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Administering low-dose intravenous ketamine transforms multimodal general anesthesia by targeting central pain pathways before surgical stimulation begins. Ketamine functions as a noncompetitive N-methyl-D-aspartate (NMDA) receptor antagonist, dampening dorsal horn wind-up and preventing acute central sensitization (Peltoniemi et al., 2016). When combined synergistically with gamma-aminobutyric acid (GABA) receptor agonists like propofol, it produces reliable hypnotic depth and somatic analgesia
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