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You're not asleep. You're in a reversible, drug-induced coma, and someone is watching every breath until you wake up. Sleep is something your brain does. Anesthesia is something we do to your brain. That's why the surgeon can cut and you don't wake up, and why we manage your breathing the whole time.
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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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