44
brain
05:45
from
05:46
people's
05:46
external
05:47
reality
05:48
and
05:49
when
05:49
you
05:49
get
05:50
up
05:51
to
05:51
half
05:51
a
05:51
milligram
05:51
per
05:51
kilogram,
05:52
that's
05:52
when
05:52
that
05:52
disconnection
05:53
really
05:54
starts
05:54
to
05:54
manifest
05:55
itself.
05:55
So
05:56
low
05:56
dose
05:57
under
05:57
point
05:57
five,
05:58
then
05:59
high
05:59
dose
06:00
is
06:00
considered
06:01
above
06:01
one
06:02
point
06:02
zero,
06:03
so
06:04
that's
06:04
when
06:04
people
06:04
start
06:05
to
06:05
become
06:05
fully
06:06
disconnected.
06:07
And
06:07
so
06:07
when
06:08
you're
06:08
using
06:08
ketamine
06:08
as
06:09
a
06:09
general
06:10
anesthetic
06:10
and
06:10
it
06:10
is
06:10
a
06:10
general
06:11
anesthetic
06:11
in
06:11
high
06:11
doses,
06:12
you're
06:12
talking
06:13
about
06:13
doses
06:13
of
06:13
one
06:14
milligram
06:15
per
06:15
kilogram
06:16
and
06:16
above.
06:16
So
06:17
that's
06:17
considered
06:17
high
06:17
dose
06:18
ketamine.
06:19
So
06:19
low
06:19
dose
06:19
under
06:20
point
06:20
five,
06:20
high
06:20
dose
06:21
up
06:21
over
06:22
one
06:22
point
06:22
zero
06:23
or
06:23
the
06:23
two
06:24
zones
06:25
where
06:25
you
06:25
really
06:25
want
06:25
to
06:26
operate.
06:26
So
06:26
there's
06:27
a,
06:27
there's
06:27
a
06:27
middle
06:27
ground
06:28
there,
06:29  Speaker 2
five
06:29
to
06:29
one,
06:31
and
06:31
I
06:31
think
06:31
you
06:32
have
06:32
an
06:32
opinion
06:32
on.
06:33
I've
06:33
intentionally
06:34
left
06:35
the
06:35
middle
06:35
ground
06:35
for
06:35
last
06:37  Speaker 3
because
06:37
the
06:37
middle
06:37
zone
06:38
is
06:38
the
06:38
minefield.
06:39
That's
06:39
where
06:39
you
06:40
don't
06:40
want
06:40
to
06:40
be
06:40
stepping.
06:41
This
06:41
is
06:42
where
06:42
ketamine
06:42
gets
06:42
its
06:42
bad
06:43
reputation
06:43
because
06:44
people
06:44
are
06:44
partially
06:45
disconnected,
06:47
you
06:47
know,
06:47
partially
06:47
connected,
06:48
partially
06:48
disconnected,
06:49
and
06:49
you
06:49
really
06:49
have
06:50
very
06:50
altered
06:50
perceptions
06:51
of
06:51
reality.
06:52
Now
06:53
lots
06:53
of
06:53
times
06:53
it's
06:54
quite
06:54
enjoyable.
06:55
In
06:55
fact,
06:55
that's,
06:55
that's
06:56
the
06:56
party
06:56
drug
06:57
reps,
06:57
the
06:57
party
06:57
drugs
06:57
zone.
06:58
And
06:58
so,
06:59
so
06:59
a
06:59
lot
07:00
like
07:00
no
07:01
ketamine's
07:02
parent
07:02
drug
07:02
which
07:02
is
07:03
PCP
07:04
or
07:04
angel
07:04
dust.
07:05
So
07:05
when
07:05
people
07:05
had
07:06
their
07:06
acid
07:06
trips
07:06
in
07:06
the
07:06
sixties,
07:08
well,
07:08
do
07:08
people
07:08
still
07:09
have
07:09
asked?
07:09  Speaker 2
I
07:10
don't
07:10
think.
07:10
I
07:10
don't
07:10
think
07:11
so
07:12
because
07:13
she
07:13
was
07:13
alive
07:13
then.
07:14
Not
07:15
at
07:15
all
07:16
at
07:16
all.
07:16
The
07:16
raves
07:17
nursing
07:17
them
07:17
all
07:17
back
07:18
to
07:19
back
07:20
in
07:20
the
07:20
sixties
07:21
with
07:22
her
07:22
lanterns.
07:22
You
07:23
work.
07:23
Did
07:23
you
07:23
go
07:23
to
07:24
school
07:24
or
07:24
Jimi
07:24
Hendrix?
07:24
Yes,
07:25
I
07:25
did.
07:25
Actually
07:28
any
07:28
many
07:29
knows
07:29
Florida.
07:30
And
07:30
uh,
07:30
that
07:30
was
07:31
well
07:31
in
07:31
our
07:31
podcast,
07:33
that
07:34
acid
07:35
choosing
07:36
ECP,
07:36
just
07:36
so
07:36
you
07:37
know,
07:37
I'm
07:37
sitting
07:37
between
07:37
them.
07:39
Exactly.
07:40  Speaker 3
So,
07:40
but
07:41
anyway,
07:41
the
07:41
middle
07:41
zone,
07:42
that's
07:42
where
07:42
people
07:43
can
07:43
have
07:43
a
07:43
good
07:43
trip
07:43
or
07:44
a
07:44
bad
07:44
trip
07:45
and
07:45
most
07:46
people
07:46
to
07:46
be
07:46
honest
07:47
actually
07:47
do
07:47
have
07:47
a
07:47
good
07:48
trip.
07:48
That's
07:48
why
07:48
it's
07:48
such
07:48
a
07:49
popular
07:49
drug.
07:50
But
07:50
the
07:50
people
07:51
who
07:51
have
07:51
a
07:51
bad
07:51
trip,
07:52
the
07:52
trips
07:52
are
07:52
so
07:53
bad
07:54
that
07:54
everyone
07:55
remembers
07:56
it
07:56
for
07:56
the
07:56
rest
07:57
of
07:57
their
07:57
lives.
07:58
And
07:58
then
07:58
this
07:58
is
07:58
where
07:58
the
07:59
stories
07:59
of
07:59
these
08:00
horrible
08:00
trips
08:00
with
08:01
Kenny
08:01
come
08:01
because
08:02
these
08:02
really
08:02
horrible
08:02
things,
08:03
although
08:03
they're
08:03
relatively
08:04
rare,
08:05
there
08:05
are
08:05
so
08:05
profound
08:06
that
08:06
everyone
08:07
in
08:07
the
08:07
room,
08:07
everyone
08:08
in
08:08
the
08:08
building,
08:08
sometimes
08:09
everyone
08:09
within
08:11
you
08:11
know,
08:11
500
08:11
yards,
08:13
you
08:13
know,
08:13
here's
08:13
a
08:13
book,
08:14
this
08:14
big
08:14
reaction
08:14
and
08:15
that's
08:15
where
08:15
can
08:15
we
08:15
get
08:16
this
08:16
fearsome
08:16
reputation.
08:17
So
08:18
it's
08:18
a
08:18
bit
08:18
overblown
08:18
in
08:19
terms
08:19
of,
08:19
you
08:19
know,
08:19
statistically
08:20
the
08:20
likelihood
08:21
of
08:21
it
08:21
to
08:21
happen.
08:22
But
08:22
if
08:22
it
08:22
does
08:22
happen
08:23
to
08:23
you,
08:23
you
08:23
will
08:24
never
08:24
forget
08:24
it.
08:24
So
08:24
it's
08:24
nice
08:25
to
08:25
avoid
08:25
it
08:25
and
08:26
there's
08:26
an
08:26
end,
08:26
there's
08:26
no
08:26
utility
08:27
to
08:27
begin
08:27
to
08:28
being
08:28
in
08:28
the
08:28
middle
08:28
ground
08:29
because
08:29
we're
08:30
either
08:30
providing
08:30
analgesia
08:31
in
08:31
the
08:31
low
08:31
zone
08:32
or
08:32
we
08:32
want
08:32
the
08:32
person
08:33
fully
08:34
sedated
08:34
in
08:34
high
08:34
zone.
08:35  Speaker 4
Can
08:36
I
08:36
ask
08:36
you
08:36
a
08:36
question
08:36
because
08:36
I'm
08:37
sure
08:37
some
08:37
of
08:37
the
08:37
nurses
08:37
will
08:38
want
08:38
to
08:38
know
08:38
that
08:38
is
08:39
there
08:39
in
08:40
that
08:40
middle
08:40
zone
08:41
because
08:41
it
08:41
is
08:41
a
08:41
party
08:42
drug,
08:42
is
08:42
there
08:42
an
08:43
addictive
08:43
piece
08:44
of
08:44
it
08:44
that
08:44
people
08:45
become.
08:46
I
08:46
guess
08:46
it's
08:47
with
08:47
like
08:47
anything
08:48
that
08:48
you're
08:48
addicted
08:48
to.
08:48
If
08:49
you
08:49
have
08:49
an
08:49
addictive
08:49
personality
08:50
that
08:51
happens,
08:51
then
08:51
I
08:52
likelihood
08:53
that
08:53
you'll
08:53
continue
08:54
to
08:54
do
08:54
that.
08:55
So.
08:55
So
08:55
Kenny
08:56
means
08:56  Speaker 3
it
08:56
doesn't
08:57
cause
08:57
addiction
08:58
in
08:58
the
08:58
same
08:58
way.
08:58
For
08:59
instance
08:59
an
08:59
opiate,
08:59
but
08:59
like
09:00
you
09:00
don't
09:00
get
09:00
a
09:00
withdrawal
09:01
syndrome
09:02
if
09:02
you
09:02
stopped
09:02
taking
09:03
ketamine,
09:03
but
09:04
other
09:04
than
09:04
the
09:05
psychological
09:06
addiction
09:06
change
09:06
to
09:06
that
09:07
feeling
09:09
then
09:09
it.
09:10
So
09:10
it's
09:10
not
09:10
truly
09:11
addictive
09:11
physiologically
09:12
though
09:12
I
09:12
suppose
09:12
it
09:12
would
09:13
be
09:14
the
09:14
experience
09:14
would
09:14
be
09:15
addictive
09:15
mentally.
09:17
Is
09:17
that
09:17
where
09:18
that
09:18
middle
09:19
zone
09:21
cleared,
09:21
that
09:21
emergent
09:22
reaction?
09:23
I
09:23
think
09:23
everybody's
09:24
worried
09:24
about
09:25
happens.
09:25
Is
09:25
it?
09:26
Exactly.
09:26
Yeah.
09:26
So,
09:27
so
09:27
here's
09:27
where
09:28
you
09:28
have
09:28
to
09:28
be
09:28
careful
09:28
about
09:29
your
09:29
dosing.
09:29
So
09:29
if
09:29
you're
09:29
providing
09:30
analgesia,
09:32
like
09:32
I
09:33
mentioned
09:33
before,
09:33
the
09:34
analgesics
09:34
zone
09:34
is
09:34
below
09:35
zero
09:35
point
09:35
five
09:35
milligrams
09:36
per
09:36
kilogram.
09:37
What
09:38
I
09:38
recommend
09:38
to
09:38
people
09:38
is
09:39
if
09:39
you're
09:39
using
09:39
it
09:39
for
09:39
Analgesia,
09:40
you
09:40
actually
09:40
want
09:41
to
09:41
go
09:41
lower
09:41
than
09:41
that
09:42
because
09:43
people,
09:43
because
09:43
everyone
09:44
else,
09:44
everyone's
09:45
an
09:45
individual
09:45
and
09:46
some
09:46
people
09:46
will
09:47
get
09:47
into
09:48
that
09:48
middle
09:48
zone
09:49
at
09:49
point
09:49
five,
09:50
milligrams
09:50
per
09:50
kilogram.
09:51
So
09:51
others
09:51
as
09:52
the
09:52
years
09:52
have
09:52
gone
09:52
by
09:52
and
09:53
people
09:53
become
09:53
more
09:53
experienced
09:54
with
09:54
using
09:54
ketamine
09:54
for
09:55
Analgesia,
09:56
we
09:56
found
09:56
that
09:57
cutting
09:58
the
09:58
dose
09:58
down,
09:59
you
09:59
still
09:59
get
10:00
a
10:00
solid
10:00
analgesic
10:01
effect
10:01
and
10:02
you
10:02
minimize
10:03
those
10:03
adverse
10:04
effects,
10:04
you
10:04
know,
10:04
the,
10:05
the
10:05
partial
10:05
dissociation.
10:06
So
10:06
I
10:07
actually
10:07
have
10:07
recommended
10:07
starting
10:08
dose
10:08
of
10:08
point
10:08
to
10:10
two
10:10
people
10:11
commenting.
10:11
You
10:11
commonly
10:12
used
10:12
point
10:12
three,
10:14
um,
10:14
and
10:14
there's
10:14
even
10:14
been
10:14
studies
10:15
comparing
10:16
point
10:16
three
10:18
to
10:18
two
10:18
lesser
10:19
doses,
10:19
like
10:19
point
10:19
one,
10:20
point
10:20
two
10:21
and
10:22
you
10:22
get
10:22
a
10:22
slightly
10:22
better
10:23
analgesic
10:24
effect,
10:24
but
10:24
still
10:25
pretty
10:25
similar.
10:26
But
10:26
the
10:26
number
10:26
of
10:26
adverse
10:27
effects
10:27
are
10:27
much,
10:27
much
10:28
less.
10:28
So
10:29
I
10:29
think
10:29
the
10:29
magic,
10:31
the
10:31
magic
10:31
dose
10:32
for
10:32
Analgesia,
10:33
I
10:33
think,
10:33
I
10:33
think
10:33
the
10:34
most
10:34
logical
10:34
starting
10:35
dose
10:35
is
10:35
point
10:36
two
10:37
because
10:37
that's
10:37
where
10:37
you're
10:37
going
10:37
to
10:37
get
10:37
a
10:37
good
10:38
solid
10:38
analgesic
10:39
effect.
10:39
And
10:39
you
10:39
can
10:40
minimize
10:40
the
10:40
amount
10:40
of
10:40
adverse
10:41
effects.
10:42
You're
10:42
still
10:42
get
10:42
adverse
10:43
effects,
10:44
they're
10:44
just
10:44
not
10:44
a
10:44
big
10:45
deal.
10:45
So
10:46
when
10:46
we
10:46
use
10:46
ketamine
10:47
and
10:47
we
10:47
use
10:47
it
10:47
intranasally
10:48
as
10:48
well
10:48
as
10:48
intravenously,
10:50
much
10:50
easier,
10:51
everyone,
10:51
everyone
10:52
about
10:52
25
10:53
percent
10:53
of
10:53
people
10:54
will
10:54
get
10:54
a
10:54
noticeable
10:55
adverse
10:55
effect.
10:56
You
10:56
know
10:56
that
10:56
25
10:57
percent
10:57
is
10:57
booked
10:57
the
10:57
same
10:58
as
10:58
you
10:58
get
10:58
when
10:58
you
10:58
use
10:58
morphine.
10:59
The
10:59
adverse
11:00
effect,
11:00
right?
11:00
So
11:01
I
11:01
tell
11:01
people
11:01
that
11:02
adverse
11:02
effects
11:03
are
11:03
not
11:03
any
11:03
more
11:03
common
11:04
than
11:04
navy
11:04
if
11:04
you
11:04
use
11:04
opiates,
11:05
it's
11:05
just
11:05
that
11:06
they're
11:06
different.
11:06
And
11:06
that's
11:06
where
11:07
people
11:07
seem
11:07
to
11:07
have
11:07
an
11:07
uncomfortableness
11:08
with
11:08
ketamine.
11:09
No.
11:09
If
11:10
you
11:10
give
11:10
someone
11:10
an
11:10
opiate
11:10
and
11:11
they
11:11
throw
11:11
up
11:11
because
11:11
Oh,
11:11
that's
11:12
just
11:12
the
11:12
opiate
11:12
and
11:13
we're
11:13
all
11:13
comfortable
11:13
with
11:13
that
11:14
because
11:14
we
11:14
grew
11:14
up
11:14
with
11:15
giving
11:15
opiates
11:16
and
11:16
everyone
11:17
knows
11:17
what
11:17
to
11:18
do
11:18
and
11:18
no
11:18
one
11:18
gets
11:18
bothered
11:19
by
11:19
it,
11:19
but
11:20
it
11:20
gives
11:20
someone
11:20
a
11:20
dose
11:20
of
11:21
ketamine,
11:21
they
11:21
get
11:21
dizzy,
11:22
and
11:23
then
11:23
all
11:23
of
11:23
a
11:23
sudden
11:23
the
11:24
EU,
11:25
it's
11:25
ketamine.
11:25
Oh
11:25
my
11:26
God.
11:26
It's
11:26
a
11:26
terrible
11:26
drug
11:27
and
11:27
I
11:27
think
11:28
it's
11:28
just
11:28
a
11:28
familiarity
11:29
thing.
11:29
So
11:29
I
11:29
think
11:30
as
11:30
the
11:30
years
11:30
go
11:30
by,
11:30
we're
11:31
going
11:31
to
11:31
become
11:31
more
11:31
and
11:31
more
11:31
used
11:32
to
11:33
decide
11:33
effects
11:33
that
11:34
happened
11:34
with
11:34
ketamine.
11:35
They're
11:35
just
11:35
different
11:35
than
11:36
what
11:36
we
11:36
see
11:36
with
11:36
opiates.
11:37
When
11:37
you
11:37
use
11:38
a
11:38
low
11:38
dose
11:39
is
11:39
the
11:39
number
11:39
one
11:39
thing
11:40
is
11:40
people
11:40
get
11:40
this,
11:40
what
11:41
they
11:41
call
11:41
a
11:41
feeling
11:41
of
11:42
unreality
11:42
or
11:43
they'll
11:43
say
11:43
dizzy.
11:44
They'll
11:44
just
11:44
feel
11:45
weird
11:46
and
11:46
the
11:46
effect,
11:47
and
11:47
I've
11:48
actually
11:48
had
11:48
low
11:48
those
11:49
ketamine
11:49
for
11:49
analgesia
11:50
due
11:50
to
11:51
a.
11:51
A
11:51
relatively
11:52
recent
11:52
orthopedic
11:53
clinical
11:54  Speaker 2
reason
11:57
don't
11:58
lead
11:58
to
11:58
more
11:58
research.
11:59
That's
12:00
it.
12:00
That's
12:00
a
12:00
different
12:00
heroic
12:01
survival
12:01
story.
12:02
You
12:02
have
12:02
different
12:03
pot,
12:03
different
12:03
podcast,
12:04  Speaker 3
so
12:05
the
12:05
effect
12:06
is
12:06
much
12:06
like
12:07
you
12:07
wouldn't
12:07
have
12:08
if
12:08
you
12:09
went
12:09
for
12:09
a
12:10
bike
12:10
ride,
12:10
came
12:10
home,
12:11
sat
12:11
on
12:11
your
12:11
back,
12:12
duck
12:12
back
12:12
deck
12:13
and
12:14
drank
12:14
half
12:14
a
12:14
beer
12:15
where
12:16
I
12:16
describe
12:16
it
12:16
to
12:16
people
12:17
as
12:17
saying,
12:18
you
12:18
know,
12:18
I
12:18
might,
12:18
I'm
12:19
not
12:19
going
12:19
to
12:19
jump
12:19
behind
12:19
the
12:20
wheel
12:20
of
12:20
my
12:20
car
12:21
because
12:21
I'm
12:21
feeling
12:21
just
12:21
a
12:22
little
12:22
tipsy,
12:23
but
12:24
I'm
12:24
feeling
12:24
together
12:25
enough
12:25
that
12:25
I
12:25
wouldn't
12:26
be
12:26
bothered
12:27
to
12:27
sign
12:27
checks.
12:28
So
12:29
and
12:29
that's
12:29
the
12:30
experience
12:30
that
12:30
people
12:30
have
12:31
with
12:31
that
12:31
low
12:31
dose
12:31
of
12:31
Ketamine.
12:32
Something's
12:32
going
12:32
on
12:33
here.
12:33
I'm
12:33
feeling
12:33
dizzy
12:35
last
12:35
about
12:35
20
12:35
minutes
12:36
goes
12:36
away.
12:37
You
12:38
do
12:38
not
12:38
get
12:38
into
12:38
any
12:39
of
12:39
these
12:39
weird
12:39
hallucinations
12:40
and
12:41
flashbacks
12:42
and
12:42
things
12:43
that
12:43
the
12:43
stories
12:44
that
12:44
people
12:44
hear
12:44
about
12:45
and
12:45
the
12:45
other
12:45
bad
12:46
effects
12:46
said
12:46
people
12:47
fear
12:47
about
12:47
ketamine,
12:47
like
12:48
no
12:49
laryngeal
12:49
spasm
12:49
and
12:49
hypersalivation
12:51
the
12:51
things
12:51
that
12:52
are
12:52
the
12:52
subject
12:52
of
12:52
horror
12:53
stories
12:54
never
12:54
happens
12:54
in
12:55
low
12:55
dose,
12:55
just
12:56
can't
12:56
happen.
12:57
So
12:57
it
12:57
just,
12:58
if
12:58
I
12:58
can
12:58
jump
12:58
in.
12:58
So
12:59
when
12:59
you
12:59
say
12:59
low
12:59
dose
13:00
and
13:00
you're
13:00
talking
13:00
to
13:00
point
13:00
two
13:01
milligrams
13:02
per
13:02
kilogram,
13:02
that's
13:03
ib
13:04
bullis
13:04
excellent
13:04
point.
13:05
And
13:05
that
13:05
is
13:06
right.
13:06
That
13:06
is
13:07
the,
13:08
the
13:09
dose
13:09
when
13:10
we're
13:10
talking
13:10
intra
13:11
nasal
13:11
administration,
13:12
because
13:12
instruction
13:13
is
13:13
about
13:13
50
13:13
percent.
13:14
Just
13:14
double
13:14
everything.
13:15
So
13:15
okay.
13:16
So
13:16
if
13:16
I
13:16
gave
13:16
point
13:17
four
13:17
milligrams
13:17
per
13:17
kilogram
13:18
of
13:18
ketamine
13:18
intranasally,
13:20
I'd
13:20
get
13:20
about
13:20
the
13:20
same
13:21
effect
13:21
as
13:21
if
13:21
I
13:21
gave
13:22
point
13:22
two
13:22
milligrams
13:24
ivy.
13:24
Okay.
13:24
And
13:24
if
13:24
I
13:24
had
13:24
someone
13:25
say
13:25
with
13:25
a
13:25
femur
13:25
fracture
13:26
and
13:26
you're
13:26
saying
13:27
this
13:27
lasts
13:27
for
13:27
about
13:27
20
13:28
minutes
13:28
and
13:28
like
13:28
giving
13:29
this
13:29
every
13:29
20
13:30
minutes
13:30
or
13:31
is
13:31
it
13:31
sort
13:31
of,
13:32
this
13:32
goes
13:32
away.
13:33
And
13:33
then
13:33
the
13:33
pain
13:34
control
13:34
is
13:34
for
13:34
a
13:34
longer
13:35
period.
13:35
Exactly.
13:36
Right.
13:36
And
13:37
this
13:37
is,
13:37
um,
13:38
this
13:38
actually
13:38
relates
13:39
to
13:39
my
13:39
personal
13:40  Speaker 2
be
13:40
the
13:41
denture,
13:42
which,
13:43
which
13:43
was
13:43
a
13:44
fractured
13:44
femur
13:44
actually.
13:44
That's
13:45
why
13:45
I
13:45
picked
13:45
that.
13:48  Speaker 3
Yeah,
13:48
it
13:49
was
13:49
a
13:49
fever,
13:49
but
13:49
it