Approved: 1 Jan 2014. Last amended: 3 Jul 2020.

15.1 General Anaesthesia

15.1.1 Intravenous anaesthetics

Recommended

  • Propofol 1%

    (10mg/ml): 20ml, 50ml

  • Ketamine

    (10mg/ml): 20ml

  • Ketamine

    (50mg/ml): 10ml

  • Ketamine

    (100mg/ml): 10ml

  • Thiopental sodium
  • Specific Indication

  • Propofol 1%

    (10mg/ml): 50ml prefilled syringe – Target Controlled Infusion

  • Propofol 2%

    (20mg/ml): 50ml – DCC only

  • Etomidate

    (2mg/ml): 10ml – Where cardiovascular stability is a particular concern. Note: a single dose of supplemental hydrocortisone is recommended (Etomidate suppresses adrenocortical function).

  • 15.1.2 Inhalational anaesthetics

    15.1.2.1 Volatile liquid anaesthetics

    Note: If high gas flows are needed during maintenance of anaesthesia (more than 500 ml/min) then isoflurane must be used due to the cost of desflurane and sevoflurane.

    Recommended

  • Desflurane
  • Isoflurane
  • Methoxyflurane

    Penthrox®

    For use in ED only

  • Sevoflurane
  • 15.1.2.2 Nitrous oxide

    Recommended

  • Nitrous oxide
  • 15.1.3 Antimuscarinic drugs

    Recommended

  • Atropine

    Injection

  • Glycopyrronium

    Injection

  • Hyoscine hydrobromide

    Injection

  • 15.1.4 Sedative and analgesic peri-operative drugs

    15.1.4.1 Benzodiazepines

    The use of high strength midazolam (5ml/ml, in 2ml and 10ml ampoules, or 2mg/ml in 5ml ampoules) should be restricted to general anaesthesia, intensive care, palliative care or other situations where the risk has been assessed. It is advised that flumazenil is available when midazolam is used to reverse the effects if necessary. Please see the NPSA Rapid Response Report.

    Recommended

  • Diazepam
  • Lorazepam
  • Midazolam
  • Temazepam
  • 15.1.4.2 Non-opioid analgesics

    Recommended

  • Ketorolac

    10mg/ml, 30mg/ml injection: 1ml

  • 15.1.4.3 Opioid analgesics

    Recommended

  • Alfentanil

    500mcg/ml injection: 2ml

  • Alfentanil

    5mg/ml injection: 1ml

  • Fentanyl

    50mcg/ml injection: 2ml, 10ml

  • Specific Indication

  • Remifentanil

    2mg, 5mg injection – Often indicated where cardiovascular stability is critically important or rapid recovery forms an integral part of the surgical procedure. Also used in maternity for PCA when epidural analgesia is contra-indicated and in DCC for sedation (5mg).

  • 15.1.4.4 Other drugs for sedation

    Specific Indication

  • Clonidine

    DCC, Post-op multimodal analgesia, Caudal use in orthopaedic surgery for children

  • Dexmedetomidine

    DCC only; restricted for the sedation of patients who need to remain responsive to verbal stimulation and for patients failing to wean from invasive ventilation with traditional management due to agitation.

  • 15.1.5 Neuromuscular blocking drugs

    15.1.5.1 Non-depolarising neuromuscular blocking drugs

    Recommended

  • Atracurium
  • Mivacurium
  • Rocuronium
  • 15.1.5.2 Depolarising neuromuscular blocking drugs

    Recommended

  • Suxamethonium
  • 15.1.6 Drugs for reversal of neuromuscular blockade

    15.1.6.1 Anticholinesterases

    Recommended

  • Neostigmine
  • Neostigmine with glycopyrronium
  • 15.1.6.2 Other drugs for reversal of neuromuscular blockade

    Specific Indication

  • Sugammadex

    Only to be used in the following circumstances:

    • Emergency reversal of rocuronium after failed intubation in order to wake patient.
    • Where there is concern about residual neuromuscular block (after rocuronium) post-operatively in patients with respiratory insufficiency who have already been reversed with a 5mg dose of neostigmine with glycopyrorronium. If possible discuss with a Consultant Anaesthetist.
    • For prompt reversal that would otherwise waste 30 minutes of theatre time (e.g. where a large dose of rocuronium has been used for a short procedure). If possible discuss with a Consultant Anaesthetist.

  • 15.1.7 Antagonists for central and respiratory depression

    Recommended

  • Flumazenil
  • Naloxone
  • 15.1.8 Drugs for malignant hyperthermia

    Recommended

  • Dantrolene
  • 15.2 Local Anaesthesia

    15.2.1 Lidocaine

    Recommended

  • Lidocaine 1% and 2%

    Injection

  • Lidocaine with adrenaline 1% / 1 in 200,000

    Injection

  • Lidocaine with adrenaline 2% / 1 in 200,000

    Injection

  • Lidocaine with adrenaline 2% / 1 in 80,000

    Cartridge – dental use

  • Lidocaine 2%

    Gel

  • Lidocaine 5%

    Ointment

  • Lidocaine 4%

    Cream (LMX 4®)

  • Lidocaine 2.5% and prilocaine 2.5%

    Cream (Emla®)

  • Lidocaine 2% and chlorhexidine 0.25%

    Gel (Instillagel®)

  • Lidocaine 10% (10mg / dose)

    Spray (Xylocaine®)

  • Lidocaine 4%

    Topical solution

  • Lidocaine 5% with phenylephrine 0.5%

    Topical solution

  • Lidocaine 4%, Adrenaline 0.1%, Tetracaine 0.5% gel (LAT gel: unlicensed)

    Only for use in children or needle phobic adults

  • Lidocaine 5% medicated plaster (Ralvo®)

    Pain Team initiation only

  • 15.2.2 Bupivacaine

    Recommended

  • Bupivacaine with adrenaline 0.25% / 1 in 200,000

    Injection: 10ml

  • Bupivacaine with adrenaline 0.5% / 1 in 200,000

    Injection: 10ml

  • Bupivacaine with glucose 5mg/80mg/ml

    Injection (Marcain Heavy®): 4ml

  • 15.2.3 Chloroprocaine

    Recommended

  • Chloroprocaine 10 mg/ml solution for injection

    Ampres®

  • 15.2.4 Levobupivacaine

    Recommended

  • Levobupivacaine 0.25% and 0.5%

    Injection: 10ml

  • Levobupivacaine 0.125%

    Infusion: 200ml

  • Levobupivacaine with fentanyl 0.1%/2mcg/ml

    Infusion: 250ml, 500ml

  • Levobupivacaine with fentanyl 0.125%/4mcg/ml

    Infusion: 500ml

  • 15.2.5 Prilocaine

    Recommended

  • Prilocaine 1%

    Injection: 50ml

  • Prilocaine with felypressin 30mg/0.03 unit/ml

    Cartridge: 2.2ml

  • Prilocaine with glucose 20mg/60mg/ml

    Injection (Prilotekal®): 5ml

  • 15.2.6 Ropivacaine

    Recommended

  • Ropivacaine with adrenaline 400mg/1mg

    Infusion: 201ml (unlicensed)

  • Ropivacaine with adrenaline and ketorolac

    Infusion: 203ml (unlicensed)

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