Anesthetic Agents

I. GENERAL ANESTHESIA - a drug induced depression of the CNS, which may reverse either through elimination of
the chemical agents from the body or the metabolic breakdown of agents
A. Inhalation Anesthesia – giving the patient gases or liquids in volatilized form which are inhaled through
a mask or endotracheal tube directly into the lungs. (-hyperpyrexia)
Examples: Desflurane, Enflurane, Halothane, Isoflurane, Methoxyflurane, Nitrous oxide (laughing
gas), Sevoflurane, Xenon (rarely used)

B. Intravenous Anesthesia – administered intravenously, patient experiences a simple pleasant and

extremely rapid induction

Barbiturates- Amobarbital (Amytal), Methohexital (Brevital), Thiamylal (Surital), Thiopental

(Penthothal) “truth serum” Etomidate, Ketamine (Ketalar), Propofol (Diprivan)

Benzodiazepines – Diazepam, Lorazepam, Midazolam

Intravenous reversal agents

 Flumazenil, reverses the effects of benzodiazepines

 Naloxone, reverses the effects of opioids
 Neostigmine, helps reverse the effects of non-depolarizing muscle relaxants
 Sugammadex, new agent that is designed to bind Rocuronium therefore terminating its action

C. Rectal Anesthesia – administered via rectal tube, absorbed by the rectal mucosa and delivered to the
CNS via circulatory system
Example: Thiopental Na (Penthothal Na)

II. REGIONAL ANETHESIA – produces a loss of painful sensation in one region of the body only and does not result
in unconsciousness.
A. Topical Anesthesia - is used to numb the surface of a body part. They can be used to numb any area of
the skin as well as the front of the eyeball, the inside of the nose, ear or throat, the anus and the genital
area. Topical anesthetics are available in creams, ointments, aerosols, sprays, lotions, and jellies.
Ex: Procaine HCL (Novacaine, Ethocaine), Lidocaine HCL (Xylocaine), Benzocaine,
Pramoxine, Proparacaine, Proxymetacaine, and Tetracaine (also named Amethocaine).
B. Local Infiltration Block – only the peripheral nerves around the area of incision are blocked
Ex: procaine HCL (Novacaine, Ethocaine), Lidocaine HCL (Xylocaine), Bupivacaine (Marcaine)
C. Field Block – the area surrounding the incision is injected and infiltrated with local anesthetics
Ex: Lidocaine HCL (Xylocaine)
D. Nerve Block – acts to the anesthetize nerves or individual plexuses of nerves that are further removed
from the operative site that those nerves that synthesized by a field block
Ex: Bupivacaine (Marcaine)
E. Spinal Anesthesia – block impulses from spinal cord and nerve roots
Ex: Procaine HCL (Novacaine, Ethocaine), Lidocaine HCL (Xylocaine), Tetracaine (Pontocaine)
F. Epidural Block – introducing anesthetic agent into the epidural space
Ex: Lidocaine HCL (Xylocaine), Bupivacaine (Marcaine)
 Antibiotic Prophylaxis to Prevent Surgical Site Infections

Preoperative antibiotic prophylaxis is defined as the administration of antibiotics before surgery to help prevent
surgical site infections. The use of antibiotic prophylaxis is just one of many actions taken to help reduce the rate
of surgical site infections. Other preoperative actions include basic infection control strategies, instrument
sterilization, and a patient's skin preparation (e.g., methicillin-resistant Staphylococcus aureus [MRSA]
decolonization, appropriate hair removal, skin antiseptic). A patient's overall medical condition and perioperative
and postoperative management are also important factors in the prevention of surgical site infections.

Wound types can be classified as clean, clean-contaminated, contaminated, or dirty/infected

 Clean wounds are not infected, without inflammation, primarily closed, and do not include the organ
systems that are outlined in a clean-contaminated wound.
 Clean-contaminated wounds involve the respiratory, alimentary, genital and urinary tract as long as the
tract is entered without unusual contamination.
 Contaminated wounds include open, fresh accidental wounds including those with non-purulent
inflammation. Contaminated wounds also include procedures with major breaks in sterile technique or gross
spillage from the gastrointestinal tract.
 Dirty or infected wounds are old traumatic wounds with devitalized tissue or involve existing clinical
infection or perforated viscera.

During clean procedures, skin flora such as coagulase-negative staphylococci (e.g., Staphylococcus epidermidis)
or Staphylococcus aureus are predominant pathogens in surgical site infections. In clean-contaminated
procedures, the most commonly found organisms causing surgical site infections are skin flora, gram-negative
rods, and Enterococci.

Antibiotic Prophylaxis to Prevent Surgical Site Infections

SURGERY COMMON PATHOGENS RECOMMENDED ANTIMICROBIALS*

Staphylococcus aureus,
Cefazolin, cefuroxime sodium
Cardiothoracic coagulase-negative
(Zinacef), or vancomycin
staphylococci

Cefoxitin (Mefoxin), cefotetan

Gastrointestinal
Enteric gram-negative
(Cefotan), ampicillin/sulbactam
bacteria, anaerobes,
(Unasyn), or cefazolin plus
enterococci
metronidazole

Gynecologic (vaginal, Enteric gram-negative

abdominal, or bacteria, group B Cefoxitin, cefotetan, cefazolin, or
laparoscopic streptococci, enterococci, ampicillin/sulbactam
hysterectomy) anaerobes

S. aureus, coagulase- Cefazolin, cefuroxime sodium, or

Orthopedic
negative staphylococci vancomycin

S. aureus, coagulase-
Vascular negative staphylococci, Cefazolin or vancomycin
enteric gram-negative bacilli