dexmedetomidine + ketamine + lidocaine + propofol

A combination of four medications used for opioid-free anesthesia (OFA). This multimodal approach combines dexmedetomidine (an alpha-2 adrenergic agonist), ketamine (an NMDA receptor antagonist), lidocaine (a local anesthetic), and propofol (a GABA receptor modulator). The combination aims to provide adequate anesthesia and analgesia while minimizing opioid use and their associated side effects. When used together, these medications complement each other: dexmedetomidine may prevent the tachycardia, hypertension, salivation, and emergence phenomena from ketamine, while ketamine may prevent the bradycardia and hypotension associated with dexmedetomidine.