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Jeff,
A couple comments regarding our choice to look at the combination of propofol
and ketamine.  The first was that while propofol provides a very reliable,
predictable and short acting sedating action, it does not have great
analgesic properties.  When we were looking at finding a compatible
analgesic, we felt using ketamine would offer good analgesia (used at
relatively low doses) while not adding to the respiratory depressant effects
that are inherent with propofol use.

A second reason we wanted to look at the combination was to start the ball
rolling on making propofol available in emergency departments.  Our
anesthesia department, while very supportive and progressive, has very real
concerns regarding the use of propofol in the emergency department setting.
There primary concern was the potential for trouble with continuous infusion
protocols.  They were more satisfied when we went to our protocol of bolus
therapy at much lower dosing.

As far as comparing this protocol to others, we are getting a protocol
through our IRB now.  For the most part, our group has gone to versed and
ketamine for most fracture reductions after we all got frustrated with the
sometimes unpredictable nature of versed and fentanyl.  Our QA numbers
suggest that the versed/ketamine combo is still going to have recovery times
15 to 30 minutes longer than our study protocol.

Hope that answers some questions.  Thanks for the interest.

Doug

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