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15.1 General anaesthetics

15.1.1 Intravenous anaesthetics

Thiopental (Thiopentone) sodium
Etomidate Lipuro
Ketamine - see section 4.7.3 for Neuropathic pain
Propofol 1%
Propofol-lipuro

Note:

Propofol-lipuro has been added to the formulary for induction of Anaesthesia in infants and chldren aged 1 month - 3 years only.

 

15.1.2 Inhalational anaesthetics

Isoflurane
Desflurane
Sevoflurane (for induction and shore procedures only)
Nitrous oxide

 

15.1.3 Antimuscarinic drugs

Atropine sulphate injection
Glycopyrronium bromide injection
Glycopyrronium tablets (unlicensed) for excessive salivation
Glycopyrronium + Hyoscine hydrobromide injection

 

15.1.4.1 Anxiolytics and neuroleptics

Clonidine suspension 100micrograms/5ml (unlicensed) for perioperative sedation/anxiolysis in paediatrics
Diazepam tablets, syrup, injection, rectal solution
Lorazepam tablets, injection
Midazolam injection
Temazepam tablets, syrup

Note:

MHRA Drug Safety Update October 2007

 

15.1.4.2 Non-opioid analgesics

Ketorolac trometamol injection - see note
Piroxicam melt

Note:

Ketorolac is licensed for use in the short-term management of moderate to severe acute post-operative pain only. Treatment should be initiated only in hospital. Maximum duration of treatment should not exceed 7 days for tablets, or 2 days for continuous daily dosing with intravenous or intramuscular formulations.

 

15.1.4.3 Opioid analgesics

Alfentanil injection
Fentanyl injection
Fentanyl 2micrograms/ml in bupivacaine 0.1% (Epidural) - unlicensed
Remifentanil injection

Note:

Remifentanil is for use in patient controlled analgesia in labour where epidural is contraindicated and pethidine is inappropriate or failed. It has also been approved by D & T for for use by consultant anaesthetist in maxillofacial, ENT and head and neck surgery in operating theatres only.

 

15.1.4.4 Other drugs for sedation

Clonidine injection
Dexmedetomidine injection

Note:

Dexmedetomidine is for use only in the following circumstances:

1. Avoiding tracheostomy due to agitation or ventilator asynchrony with appropriate trial of regimens of conventional sedative agents either as sole agents or in combination as appropriate.

2. Those patients with a tracheostomy where conventional sedation regimens do not allow weaning from mechanical ventilation due to agitation or ventilator asynchrony on waking.

Both situations must be consultant initiated and only "in hours".

 

15.1.5 Muscle relaxants

Atracurium besylate injection
Cisatracurium injection (see note)
Mivacurium injection (short surgical procedures only)
Rocuronium injection (alternative to suxamethonium + vecuronium)
Suxamethonium injection

Note – cisatracurium is reserved for use in patients with severe Acute Respiratory Distress Syndrome (ARDS). Click here for ARDS in ICU guidelines.

 

15.1.6 Anticholinesterases used in anaesthesia

Neostigmine methilsulphate injection
Sugammadex injection (for rapid reversal of neuromuscular blockade after rocuronium in rapid sequence induction or bariatric surgery)

 

15.1.7 Antagonists for central and respiratory depression

Doxapram injection, IV infusion
Flumazenil injection
Naloxone injection - see note 

Note – Naloxone: There have been reports of life-threatening, as well as fatal, acute withdrawal syndrome from unnecessary or excessive doses of naloxone given to patients on long-term opioid treatment. A Q&A document has been produced giving guidance on appropriate dosing of naloxone.

 

15.1.8 Drugs for malignant hyperthermia

Dantrolene sodium injection - use filter needle in preparation as risk of undissolved crystals with iv solution - see MHRA drug safety update July 2014

 

For link to the BNF section: 15.1 General anaesthesia