Disclaimer: This article is intended solely for informational and educational purposes only. It does not constitute medical advice.

Although anesthesia was developed for use in surgery and is primarily associated with procedural medicine, its use has expanded outside the operating room. Non-operating room anesthesia provides sedation and analgesia for painful or otherwise uncomfortable procedures in radiology, gastrointestinal imaging, cardiac catheterization, and more.¹ The increasing use of anesthesia outside the operating room demonstrates how anesthetics can be adapted to different environments and demands. Anesthesia can also be utilized outside clinical settings and medicine altogether, since its effects on pain, movement, and stress serve important practical purposes.  

In modern combat settings, delayed medical evacuation can result in injured personnel without access to specialist care. Regional anesthesia can provide prolonged, effective analgesia by blocking pain signals from specific nerves. Unlike systemic opioids, regional anesthesia can preserve consciousness, airway reflexes, and general situational awareness, enabling greater patient cooperation and lower monitoring requirements during evacuation and treatment.² Despite these tactical and logistical advantages, regional anesthesia remains largely underused; in a 2019 survey, only 20% of French military physicians reported using regional anesthesia during deployment. Similarly, a 2024 survey of US Special Operations medics found that 83% had no training with regional anesthesia, and over half were entirely unfamiliar with multimodal analgesia.³ 

The use of anesthesia in aquaculture is an interesting application of anesthetic agents outside the field of medicine. Fish are highly susceptible to fatal stressors during handling, transport, harvest, and other similar procedures. By immobilizing the animals, lowering their metabolic activity, and reducing their oxygen consumption, anesthetics can reduce this stress and decrease the risk of injury. Different anesthetics can have significant differences in effectiveness depending on species, size, temperature, water chemistry, and exposure time. For example, anesthesia can be induced in salmonids when immersed in just 25–50 mg/L of tricaine methanesulfonate, also known as MS-222, while channel catfish require 100–250 mg/L for full sedation.⁴ Only certain agents are currently approved for food fish, and lengthy withdrawal periods may additionally limit their use immediately before market. 

Fish absorb anesthesia directly through their gills, so factors such as temperature, oxygen levels, pH, and drug accumulation can all determine effectiveness and survival. As such, anesthesia delivery must account for an environment that is fundamentally different from that of human medicine. Proper administration can facilitate routine aquaculture procedures, as well as the large-scale transport and handling of fish.⁴  

The uses of anesthesia have expanded significantly since its early development and now include multiple areas outside the traditional operating room and medicine altogether. In combat medicine, regional anesthesia can provide effective pain control while preserving alertness and reducing opioid reliance. In aquaculture, anesthetics can reduce stress and injury during handling and transport. Further research and training can help expand the applications of anesthesia beyond conventional medical practice while maintaining safety and effectiveness across its use in environments with very different demands.  

References 

1. Youn AM, Ko YK, Kim YH. Anesthesia and Sedation Outside of the Operating Room. Korean Journal of Anesthesiology2015;68(4):323. 10.4097/kjae.2015.68.4.323  

2. Laitselart P, Hellander S, Josse F, et al. Regional Anaesthesia in Combat Settings: A Position Paper from Military Physicians. BMJ Military Health. 2025;172(3):203-206. 10.1136/military-2025-002988 

3. Hetzler MR. Use of Loco-regional Anesthesia in Austere Environments: A Review by and for Special Forces Medics. Journal of Special Operations Medicine. 2024;24(3):90. 10.55460/yuzf-3sf0 

4. Coyle, SD, Durborow, RM, Tidwell, JH. Anesthetics in Aquaculture. Texas: Southern Regional Aquaculture Center. 2004; 3900:1-6.