Modern anesthesia is built on a potent group of pharmacologic agents that provide unconsciousness, amnesia, analgesia, and immobility in a controlled and reversible manner. In most adult cases, intravenous drugs such as propofol, etomidate, barbiturates, benzodiazepines, and ketamine are used to induce anesthesia because of their rapid onset and predictable effects. Propofol is favored for its smooth induction and antiemetic qualities, but can cause hypotension, whereas etomidate preserves hemodynamic stability at the cost of transient adrenal suppression. Methohexital remains uniquely suited for electroconvulsive therapy due to its pro-convulsant properties, which are desired for this procedure, and benzodiazepines are widely used for anxiolysis and amnesia but may prolong recovery, particularly in older or frail patients. Ketamine provides dissociative anesthesia, preserving airway reflexes and augmenting sympathetic tone, making it valuable in trauma, hypovolemia, and cases of bronchospasm. For maintenance of general anesthesia, inhalational agents such as sevoflurane, desflurane, and isoflurane are employed in most patients. Nitrous oxide is useful as an adjunct for its analgesic properties, but should be avoided when closed gas spaces are present (e.g., small bowel obstruction and pneumothorax). All gaseous anesthesia agents, except nitrous oxide, are recognized triggers for malignant hyperthermia. Neuromuscular blocking agents (NMBAs)complement hypnotics and volatiles by enabling airway control and providing surgical relaxation. Succinylcholine remains the fastest option for rapid sequence induction but carries risks, including hyperkalemia and malignant hyperthermia susceptibility. Non-depolarizing agents such as rocuronium, vecuronium, and cisatracurium are widely used for routine cases, with cisatracurium preferred in organ failure because of its unique metabolism. Safe recovery requires quantitative neuromuscular monitoring and timely reversal with either acetylcholinesterase inhibitors or sugammadex. It is important to remember that NMBAs lack any sedative and amnestic properties. By understanding the pharmacology, applications, and complications of these agents, internists can better appreciate anesthesiologists’ decision-making and anticipate perioperative physiologic challenges and postoperative complications.