What Drugs Are Used in Anesthesia?

There are a variety of drugs used in anesthesia, depending on the type of procedure and the needs of the patient.

Pain Relievers (Analgesics).

NSAIDs and Acetaminophen.

These analgesics are typically used after surgery to help manage pain. Acetaminophen and NSAIDs can be bought over-the-counter in oral form (pills or liquids taken by mouth). They are generally considered safe for most patients when taken as directed.

Acetaminophen may also be prescribed before surgery or given by an intravenous line (IV), a thin tube inserted into a vein, during or after surgery to help with pain.

Due to the risk of bleeding, NSAIDS like aspirin and ibuprofen are generally not recommended before or during surgery.

Opioids.

Opioids are potent pain-relievers. They are the primary analgesic used during major surgery and help reduce pain after waking up. Opioids are often given via IV with other intravenous anesthetics.

These drugs may be prescribed orally for pain after major surgery but are meant for short term use. Opioids are controlled because they have a high risk for addiction and life-threatening respiratory depression (slow or shallow breathing). There are a number of opioid alternatives that patients can consider for pain after surgery.

Examples: IV Opioids like Fentanyl, Morphine, and Hydromorphone.
Oral Opioids like Hydrocodone, Oxycodone and Tramadol.

Anti-Anxiety Medication (Anxiolytics).

These medications are sedatives. Patients are often given anxiolytics to relieve anxiety before a surgical procedure. They put patients in a relaxed state that may induce sleep at higher doses. Memory loss is another common side effect.

Benzodiazepines are the primary class of anxiolytics used in anesthesia. They are regularly used for sedation in patients during procedures that don’t require full anesthesia. This can range from minimal sedation used in biopsies to moderate and deep sedation used in colonoscopies and dental surgeries.

For procedures only requiring minimal sedation, benzodiazepines are usually given orally. For deeper sedation, they are generally given via IV or injection.

Examples: Midazolam, Diazepam, and Alprazolam.

Local Anesthetics.

Local anesthetics can be used for both local anesthesia (very small areas of the body) and regional anesthesia (larger areas of the body). These drugs block nerve signals at or near the surgical site. This numbs pain and sensation only in the targeted area with fewer systemic effects compared to general anesthesia. Local anesthetics are usually given by injection but sometimes applied topically.

Local anesthetics allow patients to be awake and alert for certain medical procedures. However, sedation is often used with local anesthesia to relieve anxiety and in longer and more uncomfortable procedures using regional anesthesia.

Because of their duration and safety profile, nerve blocks are also used to treat certain types of chronic pain. They may also be given under general anesthesia to help prevent pain after surgery.

Examples: Lidocaine, Bupivacaine, and Ropivacaine.

General Anesthetics.

General anesthetics work by depressing the central nervous system creating varying levels of sedation or a state of complete unconsciousness; this is known as general anesthesia. General anesthesia allows patients to have major surgeries without feeling pain or being aware of the procedure taking place.

General anesthetics include powerful sedatives, which can cause breathing to slow down or stop. Before a patient is put under general anesthesia, the anesthesia provider will often place an airway device. This ensures the patient is breathing regularly. Airways devices are also used to deliver inhaled anesthetics.

General anesthesia typically involves a mix of intravenous and inhaled anesthetics for balanced anesthesia. These drugs will vary based on the surgery and the needs of the patient.

Intravenous (IV) Anesthetics.

IV anesthetics are the most common drugs used for moderate to deep sedation and to induce general anesthesia. Most have rapid onset with effects that wear off quickly. This is ideal for shorter procedures.

Propofol is the most widely used general anesthetic because it acts quickly, reduces nausea, and is easy to control. It also has less “hangover” after-effects like confusion or fatigue. Anesthesia inducing agents (drugs that start anesthesia) like propofol are usually combined with other IV anxiolytics or analgesics.

Examples: Propofol, Etomidate, and Ketamine.

Inhaled Anesthetics.

These anesthetics are typically inhaled through a mask and delivered directly into the lungs with other gasses like oxygen. Anesthetic gasses can irritate the airway, so patients may experience a sore throat or dry mouth when waking from surgery.

Inhaled anesthetics give anesthesia providers fast and easy control over depth of anesthesia. This makes them useful for maintaining anesthesia after IV induction.

Inhaled anesthetics are also used frequently in small children or in cases where IV access is difficult.

Nitrous oxide is the least potent inhaled anesthetic, which produces anxiolytic effects and mild to moderate pain relief. This makes it useful for sedation for dental work and before surgery.

Examples: Sevoflurane, Desflurane, and Isoflurane.

Muscle Relaxers (Paralytics).

Muscle relaxants, also known as neuromuscular blocking agents, are medications that block nerve signals to muscles, relaxing them. This prevents movement that could be dangerous during surgery.

This type of medication is used if the surgery being performed is delicate such as eye surgery or involves the belly or chest. Muscle relaxers also assist in fluid joint motion during surgeries involving bones and joints.

When an endotracheal tube (breathing tube) is placed, paralytics are used to relax the neck and throat, reducing the chance of injury. These drugs also relax chest muscles when mechanical ventilation is required to assist in breathing.

Examples: Succinylcholine, Vecuronium, and Cisatracurium.