Ketamine is a dissociative anesthetic that provides powerful analgesia while preserving spontaneous ventilation, airway reflexes, and sympathetic tone, which makes it especially valuable in trauma, bronchospasm, difficult airways, and in patients with high opioid tolerance. As a phencyclidine derivative with a chiral center, it exists as two enantiomers, with S-ketamine roughly twice as potent as R-ketamine and associated with fewer unpleasant emergence reactions, while its pKa and balanced water–lipid solubility allow rapid CNS penetration and redistribution-limited offset. Its multimodal mechanism centers on noncompetitive NMDA antagonism but also includes opioid receptor modulation, catecholamine reuptake inhibition, AMPA receptor effects, ion channel blockade, muscarinic antagonism, and anti-inflammatory actions, all of which underpin clinical dosing strategies for induction, maintenance, procedural sedation, and analgesic infusions as well as key considerations around emergence delirium, secretions, cardiovascular status, and ICP.

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In this reflective episode of the Atomic Anesthesia Podcast, we explore how perspective shifts with experience and how nurse anesthesia residents can study more effectively not just for exams, but for lasting clinical mastery. The episode outlines twelve lessons the host would apply if starting grad school again—from focusing on physiology over perfectionism, to using memory maps instead of endless notes, to treating organization as a core learning strategy rather than an afterthought. Listeners will hear why prioritizing long-term understanding, questioning clinical conventions, and building strong professional networks early can transform both their education and their future practice. Practical, honest, and experience-driven, this episode reminds anesthesia trainees that true competence comes from depth, connection, and curiosity—not from chasing straight A’s.

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This episode of the Atomic Anesthesia Podcast focuses on dexmedetomidine (Precedex), a highly selective α2-adrenergic agonist that provides cooperative, arousable sedation, analgesia, anxiolysis, and sympatholysis with minimal respiratory depression for perioperative and ICU care. Aimed at nurse anesthesia residents, it reviews dexmedetomidine’s α2-selective pharmacology, rapid distribution and hepatic metabolism, and its ability to mimic non-REM sleep via locus coeruleus inhibition while significantly reducing MAC and opioid requirements. Listeners learn practical dosing strategies for OR, ICU, and procedural sedation, common indications such as awake fiberoptic intubation, MAC cases, withdrawal management, and pediatric emergence delirium, and key safety considerations including bradycardia, hypotension, transient hypertension with rapid loading, and the ongoing need for vigilant airway and hemodynamic monitoring when incorporating dexmedetomidine into multimodal anesthetic plans.

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