ATC Group: N01A Anesthetics, general

Alfentanil is a short-acting, synthetic, agonist at mu opioid receptors, used for anaesthesia in surgery.

Anileridine is an opioid receptor agonist belonging to the piperidine class with analgesic activity. By binding to and activating opioid receptors in the central nervous sytem (CNS), anileridine mimics the endogenous opioids resulting in a decrease of nociceptive neurotransmitters and eventually an analgesic effect. Anileridine is useful for the relief of moderate to severe pain. It may also be used as an analgesic adjunct in general anesthesia in the same manner as meperidine to reduce the amount of anesthetic needed, to facilitate relaxation, and to reduce laryngospasm. In addition, anileridine exerts mild antihistaminic, spasmolytic and antitussive effects.

Desflurane is one of a family of halogenated methyl ethyl ethers, which are administered by inhalation, producing a dose-related temporary loss of consciousness and of pain sensations, suppression of voluntary motor activity, reduction of autonomic reflexes, and depression of respiration and the cardiovascular system.

Esketamine, the S-enantiomer of racemic ketamine, is a non-selective, non-competitive antagonist of the N-methyl-D-aspartate (NMDA) receptor, an ionotropic glutamate receptor. Through NMDA receptor antagonism, esketamine produces a transient increase in glutamate release. Restoration of dopaminergic neurotransmission in brain regions involved in the reward and motivation, and decreased stimulation of brain regions involved in anhedonia, may contribute to the rapid response.

Etomidate is an imidazole derivative with short-acting sedative, hypnotic, and general anesthetic properties. Etomidate appears to have gamma-aminobutyric acid (GABA) like effects, mediated through GABA-A receptor. The action enhances the inhibitory effect of GABA on the central nervous system by causing chloride channel opening events which leads to membrane hyperpolarization.

Fentanyl is a potent µ-opioid analgesic with rapid onset of analgesia and short duration of action. Its primary therapeutic actions are analgesia and sedation and is approximately 100-fold more potent than morphine as an analgesic. Secondary effects of fentanyl on central nervous system (CNS), respiratory and gastro-intestinal function are typical of opioid analgesics and are considered to be class effects.

Isoflurane is a general inhalational anaesthetic for use in induction and maintenance. Isoflurane provides rapid induction of anaesthesia and also rapid recovery.

Isoflurane is a fluorinated ether with general anesthetic and muscle relaxant activities. Although the exact mechanism of action has not been established, inhaled isoflurane, appears to act on the lipid matrix of the neuronal cell membrane, which results in disruption of neuronal transmission. This agent enhances the release of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA), thereby increasing the activity of the inhibitory neurotransmitter on synaptic transmission. Isoflurane may also both inhibit glutamatergic excitatory transmission by increasing glutamate re-uptake, and potentiate glycine receptor activity, which decreases motor function. In addition, isoflurane may alter certain pro- and anti-inflammatory cytokines, including interleukin-6 and -10 (IL-6, IL-10), possibly through the activation of the nuclear factor kappa B (NF-KB) pathway, which may affect immune responses during surgery.

Ketamine is a rapidly acting general anaesthetic for intravenous or intramuscular use with a distinct pharmacological action. Ketamine hydrochloride produces dissociative anaesthesia characterised by catalepsy, amnesia, and marked analgesia which may persist into the recovery period.

Nitrous oxide is a potent analgesic and a weak anaesthetic. Induction with nitrous oxide is relatively rapid, but a concentration of about 70% is needed to produce unconsciousness.

Phenoperidine is an opioid analgesic which is structurally related to pethidine (derivative of isonipecotic acid) and is used clinically as a general anesthetic.

Propofol (2, 6-diisopropylphenol) is a short-acting general anaesthetic agent with a rapid onset of action of approximately 30 seconds.

Remifentanil is a selective mu-opioid agonist with a rapid onset and very short duration of action. The mu-opioid activity, of remifentanil, is antagonised by narcotic antagonists, such as naloxone.

Sevoflurane is used as an inhalational anaesthetic for induction and maintenance of general anesthesia. As with all other inhalation agents sevoflurane depresses cardiovascular function in a dose related fashion. In patients with normal intracranial pressure (ICP), sevoflurane had minimal effect on ICP and preserved CO₂ responsiveness.

Sufentanil is a synthetic opioid analgesic drug approximately 5 to 10 times as potent as its parent drug, fentanyl, and 500 times as potent as morphine. Structurally, sufentanil differs from fentanyl through the addition of a methoxymethyl group on the piperidine ring (which is believed to reduce duration of action), and the replacement of the phenyl ring by thiophene. The main use of this medication is in operating suites and critical care where pain relief is required for a short period of time. It also offers properties of sedation and this makes it a good analgesic component of anesthetic regimen during an operation

Thiopental is a thiobarbiturate with rapid onset for intravenous administration. Thiopental induces hypnosis and anesthesia, but not analgesia.