General anesthetics are usually gas or vapor and are administered by inhalation. Anesthesiology is a highly specialized field, and the administration of a general anesthetic should never be undertaken without the supervision of a medical officer. There may be times, however, when you, as a Hospital Corpsman, are called upon to assist by administering general anesthesia. You should, therefore, acquaint yourself with the most commonly used general anesthetics and their respective properties.

Local anesthetics produce loss of sensation to pain in a specific area or locality of the body, without loss of consciousness or mental capacity. The majority of these drugs are administered parenterally or topically.

See appendix IV, pages 17 and 18, for a listing of several of the most commonly used anesthetics.

OXYTOCICS.-Oxytocics are drugs that produce a rhythmic contraction of the uterus. Their action is selective for the uterus, although other smooth muscles are affected. (See appendix IV, page 18.)

Biological Agents
Biological agents are prepared from living organisms or their products. The chief purpose served by these preparations in the Navy is the immunization of personnel against infectious disease. They may, however, be used in the treatment of disease or act in a diagnostic capacity. Dosage and routes of administration are described in BUMEDINST6320.1.

Biologicals include serums, viruses, toxins, antitoxins, antigens, and bacterial vaccines.

Manufacturers of these products must be licensed by the Secretary of the Treasury. Their products are style="mso-spacerun: yes"> monitored by the U.S. Public Health Service.

The label that must be placed on each package will bear the name, address, and license number of the manufacturer. It will also list the name of the product, lot number, date of manufacture (or expiration), period of potency, and the minimum potency (or the fact that there is no standard of potency).

FACTORS TO BE REMEMBERED CONCERNING BIOLOGICALS.-Most immunizing agents that are used in routine procedures may be obtained through normal supply channels. (Yellow fever vaccine must be ordered from activities that have been designated as supply points for this biological.) Biologicals must be stored in a cool, dry, and preferably dark place. (Yellow fever vaccine must be maintained in a frozen state until prepared for use.) All biological products should be examined periodically, and a thorough examination for deterioration will be held immediately preceding their use.

EXAMINATIONS OF PARENTERAL SOLUTIONS.-Solutions are examined at least three times at the activity at which they are ultimately used:

1. Upon receiving the solution.
2. Periodically while in storage.
3. Immediately preceding use. Parenteral solutions, unless the label states otherwise, must be free of turbidity or undissolved material. All solutions should be inverted and gently swirled to bring any sediment or particulate matter into view. A well-illuminated black or white background will facilitate this examination.

Parenteral solutions may be unfit for use because of

deterioration from prolonged storage,
accidental contamination occurring upon original packaging, or

defects that may develop in containers or seals.

There is no set rule that can be applicable in regards to any of these factors. Therefore, to ensure suitability for use, a regimented program of inspection is necessary.

IMMUNIZING AGENTS.-Following is a descriptive list of the most common immunizing agents used by the U.S. armed forces to inoculate military personnel against disease.

Diphtheria Antitoxin.-Diphtheria antitoxin is a transparent or slightly opalescent liquid, nearly colorless, and has a very slight odor due to its preservative. It is a sterile solution of antitoxic substances obtained from the blood serum or plasma of a healthy horse immunized against diphtheria toxin.

Tetanus Antitoxin.-Tetanus antitoxin is a sterile solution of antitoxic substances that are usually obtained from the blood serum or plasma of a healthy horse that has been immunized against tetanus toxin or toxoid. Tetanus antitoxin contains not more than 0.4 percent cresol or 0.5 percent phenol as a preservative. It is slightly opalescent with a yellow, brown, or greenish color, depending upon the manufacturer. There will be a slight odor of the preservative used.

Tetanus Toxoid.-Tetanus toxoid is a sterile solution of the growth of the tetanus bacillus, Clostridium tetani, which has been treated with formaldehyde. It is a brownish yellow or slightly turbid liquid, usually having the distinctive odor of formaldehyde.

Alum Precipitated Diphtheria and Tetanus Toxoids and Pertussis Vaccines Combined (DPT).- This is a markedly turbid, whitish liquid. It is nearly odorless or may have a slight odor of the preservative. It is a sterile suspension of the precipitate obtained by treating the mixture of diphtheria toxoid, tetanus toxoid, and pertussis vaccine with alum and combining in such proportions as to ensure an immunizing dose of each in the total dosage as listed on the label.

Cholera Vaccine.-Cholera vaccine is a suspension of killed cholera, Vibrio comma, in a suitable diluent, usually normal saline. The vaccine presents a turbid appearance, and there may be a slight odor due to the preservative. On storage, autolysis may occur so that the vaccine may become almost as clear as water.

Poliovirus Vaccine.-There are two kinds of polio vaccine: Inactivated poliovirus vaccine (IPV), which is the shot recommended in the United States today, and a live, oral polio vaccine (OPV), which consists of drops that are swallowed. Until recently, OPV was recommended for most children in the United States. OPV helped us rid the country of polio, and it is still used in many parts of the world.

Both vaccines give immunity to polio, but OPV is better at keeping the disease from spreading to other people. However, for a few people (about one in 2.4 million), OPV actually causes polio. Since the risk of getting polio in the United States is now extremely low, experts believe that using oral polio vaccine is no longer worth the slight risk, except in limited circumstances.

Inactivated poliovirus vaccine (IPV) must be stored between 2 B C and 8 B C (24 B F and 46 B F). The vaccine is clear and colorless, and it should be administered intramuscularly or subcutaneously.

ORAL POLIOVIRUS VACCINE MUST NEVERBEADMINISTERED PARENTERALLY. To maintain potency, OPVmust be stored in the freezer compartment of the refrigerator. It should be noted that certain forms of this vaccine will remain fluid at temperatures above -14 B C. If frozen, after thawing, agitate the vaccine to ensure homogeneity of its contents before use. Once the temperature rises above 0 B C, the vaccine MUST BE USED WITHIN 7 DAYS. During this period, it must be stored below 10 B C.

Yellow Fever Vaccine.-This vaccine is a dull, light orange, flaky or crust-like desiccated mass that requires rehydration immediateley before use. It must be stored at or below 0 B C until rehydration is effected with sterile sodium chloride injection USP.

Plague Vaccine.-The vaccine for plague is a sterile suspension of killed plague bacilli in an isotonic solution. The strain of bacilli used has been selected for its high antigenic efficiency. The vaccine is a turbid, whitish liquid with little or no odor. The presence of any precipitate is reason to suspect contamination.

Influenza Virus Vaccine.-The influenza virus vaccine is prepared from the allantoic fluid of incubated fertile hen eggs. It is a slightly hazy fluid, the result of minute amounts of egg protein. Its color varies from gray to very faint red, depending upon the method of manufacture.

The duration of immunity is probably no longer than a few months, which necessitates repeating the inoculation before the expected seasonal occurrence.

Do not inoculate individuals who are known to be sensitive to eggs or egg products, or personnel suffering from upper respiratory infections.

Dried Smallpox Vaccine.-This vaccine is prepared directly from calf lymph, purified, concentrated, stabilized, and dried by lyophilization. Dried smallpox vaccine is much more stable than the conventional liquid. When stored at or below 25 E C, it retains its full potency for 18 months. When reconstituted and stored below 4 E C (preferably 0 E C), it retains its full potency for 3 months.

Smallpox is no longer considered to be a threat to world health, and immunizations against it are no longer required. However, a general knowledge of the disease and its prevention is important.

Anthrax Vaccine.-The anthrax vaccine for humans licensed for use in the United States is a cell-free filtrate vaccine (using dead as opposed to live bacteria). Inspect the vaccine visually for particulate matter and discoloration before administration. Anthrax vaccine should be stored between 2 E C and 8 E C (refrigerator temperature); it must not be frozen. Do not use the vaccine if the expiration date listed on the package has expired.

The vaccine should be administered only to healthy men and women from 18 to 65 years of age. It should NOT be administered to pregnant women.

The immunization consists of three subcutaneous injections given 2 weeks apart, followed by three additional subcutaneous injections given at 6, 12, and 18 months. Annual booster injections of the vaccine are required to maintain immunity.