Anesthesiologists use a variety of medications in their practice to keep patients safe, relaxed and pain-free for their surgeries. These range from mild sedatives for minor procedures to potent inhalational gases and muscle relaxants for major or lengthy surgeries.
Analgesics (Pain Relievers)
An analgesic is a medication that helps to relieve pain. This class of medication can be subdivided into a multitude of different categories based on how each type of drug works to accomplish this task. Some of the medications commonly administered by anesthesiologists include:
- Acetaminophen (Tylenol®): This can be given as a pill or injected through an intravenous line (iv). It is commonly used in the post-operative setting in combination with the narcotic analgesics such as hydrocodone (Norco®, Lortab®).
- Non-steroidal anti-inflammatory (NSAID): Anesthesiologists will sometimes use the NSAID ketorolac (Toradol®) to help with post-operative pain. It is administered either as an intravenous or as an intramuscular injection. This class of analgesic is not as commonly used in the operative setting because it has the potential to increase the risk of bleeding following some procedures.
- Narcotics: This class of analgesics are very potent pain relievers. These drugs can be administered by several different modalities, including IV, oral or transdermal (skin patch). Some of the commonly utilized narcotics include morphine, fentanyl, hydromorphone (Dilaudid®), merperidine (Demerol®) and oxycodone (OxyContin®). Anesthesiologists administer these drugs intra-operative (during surgery) and post-operatively (after surgery) to help control pain. It is important that a patient is monitored carefully during the administration of these medications, as they can reduce the drive to breathe.
Anxiolytics are medications that help to reduce or alleviate anxiety and relax the body. In higher doses, they can also be used to induce sleep. They may also cause anterograde amnesia, where the patient does not remember the events following the administration of the medication, typically for a few hours. These medications are usually given pre-operatively to relax a patient before getting to the operating room. Anesthesiologists commonly give midazolam (Versed®) via IV injection for this purpose. In children, midazolam can be given orally as a liquid or nasal, as a spray, prior to a procedure.
Local anesthetics are medications that block the conduction of impulses in nerves that relay pain signals. These are also commonly known as “numbing agents”. Local anesthetics can be injected or sprayed in a small region to create a localized area without sensation, or can be injected next to major nerves to decrease the sensation to an entire limb. Benzocaine spray (Hurricaine®) or lidocaine ointment is sometimes utilized to numb the mouth and throat for procedures involving placement of a camera, such as ear, nose and throat (ENT) office procedure or upper gastrointestinal endoscopy (EGDs). Lidocaine, mepivicaine, bupivicaine (Marcaine®) and ropivicaine are commonly used for injections at surgical sites or for regional anesthesia (nerve blocks).
General anesthetics are medications that induce and maintain a state of unconsciousness. They cause anterograde amnesia, meaning that a patient does not remember the events that follow their administration. This class of medications create amnesia for surgery These can be given either by IV injection or inhaled as a gas.
Inhalational Gases: Sevoflurane, Desflurane, Isoflurane
Intravenous Agents: Propofol (Diprivan®), Ketamine, Etomidate
Propofol (Diprivan®) is the most commonly used IV general anesthetic. In lower doses, it induces sleep while allowing a patient to continue breathing on their own. It is often utilized by anesthesiologist for sedation in addition to anxiolytics and analgesics. At higher doses, propofol is a profound respiratory depressant (stops your breathing) and may be used to induce unconsciousness for intubation (placement of a breathing tube) and other surgical procedures.
Paralytics (Muscle Relaxants)
Paralytics are medications that induce complete relaxation of the muscles and help to facilitate intubation and surgery. These drugs are only at administered to patients that are completely unconscious and in a monitored setting. Succinylcholine is a short acting paralytic that is often used for short procedures requiring intubation and in emergent situations. Vecuronium, rocuronium (Zemuron®) and cisatracurium (Nimbex®) are longer-acting paralytics used to maintain paralysis during longer surgical procedures. At the conclusion of surgery, reversal drugs are given to undo the muscle relaxation effects prior to discontinuing anesthesia and removing the breathing tube.