dexmedetomidine + ketamine + sevoflurane

This is a combination of three anesthetic agents—dexmedetomidine, ketamine, and sevoflurane—used together for procedural sedation or general anesthesia. - **Dexmedetomidine** is a selective alpha-2 adrenergic receptor agonist with sedative, anxiolytic, and analgesic properties. It provides sedation resembling natural sleep without significant respiratory depression but can cause bradycardia and hypotension. - **Ketamine** is an NMDA receptor antagonist that produces dissociative anesthesia, analgesia, and amnesia while maintaining airway reflexes and cardiovascular stability; it may cause emergence phenomena such as hallucinations or agitation. - **Sevoflurane** is a volatile inhalational anesthetic agent used for induction and maintenance of general anesthesia; it acts primarily by enhancing inhibitory neurotransmission via GABA-A receptors in the central nervous system leading to muscle relaxation and loss of consciousness[6]. The combination leverages the complementary pharmacological profiles of each drug to provide effective sedation/anesthesia with hemodynamic stability, reduced risk of respiratory depression (from dexmedetomidine/ketamine), rapid onset/recovery (from sevoflurane), improved analgesia (from ketamine/dexmedetomidine), and smoother emergence from anesthesia[2][5]. This regimen has been studied particularly in pediatric populations for procedures such as drug-induced sleep endoscopy or surgeries where airway management or minimizing emergence agitation are important considerations[1][3][4][5].