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 Formulary Chapter 15: Anaesthesia - Full Chapter
Notes:
The development of this chapter for the George Eliot Formulary is in progress
 Details...
15.01  General anaesthesia
15.01.01  Intravenous anaesthetics
15.01.01  Barbiturates
Thiopental
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Red SO
  • Available as 500mg injection
 
   
15.01.01  Other intravenous anaesthetics
Etomidate
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Formulary
Red SO
  • Available as 20mg/10ml injection
  • Etomidate should only be administered by, or under the direct supervision of, personnel experienced in its use, with adequate training in anaesthesia and airway management, and when resuscitation equipment is available
 
   
Controlled Drug Ketamine injection (Ketalar)
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Formulary
Red SO
  • Available as 500mg/10mL injection
  • Ketamine should only be administered by, or under the direct supervision of, personnel experienced in its use, with adequate training in anaesthesia and airway management, and when resuscitation equipment is available
 
   
Propofol
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Formulary
Red SO
  • Available as:
    • 1000mg/100mL
    • 200mg/20mL
    • 500mg/50mL
  • Propofol should only be administered by, or under the direct supervision of, personnel experienced in its use, with adequate training in anaesthesia and airway management, and when resuscitation equipment is available
 
   
15.01.02  Inhalational anaesthetics to top
15.01.02  Volatile liquid anaesthetics
Isoflurane
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Red SO
  • Available as inhalation vapour (250mL bottle)
 
   
Sevoflurane
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Red SO
  • Available as volatile liquid (250mL bottle)
 
   
15.01.02  Nitrous oxide
15.01.03  Antimuscarinic drugs
Atropine
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Formulary
Red SO
  • Available as:
    • 600micrograms/1mL
    • 1mg/5mL (for cardiac boxes)
 
   
Glycopyrronium
(injection)
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Formulary
  • Available as:
    • 200mcg/mL injection
    • 600mcg/3mL injection
 
   
Hyoscine Hydrobromide
(injection)
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Formulary
  • Available as:
    • 400mcg/mL
    • 600mcg/mL
 
   
15.01.04  Sedative and analgesic peri-operative drugs
15.01.04.01  Benzodiazepines to top
15.01.04.01  Benzodiazepines
 note 

Benzodiazepines possess useful properties for pre-medication including relief of anxiety, sedation and amnesia; short-acting benzodiazepines taken by mouth are the most common premedicants. Benzodiazepines are also used in intensive care units for sedation, particularly in those receiving assisted ventilation. Flumazenil is used to antagonise the effects of benzodiazepines.

Diazepam is used to produce mild sedation with amnesia. It is a long-acting drug with active metabolites and a second period of drowsiness can occur several hours after its administration. Temazepam is given by mouth for premedication and has a shorter duration of action and a more rapid onset than oral diazepam; anxiolytic and sedative effects last about 90 minutes although there may be residual drowsiness. Lorazepam produces more prolonged sedation than temazepam and it has marked amnesic effects. Midazolam is a water-soluble benzodiazepine that is often used in preference to intravenous diazepam; recovery is faster than from diazepam, but may be significantly longer in the elderly, in patients with low cardiac output, or after repeated dosing.

Diazepam
(pre-med)
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Formulary
  • Available as:
    • Tablets 2mg & 10mg
    • Injection 10mg/2mL
    • Oral solution 2mg/5mL
  • See Chapter 4 for rectal use in epilepsy
 
   
Lorazepam
(pre-med)
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Formulary
  • Available as:
    • Injection 4mg/mL
    • Tablets
  • Tablets will dissolve under the tongue if the patients has a sufficiently moist mouth and tablets can be dispersed in water
 
   
Midazolam
(pre-med)
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Formulary
  • Available as injection
    • 10mg/2mL (palliative care/EoL)
    • 10mg/5mL
    • 5mg/5mL
  • See Chapter 4 for buccal use in epilepsy
 
   
Controlled Drug Temazepam
(pre-med)
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Formulary
  • Available as tablets
 
   
15.01.04.02  Non-opioid analgesics
Ketorolac (Toradol)
(postoperative pain)
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Formulary
  • Available as injection 30mg/mL
 
   
15.01.04.03  Opioid analgesics
 note 

Opiod analgesics given in small doses before or with induction reduce the dose requirement of some drugs used during anaesthesia. Alfentanil, fentanyl and remifentanyl are particularly useful because they act within 1-2 minutes and have short duration of action.

Controlled Drug Alfentanil
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Formulary
Red SO
  • Available as injection 1mg/2mL & 5mg/10mL
 
   
Controlled Drug Fentanyl
(injection)
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Formulary
Red SO
  • Available as injection 0.1mg/2mL
 
   
Controlled Drug Remifentanil
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Formulary
Red SO
  • Available as injection 1mg & 5mg
 
   
15.01.04.04  Other drugs for sedation
Dexmedetomidine  (Dexdor)
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Formulary
Red SO
  • Available as injection 200mcg/2mL & 400mcg/2mL
  • Dexmedetomidine should only be administered by, or under the direct supervision of, personnel experienced in its use, with adequate training in anaesthesia and airway management.
 
   
15.01.05  Neuromuscular blocking drugs to top
15.01.05  Non-depolarising muscle relaxants
Atracurium Besilate (Tracrium)
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Formulary
Red SO
  • Available as injection
 
   
Mivacurium Chloride (Mivacron)
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Formulary
Red SO
  • Available as injection
 
   
Rocuronium Bromide (Esmeron)
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Formulary
Red SO
  • Available as injection
 
   
15.01.05  Depolarising muscle relaxants
Suxamethonium Chloride
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Formulary
Red SO
  • Available as injection
 
   
15.01.06  Drugs for reversal of neuromuscular blockade
15.01.06  Anticholinesterases
Neostigmine
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Formulary
Red SO
  • Available as injection
 
   
Neostigmine with Glycopyrronium
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Formulary
Red SO
  • Available as injection
 
   
15.01.06  Other drugs for reversal of neuromuscular blockade to top
Sugammadex (Bridion)
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Formulary
Red SO
  • Available as injection
 
   
15.01.07  Antagonists for central and respiratory depression
Doxapram (Dopram)
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Formulary
Red SO
  • Available as injection
 
   
Flumazenil (Anexate)
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Formulary
Red SO
  • Available as injection
 
   
Naloxone
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Formulary
Red SO
  • Available as injection
 
   
15.01.08  Drugs for malignant hyperthermia
Dantrolene Sodium (Dantrium Intravenous)
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Formulary
Red SO
  • Available as injection
 
   
15.02  Local anaesthesia
Chloroprocaine Hydrochloride 10mg/ml (Ampres )
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Formulary
Amber SC

Ampoules

 
   
15.02  Articaine
15.02  Bupivacaine to top
Bupivacaine hydrochloride (Marcain)
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Formulary
Red SO
  • Available as 0.25% & 0.5% injection
 
   
Bupivacaine Hydrochloride with Glucose (Marcain Heavy)
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Formulary
Red SO
  • Available as injection
 
   
Controlled Drug Bupivacaine with Fentanyl
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Formulary
Red SO
  • Available as injection (bupivacaine 0.125% with fentanyl 2mcg/mL 240mL bag)
 
   
15.02  Levobupivacaine
Levobupivacaine (Chirocaine)
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Formulary
Red SO
  • Available as:
    • 0.25% (2.5mg/1mL) injection
    • 0.5% (5mg/1mL) injection
    • 0.75% (7.5mg/1mL) injection
 
   
Controlled Drug Levobupivacaine with Fentanyl
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Formulary
Red SO
  • Available as levobupivacaine 0.1% with fentanyl 2mcg/mL 100mL bag - Epidural
 
   
15.02  Lidocaine
Lidocaine
(topical solution)
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Formulary
  • Available as 4% topical solution 25mL
 
   
Lidocaine
(ointment)
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Formulary
  • Available as 5% ointment 15g
 
   
Lidocaine
(injection)
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Formulary
  • Available as 1% & 2% injection
 
   
Lidocaine
(spray)
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Formulary
  • Available as 10mg per actuation spray
 
   
Lidocaine 2.5% with Prilocaine 2.5% (EMLA)
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Formulary
  • Available as cream 5g and 30g
  • Contraindicated in child less than 37 weeks corrected gestational age
 
   
Lidocaine 5% and Phenylephrine 0.5%
(topical solution)
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Formulary
  • Available as topical solution with nasal applicator
 
   
Lidocaine with Adrenaline (Lignospan)
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Formulary
  • Available as lidocaine 2% with adrenaline 1 in 80000 injection
 
   
Lidocaine with Adrenaline (Xylocaine)
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Formulary
  • Available as:
    • lidocaine 1% with adrenaline 1 in 200000 injectin
    • lidocaine 2% with adrenaline 1 in 200000 injection
 
   
Lidocaine2% with Chlorhexidine 0.25% (Instillagel)
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Formulary
  • Available as gel 6mL and 11mL
 
   
15.02  Mepivacaine
15.02  Prilocaine
Prilocaine Hydrochloride
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Formulary
  • Available as 1% and 2% injection
 
   
15.02  Procaine to top
15.02  Ropivacaine
Ropivacaine 0.2% and 10ml of 0.75% in 200ml infusion bag
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Formulary
Amber SC

At George Eliot Hospital there has been a surge in regional anaesthesia and more and more patients are being offered regional anaesthesia for their procedures. The advantage of procedures being carried out under regional block is that they don’t need to sit in recovery bay and can be discharged faster with a much quicker recovery rate.

 

Ropivacaine offers a faster return of Motor function with effective onset and duration of sensory block. A faster return of motor function will allow patients to mobilise faster therefore leading to a quicker discharge time and will represent a significant cost saving.

 

There are specific orthopaedic procedures such as upper limb trauma cases, where consultant Orthopaedic surgeons are requesting local anaesthesia blocks which provide only sensory analgesia with little or no motor block, this enables surgeons to assess motor power of the upper limbs immediately following surgery.

 

Nerve catheters are now also in use on wards for abdominal surgery and rib fractures and this will allow patients to mobilise faster leading to a quicker recovery time, reduced risk of DVT and shorter hospital stay.

 

George Eliot Hospital NHS Trust are currently in the process of developing a method for undertaking total knee replacement as a day case procedure, Ropivacaine would be most suitable for thi.

 

  1. BMC Anesthesiol. 2019 Jun 29:19(1): 114. Doi 10.1186/s12871-019-0787-6

Continuous Adductor Canal Block used for postoperative pain relief after medial Unicondylar Knee Arthroplasty: a randomised, double blind, placebo controlled trial.

 

  1. J Anaesthesiol Clin Pharmacol. 2019 Jan-Mar:35(1):41-46. doi: 10.4103/joacp.JOACP_70_18.

The estimation of minimum effective volume of 0.5% Ropivacaine in ultrasound-guided interscalene brachial plexus nerve block: A clinical trial.

 

  1. J Clin Diagn Res. 2015 Jan; 9(1): UCO1-UC06. Comparison between Bupivacaine and Ropivacaine in

patients undergoing forearm surgeries under axillary brachial plexus block: A prospective randomised study Anupreet Kaur¹, Raj Bahadur Singh², R.K.Tripathi², and Sanjay Choubey²

 
   
15.02  Tetracaine
Tetracaine (Amethocaine) (Ametop)
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Formulary
  • Available as 4% gel
  • Licensed from > 1month old
 
   
15.02  Other local anaesthetics
Ethyl Chloride (Axongesic Spray)
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Formulary
  • Available as spray
 
   
Mepivacaine (Scandonest Plain)
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Formulary
  • Available as 3% injection
 
   
 ....
 Non Formulary Items
Propofol 2% injection in 50ml
(Only for Theatres and ITU)

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Non Formulary
Amber SC

50ml vial

 
  
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
click to search medicines.org.uk
Link to adult BNF
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Link to children's BNF
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Link to SPCs
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Red SO

SPECIALIST ONLY - These drugs are deemed to be not appropriate for prescribing by GPs. Specialists should not ask GPs to prescribe these drugs.   

Green SI

SPECIALIST INITIATED - These drugs must be initiated, i.e. the first dose prescribed, by the specialist and then may be continued when appropriate by the patients GP following communication from the specialist.   

Green SA

SPECIALIST ADVISED Specialists may simply advise a patients GP to initiate these drugs themselves after they have made an initial assessment.   

Amber SC

SHARED CARE - Responsibility for prescribing may be transferred from secondary to primary care with the agreement of an individual GP and when agreed shared care arrangements have been established. The specialist MUST stabilize the patient before asking for care to be transferred. Only specialists should initiate these drugs. Prescribing should be transferred to GPs according to an Shared Care Agreement [SCA]   

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