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These are the common anesthesia medications used in the United States today:
INTRAVENOUS MEDICATIONS:
1. PROPOFOL. Propofol is an intravenous sedative-hypnotic, and the most commonly used general anesthetic medication in the United States. Because propofol can cause the patient to stop breathing, its use is restricted to physicians who are expert in the management of airway and breathing. Propofol has ultra-fast onset and offset times, usually causing sleep within seconds of injection. Because the drug is short-acting, it is often administered by a continuous intravenous drip or infusion When propofol is administered without other anesthetic drugs, the patient usually awakens within minutes of discontinuing the drug. Propofol does not relieve pain, and most painful surgeries require additional medication(s).
2. MIDAZOLAM (Brand name VERSED). Midazolam is a short-acting anxiety-reducing drug of the Valium or benzodiazepine class. Midazolam is commonly injected as the first drug to begin an anesthetic, because it gives patients a sense of calm, and often gives them amnesia for a period of minutes afterward. Midazolam is a common drug given during sedation for colonoscopy procedures, because most patients have no awareness during the procedure, even though they are usually awake.
3. NARCOTICS. Most surgical procedures cause pain, and narcotic drugs are intravenous pain-relievers. Commonly used narcotics are morphine, meperidine (brand name Demerol), fentanyl, and remifentanil. Narcotics have the desired effect of dulling the brain’s perception of pain. Narcotics cause sleepiness in higher doses, and have the common side-effect of nausea in some patients. Morphine and Demerol are slower-onset, longer-lasting narcotics, while fentanyl and remifentanil are faster-onset, shorter-acting narcotics.
4. PARALYZING DRUGS. Some surgeries and anesthetics require the patient to be paralyzed, i.e. muscles must be rendered flaccid so that the patient can not move. It is imperative that the patient be given adequate intravenous or inhaled anesthetic drugs first, so that the patient has no awareness that they can not move. Commone paralyzing drugs are vecuronium, rocuronium, pancuronium, and succinylcholine. Because paralyzing drugs cause the patient to stop breathing, their use is restricted to physicians who are expert in the management of airway and breathing. Paralyzing drugs are used by anesthesia providers prior to the placement a breathing tube (endotracheal tube) into the patient’s windpipe (trachea). Paralyzing drugs are used during certain surgical procedures in which the surgeon requires the patient’s muscles to be relaxed, for example, abdominal surgeries, some throat surgeries, and some surgeries inside the chest.
INHALED ANESTHETICS:
1. POTENT INHALED ANESTHETICS. Potent inhaled anesthetics include sevoflurane, isoflurane, and desflurane. These drugs are liquids, administered via anesthesia vaporizers than turn them into inhaled gases. They are usually administered in low concentrations (1% to 4% for sevoflurane, 1% to 2% for isoflurane, and 3% to 6% for desflurane), because sustained higher concentrations fo these drugs cause life-threatening depression of heart and breathing functions. Because potent inhaled anesthetics can cause patients to stop breathing, their use is restricted to physicians who are expert in the management of airway and breathing.
2. NITROUS OXIDE. Nitrous oxide is a relatively weak inhaled anesthetic drug, usually administered in concentrations of 50% to 70%. At these doses, nitrous oxide does cause significant sleepiness, but will not render the patient unconscious. Nitrous oxide has the advantage of being a quick-onset, quick-offset drug, and it is non-expensive. Because every patient must inhale a minimum of 21% oxygen, the maximum dose of nitrous oxide is 100 – 21, or 79%. As a measure of safety, oxygen is usually administered at concentration of at least 30%, which is the reason why administered nitrous oxide concentrations rarely exceed 70%.
LOCAL ANESTHETICS:
1. LIDOCAINE. Lidocaine is injected into tissue to block pain at that site. The onset of local anesthesia occurs within seconds, and the duration is short, usually less than one hour. Lidocaine can be injected into the back during either a spinal anesthetic or an epidural anesthetic, to numb part of the patient’s body without causing unconsciousness. Lidocaine can also be injected near major nerves, in what is called a nerve block. Nerve blocks include injections to numb one arm, one leg, the hand, or the foot.
2. PROCAINE (Brand name Novocaine). Although the term Novocaine is commonly heard, use of this drug has been largely abandoned, replaced by lidocaine instead.
3. BUPIVICAINE (Brand name Marcaine). Bupivicaine is injected into tissue to block pain at that site. The onset of local anesthesia occurs within minutes, and the duration is longer than lidocaine, usually from 2 – 6 hours, depending on the location of the injection. Bupivicaine can be injected into the back during either a spinal anesthetic or an epidural anesthetic, to numb part of the patient’s body without causing unconsciousness. Bupivicaine can also be injected near major nerves, in what is called a nerve block. Nerve blocks include injections to numb one arm, one leg, the hand, or the foot.
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Published in September 2017: The second edition of THE DOCTOR AND MR. DYLAN, Dr. Novak’s debut novel, a medical-legal mystery which blends the science and practice of anesthesiology with unforgettable characters, a page-turning plot, and the legacy of Nobel Prize winner Bob Dylan.
KIRKUS REVIEW
In this debut thriller, tragedies strike an anesthesiologist as he tries to start a new life with his son.
Dr. Nico Antone, an anesthesiologist at Stanford University, is married to Alexandra, a high-powered real estate agent obsessed with money. Their son, Johnny, an 11th-grader with immense potential, struggles to get the grades he’ll need to attend an Ivy League college. After a screaming match with Alexandra, Nico moves himself and Johnny from Palo Alto, California, to his frozen childhood home of Hibbing, Minnesota. The move should help Johnny improve his grades and thus seem more attractive to universities, but Nico loves the freedom from his wife, too. Hibbing also happens to be the hometown of music icon Bob Dylan. Joining the hospital staff, Nico runs afoul of a grouchy nurse anesthetist calling himself Bobby Dylan, who plays Dylan songs twice a week in a bar called Heaven’s Door. As Nico and Johnny settle in, their lives turn around; they even start dating the gorgeous mother/daughter pair of Lena and Echo Johnson. However, when Johnny accidentally impregnates Echo, the lives of the Hibbing transplants start to implode. In true page-turner fashion, first-time novelist Novak gets started by killing soulless Alexandra, which accelerates the downfall of his underdog protagonist now accused of murder. Dialogue is pitch-perfect, and the insults hurled between Nico and his wife are as hilarious as they are hurtful: “Are you my husband, Nico? Or my dependent?” The author’s medical expertise proves central to the plot, and there are a few grisly moments, as when “dark blood percolated” from a patient’s nostrils “like coffee grounds.” Bob Dylan details add quirkiness to what might otherwise be a chilly revenge tale; we’re told, for instance, that Dylan taught “every singer with a less-than-perfect voice…how to sneer and twist off syllables.” Courtroom scenes toward the end crackle with energy, though one scene involving a snowmobile ties up a certain plot thread too neatly. By the end, Nico has rolled with a great many punches.
Nuanced characterization and crafty details help this debut soar.
Click on the image below to reach the Amazon link to The Doctor and Mr. Dylan:
LEARN MORE ABOUT RICK NOVAK’S FICTION WRITING AT RICK NOVAK.COM BY CLICKING ON THE PICTURE BELOW:
crisp and to the point for non medicos
Excellent notes…
I enjoyed your comments! I am an operating room nurse and wish I had read this very clear and succinct list of anesthesia meds when I was new to the operating room.
Dr. Novak, I seriously need your expertise on anesthesia before I have this upcoming major surgery. I have Gaba receptor damage from being on Benzodiazepene (Klonopin) for 8 yrs. I came off this drug 32 months ago and still have serious CNS issues. I just had surgery in Jan. and was given Fentanyl which set me back in my healing about 9 months. Propfol was fine, was given it during a colonoscopy in Nov. last year. I cannot have this surgery without knowing exactly what would work with the Propofol besides Fenantyl. I need something that won’t act on Gaba receptors in a big way. If you could answer me on this I would be so appreciative. Thank you.
I don’t have a simple answer to your complex question. I believe you should inform your next anesthesiologist of your drug intolerances, and that propofol gave you no ill effects. Fentanyl should have had very little to do with GABA, because fentanyl binds to narcotic receptors in the brain. Depending on what kind of surgery you are scheduled for, there are many alternative drugs which your anesthesiologist can use. The combination of propofol and the potent anesthetic gas sevoflurane is useful for most general anesthetics.
Dr., thank you for your reply. Even opiates affect us with our CNS so sensitive. I still have cramps and nerve pain 40 days later, after surgery, also anxiety, insomnia, shaking, and I was so much better 32 months out before this surgery. Some ppl have no problem with the anesthesia, but many do. The next surgery is a rectocele repair. It may very well have been the antibiotic they gave me after surgery, not sure what it was, will ask for what they gave me next time I visit surgeon. CNS/immune system work in conjuntion, related, 80% of immune system is in gut, and most have problems with high histamine, bad gut flora during recovery, myself included. Even probiotics make me much worse now. It’s horrible to be 32 months out and still suffering, but many are 7-10 yrs and still suffering. If you would like to see, check out Benzobuddies.org. It’s important dr’s are made aware of these devastating drugs (benzodiazepenes) that should not be prescribed for long-term use. The last surgery the anesthesiologist said he had to use Fentanyl with Propofol. I would prefer just the Propofol alone for the rectocele repair, is that possible for maybe a 2 hr surgery? Want your expert opinion. Thank you!
Rectocele surgery will have post-operative pain. You’ll likely need some narcotics. Anesthesiologists also use morphine or Dilaudid as alternative narcotics to fentanyl. Good luck.
Also, I can’t have anything with fluoride, that’s floroquinolone antibiotics or any other drugs containing fluroide, so whatever they give me needs to be benzo free as well as fluoride free. I’m allergic to sulfa, amoxicillen, etc.
Dr. Novak, I have been wondering since November 30, 2010 when I presented in the ER with a severely fractured right elbow and dislocated right shoulder, what drug did the doctor use to reset my shoulder and manipulate my arm for x-rays without me remembering the procedure or the associated pain. I was told it could also act like a type of “truth serum”, since I would be awake and able to talk, but would not remember anything at all. I did in fact feel like I had “gone to sleep” and awakened after the procedure was completed, with no memory of the event whatsoever. What wonder drug could the doctor have used?
Most likely you’re describing the drug Versed (midazlolam) which is a benzodiazepine, or a Valium analogue. We give the drug IV, and it makes a patient sleepy, relieves anxiety, and often gives amnesia. To reduce a shoulder, it’s likely a narcotic such as fentanyl was added to your IV as well to decrease any pain involved with the procedure. The same recipe is used often for colonoscopies and upper endoscopies throughout the U.S.
I suspect your guess about the drug combination may be accurate, because in addition to the shoulder procedure they had to manipulate my arm with the shattered elbow in order to get good x-ray views for the ortho surgeon who operated to repair the elbow the next morning. I don’t remember ANYTHING that happened during that time in the ER, but promptly “regained consciousness” when the doctors and nurses had completed the above procedures. I was also in no pain (due most likely to either fentanyl you mentioned above, although I recall getting a shot of dilaudid to ease my pain, somewhat before they decided they were going to do the reduce and x-rays) and remained comfortable until after the surgery the following morning.