July 1, 2026 Salus Health Care Forum

Jeremy

Yeah. I think Mark was practicing a very novel version of anesthesia. I think the combination of his approaches is of great benefit.

Mark

35 years ago, music was disallowed in the operating room. A small group of anesthesiologists, including myself, had to cajole, always putting the patient first. So, we started it with regional when the patient was awake. And we would cajole and say, hey, the patient wants to hear ACDC or Beethoven’s Pastoral, whatever it was. It was a slog. But over a five to 10 year period, it became acceptable. To now the point where surgeons who hated it now embrace it.

Jack

There’s this new treatment for depression using ketamine. I’m just wondering about the ideational train that builds up energy and content. Could the ketamine experience treating depression be similar to stopping or derailing that train at the end of every anesthesia experience. You get a blast of ketamine along with audio and visual visualization, which is essentially what the ketamine depression treatment is. You quickly put somebody under ketamine quick for a few minutes, along with visualization and preparation. So when people come out of anesthesia, they’ve had that train derailed. This might cure some past bad stuff that happened.

Mark

I don’t know. My caveat to that, of course, there will always be a segment of the patient population (it could be as high as one in five) that will have dysphoria that you cannot predict. I remember the first time I used ketamine in the emergency room. It was to break status asthmaticus. This was 30 years ago. All of a sudden ketamine became the magic drug. Everyone wanted me to tell them about ketamine. I used it in an emergent situation. But before that, I used it for burn wound changes. I used it in Africa because it supports respiration. But I always use low doses. So there’s really a caveat on dosing. And not just the drug, but the environment is critical.

Bill B

I’m wondering, Mark. if I could just go back to that ideational train. Does it keep running even under anesthesia?  What doesn’t get blocked? That fear and that racing along, is there a way in which that continues to operate even when we’re knocked out. Maybe we are even less critical, less critically discerning of what’s on the train? It could be that we’re loading stuff on it desperately when we’re unconscious—much like during dreams, The dreams take on stuff that might hop on the train all over the place. Does psychic material continue to hop on the train when we’re knocked out?