The Use of Ketamine and Dexmedetomidine in Cesarean Section: A Narrative Review of Clinical Applications and Safety Considerations

Context: Cesarean section (CS) represents a prevalent surgical intervention necessitating meticulous and efficacious anesthetic administration to optimize maternal and neonatal well-being. This narrative review aims to comprehensively examine the pharmacological properties, clinical applications, and safety considerations associated with the utilization of ketamine and dexmedetomidine as anesthetic agents within the context of CS. Evidence Acquisition: A structured literature search was performed across PubMed, Scopus, and Web of Science databases using key terms including 'Ketamine', 'dexmedetomidine', 'cesarean section', 'anesthesia', and 'pharmacogenetics'. Inclusion criteria were applied to guide the selection of relevant studies for a narrative synthesis. Data collection involved identifying information pertinent to anesthesia types (neuraxial/general), administration routes intravenous (IV)/intrathecal, dosages, and maternal and neonatal outcomes for a qualitative summary. This narrative review did not include a formal risk of bias assessment or quantitative meta-analysis. Results: A narrative synthesis of the identified literature indicates that ketamine, recognized for its dissociative anesthetic characteristics and significant analgesic potency, contrasts with dexmedetomidine, which offers distinct sedative and analgesic actions while exhibiting limited respiratory depressant effects. The concurrent administration of these two pharmacological agents holds the potential for synergistic interactions, potentially leading to improved patient outcomes through mechanisms such as reduced opioid requirements, enhanced hemodynamic stability, and minimized postoperative adverse events. Conclusions: This review underscores the potential for synergistic effects between ketamine and dexmedetomidine in enhancing both analgesic efficacy and hemodynamic stability during CS. Furthermore, it examines the safety profiles associated with this combination and considers relevant pharmacogenetic factors.