Drugs used in Anesthesia

🥛 1. The „milk“ isn’t milk at all

Propofol barely dissolves in water.

So it is carried in tiny fat droplets, made up of things like:

• soybean oil
• glycerol (a sugar-like liquid)
• egg lecithin (a natural fat building block)

The white color therefore doesn’t come from the drug itself, but from these little fat globules.

What the patient actually receives isn’t an ordinary solution, but a highly engineered fat emulsion.

Source: propofol prescribing information; Sahinovic MM et al. Clinical Pharmacokinetics. 2018.

🧠 2. The brain doesn’t switch off completely

Many people think propofol simply shuts the brain down.

It isn’t quite that simple.

Individual regions of the brain keep working. What breaks down is the communication between them.

You could say: the orchestra is still playing – but the conductor has vanished.

As a result, the brain can no longer piece all the information together into a conscious experience.

Source: Mashour GA et al. New England Journal of Medicine. 2021; Brown EN et al. New England Journal of Medicine. 2010.

⚡ 3. Unconscious in less than half a minute

After an injection into an arm vein it usually takes only 20 to 40 seconds for propofol to take effect.

In that short time the drug travels:

• through the arm vein
• to the heart
• through the lungs
• back to the heart
• and finally into the brain

A single lap of the circulation is enough.

That’s why propofol works so incredibly fast.

Source: Sahinovic MM et al. Clinical Pharmacokinetics. 2018.

🩸 4. Why does propofol wear off so quickly?

Many people assume the liver breaks propofol down especially fast. That’s only partly true.

The main reason is different: within just a few minutes propofol leaves the brain again and spreads into muscle and fatty tissue.

As a result, too little propofol is left in the brain to keep you asleep.

That’s why patients often wake up even though most of the drug hasn’t actually been broken down yet.

Source: Sahinovic MM et al. Clinical Pharmacokinetics. 2018.

🫁 5. The liver isn’t working alone

The liver handles most of the breakdown. But it gets help.

The lungs and kidneys also play a part in clearing propofol from the body.

Their contribution is much smaller than the liver’s, but it shows how cleverly the body deals with this drug.

Source: Sahinovic MM et al. Clinical Pharmacokinetics. 2018.

❤️ 6. Why does blood pressure fall?

Many people think: „Propofol just widens the blood vessels.“

That’s true – but only part of the story.

Propofol:

• widens the blood vessels
• means less blood flows back to the heart
• makes the heart pump a little more weakly
• calms the nervous system that normally keeps the circulation ticking over

All these effects together can cause blood pressure to drop.

Source: Marik PE. Clinical Consequences of Propofol. 2004.

😌 7. Propofol doesn’t relieve pain

This surprises many people.

Propofol makes people unconscious. But it is virtually not a painkiller.

During an operation the body would still register pain.

That’s why patients are also given strong pain relief or a local anesthetic.

Being asleep and being pain-free are, after all, two different things.

Source: Miller’s Anesthesia, 10th edition.

😴 8. You can dream under propofol

Some patients report dreams after anesthesia.

Many describe them as especially pleasant or very vivid.

Why some people dream and others don’t at all is something science still can’t fully explain.

Source: Leslie K et al. Anesthesia & Analgesia. 2007.

🎯 9. Less nausea after anesthesia

Many people are afraid of feeling sick or vomiting after an operation.

Propofol can genuinely lower this risk.

That’s why it is a particular favorite for outpatient surgery.

Source: Apfel CC et al. Anesthesiology. PONV Guidelines.

🔥 10. Why does propofol sometimes sting on injection?

Many patients remember this vividly.

The drug can sting as it goes into the vein. Exactly why this happens still isn’t fully understood.

So anesthesiologists try to reduce the stinging. For example with:

• a small dose of local anesthetic (lidocaine)
• a larger vein
• or an infusion that is already running

Source: Picard P, Tramèr MR. Pain on Injection with Propofol. 2000.

🧬 11. Propofol changes the brain’s electrical activity

Our brain works with tiny electrical signals. These can be measured with an EEG.

Under propofol these signals change in a very characteristic way.

Anesthesiologists can use these changes to gauge how deeply a patient is asleep.

Source: Brown EN et al. New England Journal of Medicine. 2010.

🦠 12. Why must propofol never be left standing?

The little fat droplets in propofol are unfortunately also an ideal food for bacteria.

If germs get in, they can multiply very quickly.

So the rule is:

• always work sterile
• use syringes right away
• change lines regularly

That keeps treatment safe.

Source: propofol prescribing information.

💀 13. The rarest, but most dangerous side effect

A very rare complication is called propofol infusion syndrome, or PRIS for short.

In it, the body can suddenly struggle to produce enough energy inside its cells.

In the worst case this can:

• damage the muscles
• disturb the heart rhythm
• cause the circulation to fail

Fortunately this complication occurs almost only in critically ill patients who receive very high doses of propofol over a long period.

Source: Hemphill S et al. Propofol Infusion Syndrome. 2019.

👨‍⚕️ 14. Michael Jackson didn’t die because of propofol alone

Used correctly, propofol is one of the safest anesthetic drugs there is.

Michael Jackson didn’t die because of the drug itself.

The problem was that propofol was used outside a monitored anesthetic.

Crucial safety measures were missing, such as:

• continuous monitoring
• the ability to secure the airway
• immediate resuscitation in an emergency

The case shows strikingly: it isn’t the drug that is dangerous – it’s using it the wrong way.

Source: Los Angeles County Coroner Report; propofol prescribing information.

🌍 15. The pandemic showed just how important propofol really is

During the COVID pandemic, millions of critically ill patients worldwide had to be put on ventilators.

So that they could tolerate ventilation, many of them were kept in a deep sleep with propofol.

For a while the drug became scarce as a result.

Only then did many people realize how indispensable propofol truly is for modern critical care and anesthesia.

Source: FDA Drug Shortage Reports; EMA COVID-19 Drug Shortage Reports.

🎯 Fun fact to finish

Many patients say after their operation: „That was the best anesthesia of my life – I was out instantly.“

And that’s exactly what describes propofol’s greatest strength.

Within seconds it sends people into a deep sleep. Once the anesthetic ends, they usually wake up just as quickly.

It’s precisely this extraordinary controllability that has made propofol the gold standard of modern intravenous anesthesia for decades.

😴 1. Midazolam erases memories – not necessarily consciousness

Perhaps the most astonishing thing first: many people believe midazolam simply makes you drowsy.

In fact, its pronounced anterograde amnesia is one of its most remarkable properties.

Many patients:

• answer questions
• hold conversations
• crack jokes
• seem surprisingly awake

Yet afterward they remember little or nothing. The brain experiences the moment – but doesn’t store it permanently.

Source: Kanto JH. Pharmacotherapy. 1985; Olkkola KT & Ahonen J. Handbook of Experimental Pharmacology. 2008.

🧠 2. The hippocampus takes a little break

Midazolam boosts the effect of the body’s own messenger GABA.

Particularly affected is the hippocampus, which plays a key role in forming new memories.

You could say: the camera is still rolling – but the save button suddenly stops working.

Source: Mohamed WMY et al. CNS Neuroscience & Therapeutics. 2020.

💧 3. Midazolam is a chemical chameleon

Most benzodiazepines dissolve poorly in water. Midazolam doesn’t.

The trick: in the ampule the molecule has an open ring structure, which makes it water-soluble.

As soon as it reaches the blood, this ring closes again. Now midazolam becomes fat-soluble – and so gets into the brain especially fast.

A rather elegant chemical solution.

Source: Kanto JH. Pharmacotherapy. 1985.

⚡ 4. It works faster than many expect

After an intravenous dose:

• first effect after about 30–60 seconds
• peak effect after 3–5 minutes

That’s why anesthesiologists usually give the drug slowly and wait a moment. Top up too quickly and it’s easy to underestimate the real effect.

Source: StatPearls – Midazolam.

😌 5. Four effects at once

Midazolam can, at the same time:

• 😌 relieve anxiety
• 💤 calm
• 😴 cause drowsiness
• ⚡ suppress seizures

It’s exactly this combination that has made the drug so valuable for decades.

Source: Olkkola KT & Ahonen J.

🦷 6. This is why dentists like midazolam

People with a marked fear of the dentist benefit especially. During treatment many feel noticeably more relaxed.

And afterward they often barely remember:

• the injection
• the sound of the drill
• the procedure itself

That’s why midazolam is one of the most important drugs for sedation in dentistry worldwide.

Source: ADA Guidelines; Olkkola KT.

🚑 7. A genuine life-saver

Midazolam isn’t only used in the operating room. It is one of the most important drugs worldwide against epileptic seizures.

It can be given:

• intravenously
• intramuscularly
• into the cheek (buccal)
• into the nose

The nasal spray in particular has made emergency treatment much simpler.

Source: European Resuscitation Council Guidelines 2021.

💉 8. There really is an antidote

Many drugs simply have to be broken down by the body. Midazolam is one of the few exceptions.

With flumazenil its effect can often be reversed on purpose within a few minutes.

Almost like a reset button.

Source: StatPearls – Flumazenil.

🫁 9. Calming doesn’t mean harmless

Midazolam can slow breathing.

This effect is especially marked together with:

• fentanyl
• sufentanil
• morphine
• alcohol

That’s why midazolam is only used with appropriate monitoring.

Source: midazolam prescribing information; StatPearls.

👴 10. Age makes a big difference

An 85-year-old patient often needs far less midazolam than a 30-year-old.

With increasing age the brain becomes considerably more sensitive to benzodiazepines.

That’s why the rule in anesthesia is: start low – go slow.

Source: Olkkola KT & Ahonen J.

🌙 11. Artificial sleep isn’t natural sleep

Patients do sleep deeply and calmly under midazolam. But this sleep differs from natural nighttime sleep.

Certain sleep phases – particularly REM sleep – are altered.

That’s why sedation often feels different afterward from an ordinary night’s sleep.

Source: Handbook of Experimental Pharmacology.

⏳ 12. Why some patients sleep longer than expected

Midazolam itself acts relatively briefly.

Its most important breakdown product is called 1-hydroxymidazolam – and it too has a sedating effect.

With reduced kidney function this substance can build up. As a result the drowsiness can last considerably longer.

Source: StatPearls – Midazolam.

🍊 13. Grapefruit can boost midazolam

As harmless as it looks: grapefruit inhibits the enzyme CYP3A4.

As a result midazolam is broken down more slowly.

Especially with tablets, the effect can become much stronger and longer.

So a glass of grapefruit juice really can make a difference.

Source: FDA Drug Interaction Database; StatPearls.

🤯 14. Sometimes exactly the opposite happens

Rarely, the body reacts paradoxically.

Instead of becoming calm, patients can:

• become restless
• cry
• react aggressively
• be hard to settle

Why this happens still isn’t fully understood. Children and older people seem to be affected more often.

Source: Weinbroum AA et al. European Journal of Anaesthesiology. 2001.

🎬 15. Midazolam changed outpatient medicine

Before it was introduced, there was no benzodiazepine that at the same time:

• worked so fast
• was water-soluble
• reliably relieved anxiety
• caused pronounced amnesia

Today, upper endoscopies, colonoscopies, bronchoscopies, cardiac catheterizations, or minor operations without midazolam are, in many places, part of everyday medicine.

It remains one of the most important drugs in modern sedation.

Source: Kanto JH. Pharmacotherapy. 1985.

🎯 Fun fact to finish

When patients say after their operation: „I was awake the whole time.“

…they are often actually right.

What’s fascinating about midazolam isn’t necessarily that it fully „switches people off.“ Its special strength lies far more in the fact that many experiences are never stored permanently in memory in the first place.

It’s precisely this extraordinary property that has made midazolam one of the most important drugs in modern anesthesia for decades.

⚡ 1. The fastest „on–off“ opioid

Most opioids don’t disappear from the brain because they are broken down right away. Instead they first spread into muscle, fatty tissue, and other organs.

Remifentanil is different.

It is broken down continuously while still in the circulation.

That’s why its effect usually disappears just a few minutes after the infusion is switched off.

Source: Egan TD. Remifentanil Pharmacokinetics and Pharmacodynamics. Anesthesiology. 1993.

🧪 2. It isn’t the liver that does the work

Most drugs are broken down mainly in the liver.

Remifentanil, by contrast, is dismantled by special enzymes found in the blood and in many body tissues.

That means:

• The liver plays only a minor role in its breakdown.
• The kidneys barely affect how long it lasts either.
• Breakdown begins almost immediately, throughout the whole body.

Among opioids this is almost unique.

Source: Egan TD et al. Anesthesiology. 1993; Ultiva® prescribing information.

⏳ 3. The famous 3-minute rule

Perhaps the most fascinating thing about remifentanil:

Whether the infusion has run for five minutes, an hour, or ten hours – after switching it off the effect fades almost always at the same speed.

Experts call this the context-sensitive half-time. In other words: the duration of effect barely lengthens even after a long infusion.

For remifentanil it is only about 3 minutes.

No other commonly used opioid can be controlled so precisely.

Source: Hughes MA et al. Anesthesiology. 1992.

🎮 4. Almost like a volume dial

Even small changes in the infusion rate can noticeably change the effect.

This lets remifentanil be matched very precisely to the level of pain during an operation.

That’s exactly why it is one of the most popular opioids for procedures where the pain stimulus is constantly changing.

Source: Miller’s Anesthesia, 10th edition.

🔪 5. Even the strongest pain stimuli can be controlled precisely

Operations such as:

• heart operations
• brain operations
• major vascular operations

cause particularly strong pain stimuli.

Remifentanil can be adjusted within a few minutes so that these stimuli are very precisely controlled.

Source: Miller’s Anesthesia.

😮 6. And suddenly everything hurts

This is the flip side of its extraordinary controllability.

Remifentanil disappears from the body so fast that after switching off there is practically no pain relief left.

That’s why, before the end of the operation, a longer-acting painkiller or a regional anesthetic (numbing larger nerves) must always take over.

For example:

• morphine
• hydromorphone
• oxycodone
• regional anesthesia

Source: Guignard B. Acute Opioid Tolerance. Anesthesiology. 2000.

🧠 7. Small dose – big effect

Even slight changes in infusion speed can noticeably affect circulation and pain response.

That’s why remifentanil is ideal for so-called TCI systems (target-controlled infusion). These are computer-controlled infusion pumps that calculate and adjust the drug dose especially precisely.

Source: Egan TD et al.

❤️ 8. The heart sometimes beats more slowly

Remifentanil can slow the heartbeat and lower blood pressure.

Especially in combination with propofol, the circulation can quickly become much calmer.

For this reason blood pressure and heart rate are monitored continuously during anesthesia.

Source: Ultiva® prescribing information.

💪 9. Why patients can suddenly go „stiff“

Very fast or high doses can trigger so-called chest-wall (thoracic) rigidity.

This means the chest and breathing muscles suddenly become very stiff.

As a result, ventilation can become difficult.

This is:

• not an allergy
• not an asthma attack

but a known side effect of some strong opioids.

Source: Miller’s Anesthesia.

🧬 10. An enzyme deficiency doesn’t prolong its effect

Some people have an inherited enzyme deficiency. As a result certain drugs act far longer than usual.

Surprisingly, this doesn’t affect remifentanil.

That’s because remifentanil is broken down by different enzymes from the drugs affected by this deficiency.

So its duration of effect normally stays unchanged.

Source: Ultiva® prescribing information.

🩺 11. Why remifentanil is so popular for brain operations

After a brain operation the surgeons want to check as soon as possible:

• Can the patient speak?
• Are they moving their arms and legs?
• Are the cranial nerves working?

Remifentanil often allows a very rapid wake-up and is therefore especially well suited to such procedures.

Source: Miller’s Anesthesia.

👶 12. Predictable even in severe liver or kidney disease

Because its breakdown barely depends on the liver or kidneys, its duration of effect stays remarkably constant even with severely impaired organ function.

That makes remifentanil easy to plan for in many difficult situations.

Source: Egan TD et al.

🎯 13. Ideal for modern, rapid wake-up

In many modern surgical concepts doctors want patients to wake up again as quickly as possible.

This concept is called fast-track anesthesia.

The aim:

• operation finished
• breathing tube removed
• patient awake
• immediately assessable neurologically

This is exactly where remifentanil plays to its greatest strength.

Source: Miller’s Anesthesia.

🤯 14. The strongest opioid is sometimes the worst painkiller

That sounds contradictory.

During the operation remifentanil provides excellent pain control.

After the operation, however, its effect disappears within a few minutes.

That’s why it isn’t suitable as the sole pain treatment after an operation.

Source: Guignard B. Anesthesiology. 2000.

🌡️ 15. Remifentanil doesn’t make you unconscious

Many patients believe: „If I feel no pain, I’ll automatically be asleep.“

That isn’t true.

Remifentanil:

• doesn’t cause unconsciousness
• doesn’t make memories disappear
• mainly relieves pain

That’s why it is almost always combined with a hypnotic such as propofol.

Source: Miller’s Anesthesia; Ultiva® prescribing information.

🚀 Fun fact to finish

Many anesthesiologists jokingly describe remifentanil as a „light switch for pain.“

Some even say: „When the pump runs out, sometimes it’s the surgeon who notices first.“

Of course that’s an exaggeration.

But the comparison captures remarkably well how quickly remifentanil responds to changes in dose.

It’s precisely this extraordinary controllability that keeps remifentanil one of the most important drugs in modern anesthesia to this day.

🌍 1. Standard in some countries – never approved in others

Metamizole is one of the most widely used painkillers in Germany, Spain, Portugal, and many South American countries.

In the United States, the UK, and Sweden, by contrast, it isn’t approved and hasn’t been for decades.

The reason isn’t a different effect – but a different judgment about a very rare side effect called agranulocytosis.

In it, certain white blood cells that normally protect the body against bacteria suddenly fall sharply. As a result, even normally harmless infections can become dangerous.

So the very same drug is judged completely differently around the world.

Source: EMA Pharmacovigilance Reports; metamizole prescribing information.

🔥 2. It relieves pain, lowers fever, and eases cramps

Most painkillers can do two things:

• relieve pain
• lower fever

Metamizole can, in addition, ease cramp-like spasms of the internal organs.

That’s why it works especially well for:

• biliary colic (severe pain from gallstones)
• renal colic (intense pain from stones in the ureter)
• cramping abdominal pain

This antispasmodic effect sets metamizole apart from many other painkillers.

Source: metamizole prescribing information.

🧪 3. Strictly speaking, nobody receives metamizole

That sounds odd. But it’s true.

After it is taken, metamizole is converted within minutes almost entirely into another substance: 4-MAA.

This substance does most of the actual pain-relieving work.

You could say: metamizole only brings the active ingredient to the front door – the real work is done by its breakdown product.

Source: Levy M et al.; prescribing information.

🧠 4. To this day nobody knows exactly how it works

Scientists understand most drugs fairly well. With metamizole it’s different.

Several mechanisms probably act at the same time:

• certain pain messengers are inhibited
• the body’s own cannabinoid system is influenced
• regions in the brain and spinal cord also play a role

Research is still ongoing.

A drug that has been used for over 100 years – and whose mechanism of action still isn’t fully understood.

Source: Pierre SC et al.; Rogosch T et al.

❤️ 5. Kinder to the stomach than many other painkillers

Many well-known painkillers such as ibuprofen or diclofenac can:

• irritate the stomach
• promote stomach ulcers
• encourage bleeding

Metamizole causes these problems considerably less often.

Especially after operations, this is one reason doctors in countries where it’s approved often reach for it.

Source: metamizole prescribing information.

💉 6. Why metamizole is injected slowly

Given quickly into a vein, blood pressure can suddenly drop sharply.

That’s why metamizole is injected slowly.

Not because the drug is dangerous – but so the circulation can adapt better.

Source: metamizole prescribing information.

🌡️ 7. One of the strongest fever reducers

Metamizole is one of the most effective fever-reducing drugs there is.

Especially for very high fever that responds poorly to acetaminophen or ibuprofen, it is often used.

Source: metamizole prescribing information.

🩸 8. The famous agranulocytosis

Almost everyone has heard the term. Few know what lies behind it.

In agranulocytosis the number of certain white blood cells falls almost to zero.

These cells are an important part of our immune system. Without them the body can barely fight bacteria.

Fortunately this side effect is very rare.

Source: EMA; metamizole prescribing information.

⚠️ 9. A sore throat can be a warning sign

Anyone who, during treatment with metamizole, suddenly develops:

• a sore throat
• fever
• painful inflammation in the mouth

should stop the drug immediately and be examined by a doctor.

These symptoms can be early signs of agranulocytosis.

Fortunately this happens only very rarely.

Source: metamizole prescribing information.

🚑 10. Hard to imagine critical care without it

After operations or in the ICU, metamizole is often part of standard treatment where it’s approved.

Why? It combines superbly with other painkillers and can noticeably reduce the need for them.

As a result, fewer strong opioids are often required.

Source: acute pain guidelines.

🧬 11. Everyone breaks metamizole down a little differently

Our body processes drugs with the help of various enzymes. These differ from person to person.

That’s why metamizole can act a little more strongly or for longer in some people than in others.

Why this is so is still being intensively researched.

Source: Rogosch T et al.

🚫 12. Not every case of asthma tolerates metamizole

Some people react to painkillers such as aspirin or ibuprofen with breathlessness. This condition is called analgesic intolerance.

Metamizole is often tolerated better. But allergic or hypersensitivity reactions can’t be completely ruled out.

That’s why the first dose is monitored especially carefully in people with known painkiller allergies.

Source: EAACI Guidelines.

🤝 13. A real team player

Metamizole works especially well together with other painkillers.

For example with:

• acetaminophen
• opioids
• local anesthetic techniques

This often improves pain treatment while reducing the amount of strong opioids needed.

Doctors call this multimodal pain therapy – treatment that combines different drugs with different mechanisms of action.

Source: acute pain guidelines.

🏥 14. In use for over 100 years

Metamizole was introduced back in 1922.

Despite its age it remains one of the most prescribed painkillers in Germany.

Only a few drugs stay a fixed part of medicine over such a long period.

Source: historical drug reviews; prescribing information.

🤯 15. A drug full of contradictions

Hardly any other painkiller is judged so differently around the world.

In Germany it is used thousands of times a day. In other countries it isn’t available at all.

Known for over a century. And yet scientists still debate its exact mechanism of action today.

That’s exactly what makes metamizole one of the most intriguing painkillers of all.

Source: EMA; Pierre SC et al.; metamizole prescribing information.

🎯 Fun fact to finish

Many patients think: „Metamizole is just a stronger ibuprofen.“

That’s wrong in several ways.

Metamizole doesn’t belong to the classic anti-inflammatory painkillers (NSAIDs), also has an antispasmodic effect, is far gentler on the stomach, and affects blood clotting much less.

That’s exactly why, where it’s approved, it holds a firm place in modern pain therapy – and is far more than just „a stronger ibuprofen.“

🌍 1. Almost unknown worldwide – a classic in Germany

Many strong painkillers such as morphine or fentanyl are used worldwide.

Piritramide is different.

It is used mainly in Germany, Belgium, the Netherlands, Austria, and a few other European countries.

In the United States and the UK, by contrast, it isn’t approved at all.

So it’s a drug that is part of everyday life in some countries – and that practically nobody knows in others.

Source: NCI Drug Dictionary – Piritramide; LactMed Database.

💪 2. It belongs to the strong opioids

Piritramide is one of the so-called opioids.

These are drugs that act at the same docking sites in the brain as the body’s own endorphins – our natural pain inhibitors.

As a result piritramide can reliably relieve even severe pain after operations.

Source: NCI Drug Dictionary.

⏳ 3. It acts longer than remifentanil – but shorter than morphine

Not every strong painkiller acts for the same length of time.

Remifentanil disappears just a few minutes after the infusion is stopped.

Morphine often acts for many hours.

Piritramide sits roughly in between.

That’s why it is especially well suited to pain directly after an operation.

Source: piritramide prescribing information; MeSH.

😌 4. It doesn’t make you unconscious

Many patients believe: „If I’m given a strong painkiller, I’ll fall asleep automatically.“

That isn’t true.

Piritramide relieves pain. But it doesn’t replace an anesthetic.

That’s why, during general anesthesia, it is almost always combined with a hypnotic such as propofol.

Source: NCI Drug Dictionary.

❤️ 5. Freedom from pain has its price

Like almost all strong opioids, piritramide can:

• slow breathing
• cause drowsiness
• trigger nausea
• make the bowel more sluggish

That’s why patients are monitored well after it is given.

Source: piritramide prescribing information; LactMed.

🤢 6. Why some patients feel sick

In the brain there is a center that controls nausea and vomiting.

Opioids can irritate this center.

That’s why many patients are also given anti-nausea medicines.

Not because something has gone wrong – but because doctors want to prevent this known side effect.

Source: standard anesthesia texts; PONV guidelines.

🧠 7. Pain disappears – memories remain

Piritramide relieves pain.

But it doesn’t make memories disappear.

That’s why many patients still remember conversations or events after the operation quite well.

Source: NCI Drug Dictionary.

🚶 8. Less pain often means moving sooner

People in less pain can often, after an operation:

• breathe deeply more easily
• get up sooner
• cough more easily
• move more quickly

Good pain treatment therefore doesn’t only help against pain – it often supports recovery too.

Source: acute pain guidelines.

💉 9. Usually a small amount is enough

Piritramide is one of the very effective painkillers.

Just a few milligrams can noticeably relieve severe pain.

That’s why doctors dose the drug carefully and adjust the amount individually.

Source: piritramide prescribing information.

🔄 10. Everyone reacts a little differently

Some patients need only a little piritramide.

Others need considerably more.

Age, weight, pre-existing conditions, and genetic differences all affect how strongly the drug works.

That’s why there is no single dose that suits everyone.

Source: piritramide prescribing information.

🌙 11. Drowsy doesn’t mean unconscious

After piritramide many people become sleepy. But that doesn’t mean they are unconscious.

Most can still:

• answer questions
• be aware of their surroundings
• hold conversations

That’s why doctors regularly check how awake a patient is.

Source: NCI Drug Dictionary.

🚑 12. There is an antidote

If an opioid ever acts too strongly, there is an antidote.

It is called naloxone (Narcan®).

This drug can noticeably weaken or even reverse the effect of piritramide within a few minutes.

That makes its use additionally safe.

Source: standard emergency medicine texts.

🤝 13. It likes to work on a team

After an operation patients often receive several painkillers at once.

For example:

• acetaminophen
• ibuprofen
• or a local anesthetic

This often means less piritramide is needed.

This principle is called multimodal pain therapy – different drugs work together to relieve pain as well as possible.

Source: acute pain guidelines.

😴 14. It helps you sleep – but isn’t a sleeping pill

People in severe pain usually sleep badly.

When piritramide relieves the pain, many patients automatically feel more relaxed and drowsy.

But that’s mainly down to the pain relief – not because piritramide is a classic sleeping pill.

Source: NCI Drug Dictionary.

🏥 15. A fixture in many hospitals for decades

Although new drugs are constantly being developed, piritramide remains part of standard post-operative treatment in many European hospitals.

That shows: some drugs stay successful for decades – because they work reliably.

Source: MeSH; NCI Drug Dictionary.

🎯 Fun fact to finish

Many patients know morphine or fentanyl.

Piritramide, by contrast, is usually known only to people who have been operated on in the hospital in the right country.

Yet it has been one of the most important painkillers in German recovery rooms for decades.

It’s something like the „quiet hero“ of post-operative pain therapy – used millions of times, but almost unknown outside the hospital.

😮‍💨 1. All you have to do is breathe

Most anesthetic drugs are injected through a vein.

Sevoflurane works differently.

It is simply breathed in. With every breath a little more anesthetic gas passes through the lungs into the blood, and from there into the brain.

After a few breaths the effect begins.

That’s why children in particular can often fall asleep with no injection at all.

Source: Goa K et al. Sevoflurane in Paediatric Anaesthesia. 1999.

🍦 2. It smells surprisingly pleasant

Earlier anesthetic gases often had a pungent smell and irritated the airways.

Sevoflurane is much more pleasant.

That’s why many children can breathe in the anesthetic calmly through a mask without coughing right away.

It often makes the start of anesthesia much more relaxed.

Source: Goa K et al. Paediatric Drugs. 1999.

⚡ 3. A few breaths are enough

Sevoflurane works remarkably fast.

With every breath the amount of gas in the blood – and eventually in the brain – rises.

As a result many patients fall asleep after a short time.

The deeper the breathing, the faster the anesthetic builds up.

Source: Clinical Review of Sevoflurane.

🌬️ 4. What goes in comes out again almost unchanged

Many drugs first have to be broken down by the liver.

With sevoflurane it’s different.

By far the greatest part is simply breathed out again.

Only a small part is processed in the body.

That’s why the anesthetic is especially easy to control.

Source: Clinical Review of Sevoflurane.

🎚️ 5. The anesthesiologist can adjust the anesthetic almost like a dimmer

The more sevoflurane is breathed in, the deeper the anesthetic.

If less gas is given, the effect fades again.

It works much like a light dimmer.

So the anesthesiologist can adjust the anesthetic constantly throughout the operation.

Source: Clinical Review of Sevoflurane.

👶 6. Why pediatricians love sevoflurane

Many children are afraid of injections.

With sevoflurane they can often first fall asleep calmly through a mask.

Only once they are asleep is an IV placed.

For many children this is much more pleasant.

Source: Goa K et al. Paediatric Drugs. 1999.

🌈 7. Some children are briefly confused after waking

A small proportion of children seem restless or confused for a few minutes after a sevoflurane anesthetic.

They may cry, scream, or not recognize their parents at first.

Doctors call this emergence agitation or emergence delirium.

It often looks dramatic, but usually settles again on its own after a short time.

Source: Meta-analysis 2024; Cochrane Review.

💨 8. It disappears through the lungs

When sevoflurane is stopped, the patient simply breathes the gas out again.

That’s why many people wake up relatively quickly after a sevoflurane anesthetic.

The better the lungs work, the faster the gas disappears from the body.

Source: Clinical Review of Sevoflurane.

🔥 9. An extremely rare inherited condition makes sevoflurane dangerous

For the vast majority of people sevoflurane is a very safe drug.

However, there is a very rare inherited condition called malignant hyperthermia.

In it, the muscles suddenly react uncontrollably to certain anesthetic drugs.

Body temperature rises sharply and metabolism spirals out of control.

Fortunately this condition is very rare and can usually be treated successfully today.

Source: Sevoflurane Reviews.

🫁 10. The airways usually stay calm

Some older anesthetic gases could trigger coughing or spasm of the airways.

Sevoflurane irritates the airways far less.

That’s why it is especially well suited to falling asleep through a face mask.

Source: Goa K et al.

🧒 11. Children need more than adults

This sounds surprising at first.

For an equally deep anesthetic, children usually need a higher concentration of sevoflurane than adults.

That’s because the child’s brain reacts slightly differently to the anesthetic gas.

Source: Lerman J et al. Anesthesiology.

😴 12. Sleep isn’t the same as freedom from pain

Sevoflurane, too, mainly does one thing: it makes us lose consciousness.

But it doesn’t reliably prevent pain.

That’s why patients are also given strong painkillers.

Being asleep and being pain-free are two different things.

Source: Clinical Review of Sevoflurane.

❄️ 13. Why do many people feel cold after the operation?

During anesthesia the body loses part of its ability to keep its temperature constant.

On top of that, the operating room is often cool.

That’s why many people feel cold or shiver after waking up.

This is usually not down to the sevoflurane itself, but to the anesthetic as a whole.

Source: Clinical Review of Sevoflurane.

📏 14. There’s a unit of measurement for anesthetic gases

Anesthesiologists often talk about the MAC.

It stands for Minimum Alveolar Concentration.

Put simply: the MAC describes how much anesthetic gas is needed, on average, for most people to stop reacting to a surgical stimulus.

So it’s a kind of benchmark for the strength of different anesthetic gases.

Source: Lerman J et al. Anesthesiology.

🌍 15. Millions of people fall asleep with sevoflurane every year

Sevoflurane is one of the most widely used anesthetic gases in the world.

Whether in children or adults, for short or long operations – it is hard to imagine modern anesthesia without it.

Its fast action, easy control, and usually pleasant induction have made it one of the most important anesthetic drugs for many years.

Source: Clinical Review of Sevoflurane.

🎯 Fun fact to finish

Many people believe an anesthetic gas leaves the body completely as soon as the operation is over.

In fact, by far the greatest part of the sevoflurane is simply breathed out again – almost as if you breathe the anesthetic back out after the operation.

That’s exactly why sevoflurane is so easy to control and remains one of the most popular anesthetic gases in the world to this day.

🚑 1. It saves lives when every second counts

After serious accidents or with life-threatening injuries, an anesthetic sometimes has to be started within seconds.

Many anesthetic drugs can lower blood pressure sharply in doing so. Ketamine is different.

It often even causes blood pressure and heart rate to rise slightly at first.

That’s why it is used especially often in emergency medicine and in severely injured patients.

Source: Green SM et al. Clinical Practice Guideline for Emergency Department Ketamine Dissociative Sedation. Ann Emerg Med. 2011; Miller’s Anesthesia, 10th edition.

🧠 2. The brain doesn’t sleep the way it does with other anesthetics

Most anesthetics dampen the brain evenly. Ketamine works differently.

It separates certain regions of the brain from one another. As a result, sensory impressions, pain, and conscious experience are no longer properly connected.

Doctors call this a dissociative anesthetic.

Put simply: the eyes may be open – but the brain no longer consciously processes the surroundings.

Source: Domino EF. Clin Pharmacol Ther. 2010; Sleigh J et al. Br J Anaesth. 2014.

😌 3. It is a hypnotic and a painkiller at the same time

Many anesthetic drugs only cause unconsciousness.

Ketamine causes unconsciousness and at the same time relieves severe pain.

That makes it especially valuable in emergency medicine and for short procedures.

Source: Miller’s Anesthesia.

❤️ 4. Blood pressure often rises

While propofol often lowers blood pressure, with ketamine the opposite often happens.

The drug activates the body’s own stress system.

As a result the heart and circulation often beat a little more strongly.

Especially in patients with low blood pressure this can be a great advantage.

Source: Corssen G et al.; Miller’s Anesthesia.

🌬️ 5. Breathing often stays remarkably stable

Many strong hypnotics slow breathing considerably.

Ketamine usually does so far less.

That’s why spontaneous breathing is preserved in many patients.

Even so: breathing and circulation must be carefully monitored under ketamine too.

Source: Green SM et al. Ann Emerg Med. 2011.

👶 6. Children often benefit especially

Children are often afraid of injections.

Ketamine can be given in various ways – for example through a vein, into the muscle, or, in certain situations, through the nose.

Especially in pediatric and emergency medicine this offers advantages.

Source: ACEP Clinical Policy.

😴 7. Some people dream very intensely

Ketamine can cause extraordinarily vivid dreams.

Some people find them pleasant.

Others report unusual images or a feeling of floating.

These experiences usually disappear again after a short time.

Source: Domino EF.; Miller’s Anesthesia.

💭 8. This is why ketamine is often combined with midazolam

Because ketamine can cause intense dreams or restlessness, it is sometimes given together with midazolam.

Midazolam has a calming effect and can help to soften such experiences.

Not every patient needs this combination – it is decided individually.

Source: Miller’s Anesthesia; ASA Practice.

🦴 9. It is excellent for painful procedures

Ketamine is used often worldwide for procedures such as:

• a dislocated shoulder
• a broken arm
• a painful wound treatment

It reliably relieves pain and at the same time allows a short anesthetic or deep sedation.

Source: Green SM et al.

🧬 10. A new drug against depression grew out of ketamine

Researchers discovered by chance that ketamine can improve some severe depressions remarkably quickly.

Today there is even a specially developed active ingredient, esketamine, for treating certain depressions.

It was one of the biggest surprises in modern psychiatry.

Source: Daly EJ et al. JAMA Psychiatry. 2019.

🧪 11. Ketamine actually exists twice

Ketamine is made up of two almost identical molecules.

You can picture them like a left and a right hand: they look similar but aren’t completely the same.

One of them is called esketamine.

It works a little more strongly and is now used in a targeted way in some areas.

Source: Spravato® prescribing information.

🌍 12. A drug for almost the whole world

Ketamine is one of the most important drugs on the World Health Organization’s (WHO) list.

Especially in countries with little medical equipment it is often indispensable.

Because it is reliable, versatile, and comparatively simple to use.

Source: WHO Model List of Essential Medicines.

🚁 13. This is why EMS crews like ketamine

Whether on the street, in the ambulance, or in the helicopter: ketamine is standard equipment in many emergency systems.

It works fast, relieves severe pain, and often supports the circulation better than many other anesthetics.

That makes it especially valuable outside the hospital.

Source: European Trauma Guidelines; ERC Guidelines.

⚠️ 14. Not every story about ketamine is true

Ketamine keeps appearing in movies and the media. This creates many myths.

In medicine, however, ketamine is used in precisely calculated doses and under constant monitoring.

There is an enormous difference between a controlled anesthetic and misuse.

Source: WHO; specialist literature.

🎨 15. A drug that still surprises today

Hardly any other drug is used in so many areas:

• anesthesia
• emergency medicine
• pain therapy
• pediatrics
• critical care
• psychiatry

And yet scientists keep discovering new uses to this day.

That makes ketamine one of the most intriguing drugs in modern medicine.

Source: Sleigh J et al. Br J Anaesth. 2014.

🎯 Fun fact to finish

Many people know ketamine only as a „horse tranquilizer.“

In fact ketamine is indeed also used in veterinary medicine – just like propofol, sevoflurane, and many other anesthetic drugs.

But in hospitals worldwide ketamine has been standard kit for anesthesiologists and emergency physicians for decades.

It is one of the few drugs that can relieve pain, enable an anesthetic, and keep the circulation stable all at the same time.

💪 1. It doesn’t make you unconscious

This surprises many people.

Mivacurium doesn’t make you fall asleep.

Nor does it relieve pain.

It does only one thing: the muscles are temporarily unable to move.

That’s why mivacurium is always given together with an anesthetic and a painkiller.

Source: Miller’s Anesthesia; review of mivacurium.

🧠 2. The brain takes everything in – if no anesthetic were given

Mivacurium doesn’t act in the brain.

It only blocks the connection between nerve and muscle.

Without a hypnotic a person would therefore be awake but unable to move.

That’s why every general anesthetic always includes a drug that causes unconsciousness.

Source: Miller’s Anesthesia.

⚡ 3. It acts remarkably briefly

Most muscle relaxants act considerably longer.

Mivacurium, by contrast, is one of the short-acting ones.

After a usual dose the muscles relax for about 10 to 20 minutes.

After that, muscle strength returns on its own in most people.

Source: reviews of mivacurium.

🩸 4. The liver has almost nothing to do with it

Many drugs are broken down mainly in the liver.

Mivacurium is different.

It is broken down by an enzyme in the blood.

That means:

• The liver plays only a small role.
• Breakdown begins directly in the blood.
• That’s why the effect usually disappears quite quickly.

Source: Clinical Pharmacology Review.

🧬 5. Some people stay paralyzed much longer

There is a rare, usually inherited peculiarity.

In it, the enzyme that breaks down mivacurium works much more slowly, or not at all.

Then the muscle relaxation can last several hours instead of a few minutes.

This peculiarity is called pseudocholinesterase deficiency.

Fortunately it is rare – but anesthesiologists know it very well.

Source: review of mivacurium.

🫁 6. This is why breathing is always supported during anesthesia

As long as mivacurium is working, the breathing muscles relax too.

Breathing unaided would then no longer be possible.

That’s why a ventilator takes over breathing during the operation.

As soon as the effect wears off, the patient can breathe on their own again.

Source: Miller’s Anesthesia.

🎯 7. Ideal for short operations

Not every operation lasts several hours.

For short procedures a muscle drug with a short duration of action is often especially practical.

That’s exactly what mivacurium was developed for.

Source: review.

📈 8. More drug means not only a stronger, but also a longer effect

The higher the dose of mivacurium, the longer the muscles stay relaxed.

That’s why anesthesiologists calculate the amount very precisely and adjust it to body weight and the procedure.

Source: Clinical Pharmacology Review.

🌡️ 9. Injecting too fast can affect the circulation

If mivacurium is given very fast or in a high dose, the body can release histamine.

Histamine is a messenger substance made by the body that, among other things, widens the blood vessels.

As a result, blood pressure can briefly fall or the skin can flush.

That’s why mivacurium is usually injected slowly.

Source: Clinical Pharmacology Review.

👀 10. The body is paralyzed – often the eyes first

The small muscles in the face often react earlier than the large muscles in the arms and legs.

That’s why anesthesiologists often observe the effect with special measuring devices, rather than relying only on outward impression.

Source: Miller’s Anesthesia.

📟 11. Muscle strength is measured during the operation

Anesthesiologists don’t rely on gut feeling.

With small electrical impulses they regularly check how strongly the muscles still respond.

This measurement is called train-of-four, or TOF for short.

It shows precisely when muscle strength is returning.

Source: clinical studies of mivacurium.

🔄 12. It normally doesn’t build up in the body

Some drugs act longer and longer after prolonged use.

With mivacurium this is normally not the case.

As long as the enzyme in the blood works normally, the drug is broken down continuously.

As a result its effect stays nicely predictable.

Source: review.

🚫 13. It isn’t a painkiller

Many people think: „If my muscles can’t move, surely I won’t feel any pain either.“

That isn’t true.

Mivacurium only prevents muscle movement.

Pain has to be treated with other drugs.

Source: Miller’s Anesthesia.

⏱️ 14. Mivacurium used to be a real star

Before modern reversal agents for other muscle relaxants existed, mivacurium was especially popular.

Today it is used less often, because many longer-acting muscle relaxants can be reversed very quickly with drugs such as sugammadex.

Even so, mivacurium still has its place for certain short procedures.

Source: specialist reviews on the development of muscle relaxants.

🧪 15. The effect often wears off entirely on its own

The special thing about mivacurium is: in most patients no special reversal agent is needed at all.

As soon as the enzyme in the blood has done its work, muscle strength returns step by step.

It’s exactly this that makes mivacurium a remarkable drug to this day.

Source: Clinical Pharmacology Review.

🎯 Fun fact to finish

Many drugs first have to be laboriously processed by the liver.

Mivacurium takes the shortcut.

It is broken down directly in the blood – almost as if it says goodbye to itself.

That’s exactly why mivacurium is one of the shortest-acting muscle relaxants in modern anesthesia.

🌿 1. The name has a hidden meaning

The name ibuprofen sounds random – but it isn’t.

It is made up of several parts of its chemical structure:

• Ibu = isobutyl
• Pro = propionic acid
• Fen = phenyl ring

So the name describes how the molecule is built.

Source: U.S. Pharmacopeia (USP); PubChem – Ibuprofen.

🔥 2. It doesn’t only fight pain

Many people think ibuprofen is simply a painkiller.

In fact it can do three things at once:

• relieve pain
• lower fever
• reduce inflammation

It’s this anti-inflammatory effect in particular that sets ibuprofen apart from acetaminophen.

Source: ibuprofen prescribing information; Goodman & Gilman’s The Pharmacological Basis of Therapeutics.

🧪 3. It turns down the „pain alarm“

When we injure ourselves, the body produces so-called prostaglandins.

These are messenger substances that amplify pain, inflammation, and fever.

Ibuprofen slows their production.

You could say: it doesn’t repair the injury – but it turns down the volume of the pain alarm.

Source: Vane JR. Nature New Biology. 1971.

⏳ 4. It works faster than many think

After swallowing it usually takes only 30 to 60 minutes for ibuprofen to reach its strongest effect.

Liquid preparations or liquid-filled capsules can work a little faster still.

Source: ibuprofen prescribing information.

🍔 5. With or without food?

Many people take ibuprofen after eating as a matter of course.

This does protect the stomach a little. However, the drug can then also work a little later.

Anyone with a sensitive stomach is usually still better off taking it with a meal.

Source: ibuprofen prescribing information.

🤕 6. Why the stomach sometimes protests

The stomach forms a protective layer of mucus.

Prostaglandins help with this too.

Because ibuprofen inhibits these messengers, the stomach’s protection also becomes weaker.

That’s why stomach pain, ulcers, or bleeding can occur with prolonged or high-dose use.

Source: ibuprofen prescribing information; FDA.

❤️ 7. The heart can be affected too

Taken short-term, ibuprofen is considered well tolerated by most people.

But anyone taking high doses over a long period can have a slightly increased risk of cardiovascular disease.

That’s why ibuprofen should always be taken only as high and for as long as necessary.

Source: FDA Drug Safety Communication.

🌡️ 8. Why fever falls

Fever doesn’t arise simply by chance.

Certain messengers set the „body temperature“ higher in the brain – much like a thermostat.

Ibuprofen slows these messengers.

As a result the body returns to its normal temperature.

Source: Goodman & Gilman.

🦴 9. Helps against pain – but doesn’t speed up healing

Many people believe: „Once the pain is gone, the injury heals faster.“

Unfortunately that isn’t true.

Ibuprofen relieves symptoms and reduces inflammation.

The actual healing is still done by the body itself.

Source: ibuprofen prescribing information.

🩸 10. It makes the blood a little „slower“

Ibuprofen also affects the platelets.

These are small cells that stop bleeding.

The effect, however, is much shorter and weaker than with aspirin.

That’s why ibuprofen isn’t used to prevent heart attacks.

Source: FDA; prescribing information.

👶 11. Children may have ibuprofen too

Ibuprofen is one of the few painkillers already suitable for many children.

The dose is based on body weight, not age.

That’s why parents should never simply split or guess an adult dose.

Source: ibuprofen prescribing information; WHO.

💧 12. Drinking too little can become a problem

Our kidneys need a good blood supply to work properly.

With severe fluid loss – for example through high fever, vomiting, or diarrhea – ibuprofen can put extra strain on the kidneys.

That’s why you should drink enough when taking it, and seek medical advice with ongoing fluid loss.

Source: KDIGO Guidelines; prescribing information.

🧬 13. Everyone breaks ibuprofen down a little differently

Ibuprofen is processed mainly in the liver.

Enzymes help with this, and they work slightly differently from person to person.

That’s why the drug can act a little longer or shorter in some people than in others.

Source: PharmGKB; prescribing information.

🚫 14. More doesn’t automatically help more

Many people think: „If one tablet helps, two will surely help even better.“

That’s true only up to a point.

Above a certain dose the risk of side effects rises more steeply than the pain-relieving effect.

That’s why you should always stick to the recommended dose.

Source: ibuprofen prescribing information.

🌍 15. One of the most used medicines in the world

Since its introduction in the 1960s, ibuprofen has been taken billions of times.

Today it is one of the most important medicines against pain and fever worldwide.

Hardly any other painkiller is so well known and at the same time so versatile.

Source: WHO Model List of Essential Medicines; ibuprofen prescribing information.

🎯 Fun fact to finish

Many people call any painkiller simply „an ibuprofen.“

Yet there are big differences.

Ibuprofen, acetaminophen, and aspirin all work against pain – but they do so in quite different ways.

That’s exactly why doctors often deliberately choose the right painkiller depending on the condition.

🌍 1. Almost everyone knows acetaminophen

Acetaminophen is one of the most widely used medicines in the world.

Every day millions of people take acetaminophen – for headache, toothache, fever, or pain after an operation.

The World Health Organization (WHO) even lists it among the most important medicines.

Source: WHO Model List of Essential Medicines; acetaminophen prescribing information.

🧠 2. To this day nobody knows exactly how it works

That sounds astonishing.

Acetaminophen has been used for over 70 years.

Yet it still isn’t fully clear why it relieves pain and lowers fever.

Several mechanisms probably act at the same time – above all in the brain and spinal cord.

Research into this continues to this day.

Source: Graham GG et al. Inflammopharmacology. 2013.

🔥 3. It lowers fever – but barely inflammation

Many people think acetaminophen and ibuprofen are almost the same.

That isn’t true.

Both relieve pain and lower fever.

Ibuprofen is also markedly anti-inflammatory. Acetaminophen, by contrast, barely is.

That’s why it is especially good for pain or fever, but less so for strong inflammation.

Source: acetaminophen prescribing information; Goodman & Gilman.

❤️ 4. Gentler on the stomach than many other painkillers

Many painkillers can irritate the stomach or promote stomach ulcers.

Acetaminophen does so far less often at the recommended dose.

That’s exactly why it is often used when someone has a sensitive stomach or doesn’t tolerate other painkillers well.

Source: acetaminophen prescribing information.

👶 5. One of the most important medicines for children

Acetaminophen is one of the most widely used painkillers in children.

The right amount is based on body weight.

That’s why parents should never simply give half an adult tablet, but follow the dosage carefully.

Source: WHO; acetaminophen prescribing information.

🍷 6. Alcohol and acetaminophen aren’t a good combination

The liver breaks down both alcohol and acetaminophen.

Anyone who regularly drinks a lot of alcohol or has severe liver disease should therefore take acetaminophen only after medical advice.

In healthy adults, occasional use at the recommended dose is usually unproblematic.

Source: acetaminophen prescribing information.

⚠️ 7. More doesn’t help better

Many drugs become stronger at a higher dose.

With acetaminophen caution is especially important.

Even a marked overdose can severely damage the liver.

That’s why the recommended maximum daily dose should never be exceeded. And watch out: acetaminophen is also hidden inside many combination cold and pain products.

Source: acetaminophen prescribing information; FDA.

🧪 8. The liver has an emergency plan

When acetaminophen is broken down, a tiny amount of a substance is formed that can be toxic to the liver.

Fortunately our body has a natural defense.

A substance called glutathione normally renders this breakdown product harmless right away.

Only in an overdose does this protection eventually run out.

Source: Prescott LF. Paracetamol Overdose. 1983.

💉 9. There’s even an antidote

If someone has taken too much acetaminophen, there is an effective antidote.

It is called acetylcysteine.

It helps the liver rebuild its natural protection.

Given in time, it can often prevent severe liver damage.

Source: Prescott LF.; acetylcysteine prescribing information.

🤕 10. It isn’t a miracle cure

Acetaminophen works well against:

• headache
• toothache
• fever
• pain after operations

But it neither heals inflammation nor removes the actual cause of the pain.

It relieves the symptoms – the rest is done by the body.

Source: acetaminophen prescribing information.

🩺 11. It’s even given into the vein in the hospital

Many know acetaminophen only as a tablet or syrup.

But the drug also exists as an infusion.

After operations, or when patients aren’t allowed to swallow anything, it can be given directly into the vein.

Source: intravenous acetaminophen prescribing information (Ofirmev®).

🤝 12. It likes to work with other painkillers

Acetaminophen is often combined with other painkillers.

For example with:

• ibuprofen
• or opioids such as morphine

This often treats pain better, without needing very high amounts of any single drug.

Doctors call this multimodal pain therapy – different drugs working together.

Source: acute pain guidelines.

🧬 13. Everyone processes acetaminophen a little differently

The liver breaks acetaminophen down with the help of various enzymes.

These work slightly differently in each person.

That’s why the drug can be processed a little faster or slower in some people.

Source: PharmGKB; prescribing information.

🌡️ 14. Fever isn’t always bad

Acetaminophen can lower fever.

But that doesn’t mean every fever has to be treated right away.

Fever is often a natural defense response of the body against pathogens.

Whether treatment makes sense depends on how high the fever is and how the patient is doing.

Source: AAP Clinical Report – Fever in Children; WHO.

🏥 15. Indispensable for decades

Whether children’s hospital, dental office, ER, or operating room: acetaminophen is part of standard equipment almost everywhere.

Hardly any other painkiller is used so often worldwide.

That shows how reliable and versatile this medicine is.

Source: WHO Model List of Essential Medicines; acetaminophen prescribing information.

🎯 Fun fact to finish

Many people believe: „Acetaminophen is harmless because you can buy it over the counter.“

That’s only partly true.

At the correct dose, acetaminophen is one of the safest painkillers there is.

But precisely because it is so well tolerated, it’s sometimes forgotten that this medicine, too, can cause serious side effects if too much is taken – especially since it’s also hidden inside many cold and flu products.

So here too: the right dose makes all the difference.