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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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The SCM is one of those muscles I rarely ignore when working with the face. It connects the skull to the sternum and clavicle and sits close to major lymphatic and vascular pathways of the neck. Its tone also affects head position and rotation, which is why I pay attention to it when working with facial puffiness, asymmetry, jaw tension and overall tissue mobility. And yes, many people struggle with this area at first. It can feel tight, sensitive and difficult to work with. But consistently giv
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