Four Tragic Dog Deaths: Lessons in Program Design and Development

Four Tragic Dog Deaths: Lessons in Program Design and Development

Academic programs are built on four main pillars: clinical excellence, research, education, and administration. These apply whether you build and design an u/s program or division, a simulation program, a toxicology or pre-hospital program and even an academic department. You never forget when your childhood dog dies. And I will never forget how all four of my childhood dogs died. […]

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Slow Ketamine is Less Bad than Fast Ketamine

In today’s report of study findings that ought not surprise anyone – slow infusion of ketamine is less bothersome than IV push dosing.

This is a quite small study, randomizing just 62 patients to 0.3mg/kg of ketamine by either IVP over 1 minute, or dilution into 100mL of saline and infused over 15 minutes. Of the 59 completing the study, nearly all patients experience some side effect – 86% of the IVP arm and 70% of those receiving infusion. When qualified by “moderate or greater” side effects, the difference was magnified to be 76% vs. 43%, mostly driven by feelings of unreality or hallucinations. The study was underpowered to detect differences in pain scores, but no underlying difference is suggested by these data.

Ketamine has become increasingly popular for pain control as of late, and these findings help support practice in terms of improving tolerability.

“Slow infusion of low-dose ketamine reduces bothersome side effects compared to IV push: a double-blind, double dummy, randomized controlled trial”
https://www.ncbi.nlm.nih.gov/pubmed/29645317