No **** Sherlock. I didn't say this was a study to base our practice on.
although i never called that into question and it's you who seems to want to make this an issue of contention (not me), i'd only now point out that you originally intimated by your statement...
It is so easy to squirt 0.5mg /kg in the first liter of fluid and let it run.
... that perhaps we should consider it's use routinely specifically to derive this theoretical benefit described in this study. to me, that suggests that you in some way have concluded that it is something we should perhaps "
base our practice on."
i don't have an issue with using ketamine routinely, but i think, as i already stated, that one should not base or make treatment decisions for its use as a result of this one, small study.
and, your unnecessary ad hominem is, again, noted.
And I have seen people wake up from Ketaphol in a very brightening manner. Many times.
then, we are at an impasse. so, i propose a study: design a randomized, blinded trial of propofol vs. propofol+ketamine to see if there is a difference.
Can you explain how a nmda antagonist is counter intuitive to an anti depressive?
nmda is a excitatory neurotransmitter. non-selectively blocking it would seem to "dampen" electrical activity in the brain, which has classically been expressed as having depressive effects - not anti-depressive effects. painting in broad brush strokes, this is, in fact, how ketamine exerts its primary effect. furthermore, such a short duration of treatment, even if it were to temporarily down-regulate nmda receptors, would seem to be clinically irrelevant because natural recovery would occur. so, any "anti-depressive" effects occurring as nmda receptors were being recycled would be transitory at best. this assumes that we understand how ketamine works in the brain using current models, which may be either inaccurate or not full elucidated. and, we're not suggesting that we should administer ketamine chronically, are we?
By the way, I thought these health magazines were to new authority in journalism. Or is it just Men's Health that does its research.
there is such a phenomenon as "journal shopping." study authors always submit to big journals first, and when those pass they submit to others. this goes on down the line until eventually someone picks up the study for publication no matter how 'schlocky' the study was.
you can get a rough barometer of how relevant a study is by who picks it up. in this case, the study was published in the "archives of psychiatry", which is not the signpost for the profession. iow, it was not picked up by the "american journal of psychiatry", the academic journal of the american psychiatric association - nor nejm, jama, neurology, even anesthesiology. does that mean much in the grand scheme of things? not really. probably just that they passed on this study for publication because it wasn't particular interesting or relevant, in their opinion. that alone certainly does not mean the study was flawed or clinically irrelevant (nb: see my previous comments above).
lastly, men's health is not a peer-reviewed journal, so your intended sarcastic comparison is misplaced.
