Different types of anesthetics have other uses and effects on the body. Anesthesiologists use these drugs to calm patients and not feel pain during surgery. Mild sedation may be used for minor surgeries, and potent anesthetic gases and muscle relaxants may be used for major surgeries. Stay with us to learn more about the types of anesthetics, their effects on the body, and care after using them.
What is an anesthetic?
An anesthetic is a substance that causes complete or partial loss of consciousness. There are three types of anesthesia: general, regional, and local. When the patient receives general anesthesia, he loses all senses and consciousness. General anesthesia is created in different ways, including intravenous anesthetic injection. Another method uses anesthetic gas with an oxygen mask; injection and gas are sometimes used simultaneously.
All kinds of anesthetics and sedatives
1. Painkillers
Pain relievers relieve pain. These types of drugs are divided into different categories depending on their function, and some of the most commonly used examples are:
- Acetaminophen: This drug is administered orally or by injection. Acetaminophen is usually prescribed after surgery, along with narcotic pain relievers such as hydrocodone.
- Nonsteroidal anti-inflammatory drugs (NSAIDs): The nonsteroidal anti-inflammatory drug ketorolac is sometimes used to reduce pain after surgery. This medicine can be given by intravenous or intramuscular injection. Of course, this painkiller is less often used after surgery because it increases the risk of bleeding.
- Narcotics: These drugs are powerful pain relievers. There are different ways to take narcotic pain relievers, including intravenous injection, oral use, and skin patch. Some common examples of narcotic pain relievers are morphine, fentanyl, Hydromorphone, meperidine, and oxycodone. Anesthesiologists prescribe these drugs during and after surgery to control pain. It is essential to carefully monitor the patient’s condition while taking these medications, as they may cause respiratory depression.
2. Tranquilizers
Sedatives reduce anxiety and relax the body. A higher dose of these drugs makes the patient fall asleep. Sometimes they may cause anterograde amnesia; the patient does not remember the events after the drug injection until several hours later. These drugs are usually given before surgery so the patient can relax before entering the operating room. One of the most common sedatives is midazolam, injected through a vein. Of course, children may be given midazolam as an oral liquid or nasal spray.
3. Local anesthetics
These drugs block nerve messages that transmit pain. These drugs are usually called anesthetics. Local anesthetics can be injected or sprayed into a small body area to numb the same limited space. They can also be injected near essential nerves to reduce full-body sensation. Benzocaine spray or lidocaine ointment is sometimes used to numb the mouth and throat for endoscopy or minor ear, throat, and nose operations. Some types of local anesthetic injections that are used near the surgical site for local anesthesia include:
- lidocaine;
- mepivacaine;
- bupivacaine;
- Ropivacaine.
4. General anesthetics
General anesthetics make you lose consciousness and stay in that state. These drugs may also cause post-dose amnesia, meaning the patient does not remember what happened after taking them. General anesthetics are used for surgical anesthesia and are usually given to the patient by intravenous injection or inhaled gas.
- Common types of anesthetic gas: isoflurane, desflurane, isoflurane
- General intravenous anesthetics: propofol, ketamine, and Etomidate
Propofol is the most common intravenous general anesthetic. A low dose of this drug makes the patient sleep but does not stop his breathing. Usually, the anesthesiologist prescribes this drug to calm the person, along with other sedatives and painkillers. High-dose propofol is a robust respiratory depressant and can be used for anesthesia and intubation, and other surgical procedures.
5. Muscle relaxants
Muscle relaxants are drugs that entirely relax muscles and make breathing tube placement and surgery easier. These drugs are only given to patients who are sedated and under observation. Succinylcholine is a short-acting muscle relaxant used during short operations requiring intubation or an emergency. Vecuronium, rocuronium, and cisatracurium are longer-acting muscle relaxants for more prolonged procedures. After the surgery, the person is given restorative drugs to counteract the effect of these muscle relaxants before the anesthesia wears off and the breathing tube is removed.
Some commonly used anesthetics and their side effects
Narcotic painkiller surgery drug
1. Fentanyl
Fentanyl is a narcotic pain reliever to treat acute, severe, or chronic pain. This drug is widely used for anesthesia and can be used before, during, and after surgery. This drug interacts with other medicines that induce sleep or slow breathing (narcotics, sleeping pills, muscle relaxants, and anxiety and seizure medications). The most common side effects of fentanyl are:
- blurred vision;
- confusion;
- Chest pain;
- dizziness;
- Lethargy;
- respiratory depression;
- Headache;
- anxiety;
- Sweating;
- Unusual tiredness or weakness.
2. Remifentanil
It is a drug used to prevent pain during and after surgery. This drug is beneficial for patients who have undergone surgery. The drug interactions of remifentanil and its side effects are entirely similar to fentanyl.
3. Hydromorphone
It is a type of oral anesthetic for humans, is seven times more effective than morphine, and controls moderate to severe pain. Short-acting hydromorphone compounds treat mild to severe pain, but long-acting compounds can be given regularly to control pain. This medicine is available in the form of syrup and tablets. Consuming 2.5 to 10 ml of its syrup is recommended every 3 to 6 hours, according to the patient’s pain. Its pill should also be used every 4 to 6 hours in 2 or 4 mg doses. Like other narcotics, Hydromorphone interacts with sleeping pills, narcotics, muscle relaxants, and anxiety and seizure medications. The side effects of this drug include blurred vision, confusion, chest pain, dizziness, lethargy, respiratory depression, headache, anxiety, sweating, and unusual weakness and fatigue.
Injectable anesthetic
1. Etomidate
This soothing and hypnotic substance causes general anesthesia by affecting the central nervous system. The hypnotic effect of Etomidate turns light sleep into anesthesia. This anesthetic is used in patients with poor cardiopulmonary function because it causes less respiratory depression than other intravenous anesthetics, such as barbiturates and propofol.
Etomidate has drug interactions with isocarboxazid, phenelzine, selegiline, and tranylcypromine, and their simultaneous use affects blood pressure. Sodium oxybate may also exacerbate etomidate side effects such as dizziness, lightheadedness, drowsiness, confusion, low blood pressure, shallow breathing, impaired thinking, judgment, or coordination of movements. A severe reaction of the two may also lead to coma or death. Common side effects of Etomidate include post-operative nausea, vomiting, injection site pain, and muscle movement pain.
2. Ketamine
This injectable anesthetic is used in surgery and prevents pain. Ketamine is not only used before and during surgery but it is also used to reduce the pain of some other medical treatments. This drug may also have many dangerous interactions with other medications. One hundred seventy-seven drugs have severe interactions with ketamine, and 173 have moderate interactions. The most common interactions include narcotics, sleeping pills, muscle relaxants, and anti-anxiety or anticonvulsant drugs.
Ketamine may have many side effects, including confusion, hallucinations, unusual thoughts, intense fear, painful or decreased urination, urinary incontinence, blood in the urine, dizziness, slow heart rate, shallow breathing, blurred vision or double vision, nausea, loss of appetite, insomnia, and vomiting. If ketamine causes hallucinations, benzodiazepines, vitamin V, or barbiturates (propofol) can be used.
3. Methohexital
This injectable anesthetic slows down the activity of the brain and nervous system. Methohexital makes the patient sleep before the operation. This drug reduces the amount of anisendione, dicamarol, or warfarin in the blood and reduces the effect of these blood clot prevention drugs. Combining Methohexital with ethanol may aggravate some side effects, such as dizziness and drowsiness. The hemin drug’s development also decreases with this anesthetic’s use.
Possible side effects of Methohexital include burning and inflammation at the injection site, irritation of the airways, rapid heart rate, numbness, dizziness, shallow breathing, confusion, anxiety, drowsiness, chills, nausea, cough, hiccups, muscle spasms, skin hives, and vomiting. A low dose of this drug can cause muscle spasms, hiccups, or convulsions. Of course, high doses of Methohexital are used to treat seizures.
4. Propofol
Propofol is an anesthetic that slows down the brain and nervous system activity. This medicine is used before the operation to make the patient sleep and keep him unconscious. Also, this drug is used instead of sedation for patients who are hospitalized in the intensive care unit and need a ventilator.
Common side effects of propofol include dizziness, shallow breathing, severe pain, burning at the injection site, fast heart rate, slow heart rate, or mild hives. Long-term use of this substance may cause propofol injection syndrome and death. In adults with severe illness and head injuries who have received propofol for a long time, complications such as increased blood lipids, indigestion of fat by the liver, liver inflammation, metabolic acidosis, muscle breakdown, and accumulation of myoglobin in the urine may be seen.
Inhalation anesthetic
1. Desflurane
Desflurane is a widely used general anesthetic given to the patient through inhaled gas and acts on GABA receptors. Desflurane inhalation can cause unconsciousness during or before surgery. Usually, this gas is used to maintain anesthesia after receiving the anesthetic.
Using desflurane with droperidol increases the chance of an irregular heart rhythm, a dangerous but rare complication. People with long QT syndrome, other heart diseases, or electrolyte imbalances are more prone to this condition. The side effects of this gas usually include blue lips or skin, nasal congestion, cough, dry or sore throat, hoarseness, respiratory suppression, runny nose, feeling of pressure in the chest, difficulty swallowing, and voice change.
2. Isoflurane
This drug is a type of inhalation liquid anesthetic that is given to the patient after vaporization. This compound is used to induce or maintain general anesthesia.
Isoflurane also interacts with droperidol and increases the chance of developing an irregular heart rhythm, especially in people with hereditary long QT syndrome, other heart diseases, or electrolyte imbalances. Epinephrine and norepinephrine, if used with isoflurane, may affect the heart rhythm and cause blurred vision, nausea, and seizures. Of course, there is nothing wrong with using these drugs simultaneously in case of dangerously low blood pressure or cardiac arrest.
The simultaneous use of this drug with isocarboxazid, phenelzine, selegiline, or tranylcypromine may have a severe effect on blood pressure, and these drugs should not be used until 24 hours after inhalation anesthesia. Sodium oxybate may also aggravate the results of this gas. In rare cases, severe interactions between these two drugs may occur and lead to coma or death of the patient. There should be at least 24 hours between the use of sodium oxybate and inhalation anesthesia.
Side effects of isoflurane include increased potassium, irregular heartbeat, confusion, lightheadedness, lethargy, shortness of breath, numbness, respiratory depression, muscle stiffness, and bluing of the skin, lips, and nail beds of the fingers or toes. The combination may also cause malignant hyperthermia (significantly elevated body temperature), beginning with rapid heartbeat, breathing, fever, spasms, or jaw locking.
3. Sevoflurane
This inhalation anesthesia creates anesthesia before, during, or after surgery. This drug interacts severely with 63 other compounds and moderates with 217 combinations. Therefore, the patient’s medical history should be carefully checked before the doctor prescribes it. Common side effects of sevoflurane include cough, nausea, chills, dizziness, increased salivation, dizziness, headache, and vomiting.
Local anesthetics
1. Cys-atracurium
This anesthetic is usually given before general anesthesia and keeps the patient still during surgery by relaxing the muscles. It also expands the throat muscles, making it easier to insert the breathing tube. Specialists should only use Cis-atracurium for patients with an open airway. Common side effects of this drug include:
- paralyzed
- respiratory arrest ;
- slow heartbeat;
- dizziness;
- redness and warmth;
- Tingling sensation.
2. Rocaronium
This anesthetic is given before surgery and keeps the patient still during surgery by immobilizing the muscles. This drug also makes intubation easier. Its typical side effects include paralysis, respiratory arrest, muscle weakness, loss of ability to move the body, lightheadedness, high blood pressure, lethargy, blurred vision, headache, anxiety, or confusion. The side effects of using it will be more prolonged for patients who have liver failure, are elderly, or are pregnant.
3. Succinylcholine
This drug is used to relax muscle fibers for short-term medical treatments and is used after general anesthesia. In addition, it may be used to loosen the throat muscles and intubate the respiratory tract. Increased potassium is one of the dangerous side effects of succinylcholine, and for this reason, it should not be used for some patients.
Side effects of succinylcholine include paralysis, respiratory arrest, muscle pain, increased eye pressure, increased potassium, fast heart rate, slow heart rate, increased blood pressure, decreased blood pressure, redness, hives, excessive secretion of saliva, and increased intestinal pressure. Succinylcholine increases the level of potassium in the blood, which may cause an irregular heart rhythm or cardiac arrest.
4. vecuronium
Vecuronium is a muscle relaxant used for short procedures and after general anesthesia. This drug makes respiratory intubation easier. Its complications include paralysis, respiratory arrest, muscle weakness, loss of ability to move the body, and shallow breathing.
5. Midazolam
This drug is used as a sedative and is five times stronger than diazepam. Midazolam is used for minor surgeries, dental procedures, and other special medical procedures. The side effects of this drug include suppression of respiratory tract responses, decreased ability to swallow, blurred vision, dizziness, irregular heartbeat, nausea, sweating, body aches, chills, fever, nasal congestion, sore throat, insomnia, confusion, blue or pale lips, skin and nails, mood changes, tremors, or vomiting. Midazolam may cause apnea.
Problems that may prevent general anesthesia
Before the surgery, the anesthesiologist will examine you to ensure you are in good condition for the operation. For this, you should discuss the details with your doctor, including:
- Medical history, including underlying diseases such as diabetes or heart disease ;
- history of surgery;
- drug and food sensitivities;
- drugs used;
- Use of addictive substances such as cigarettes or alcohol.
You should also discuss these details with your doctor or nurse:
- Eating and drinking Usually, you should avoid eating or drinking for a few hours before the surgery.
- I was shaving the hair from the operation area.
- Other medical treatments. You may need some pre-surgery therapies, such as an enema.
Care after general anesthesia and surgery
After surgery, the caregiver will record this information about you:
- breathing, heart rate, and blood pressure;
- level of consciousness and other details related to the surgery;
- Any intravenous fluids you have received.
Depending on the type of surgery, you may experience the following after regaining consciousness:
- A tube that came out of the surgical site to drain the secretions in the wound;
- Bladder catheter to control the amount of urine;
- Recommend deep breathing exercises and leg movement at least once every hour after surgery;
- receiving painkillers;
- Drowsiness, nausea, headache, and sore throat that gets better after a short time.
Complications of general anesthesia
Some rare side effects after general anesthesia are:
- injection site injury;
- infection;
- respiratory problems;
- short-term damage to nerves;
- An allergic reaction such as an asthma attack;
- having feelings and pain during surgery;
- injury to the mouth, teeth, lips, or tongue;
- damage to the vocal cords;
- heart attack ;
- lung damage;
- brain damage;
- stroke ;
- Kidney failure;
- liver failure;
- Paralysis from the torso down;
- Paralysis from the neck down.
home care
To take care of yourself at home after surgery, you should pay attention to what your doctor or anesthesiologist says, but also remember these general points:
- Do not drive for 24 hours after surgery.
- Do not be hard on yourself for a day or two after surgery. Rest at home. Remember that it may take a few days to get back to normal.
- Do not use herbal medicines for a few days or weeks after surgery. Ask your doctor about this.
final word
Different anesthetics are used in other conditions, with different characteristics and side effects. Of course, all these drugs are used in the operating room or hospital environment, and the care team monitors their results. Knowing the side effects of different medications will help you take better care of yourself or your loved ones after surgery and be more prepared to face these challenging conditions.
Warning! This article is only for educational purposes; to use it, it is necessary to consult a doctor or specialist.
