Approved: 1 Jan 2014. Last amended: 3 Jul 2020.
15.1 General Anaesthesia
15.1.1 Intravenous anaesthetics
(10mg/ml): 20ml, 50ml
(10mg/ml): 50ml prefilled syringe – Target Controlled Infusion
(20mg/ml): 50ml – DCC only
(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
188.8.131.52 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.
For use in ED only
184.108.40.206 Nitrous oxide
15.1.3 Antimuscarinic drugs
15.1.4 Sedative and analgesic peri-operative drugs
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.
220.127.116.11 Non-opioid analgesics
10mg/ml, 30mg/ml injection: 1ml
18.104.22.168 Opioid analgesics
500mcg/ml injection: 2ml
5mg/ml injection: 1ml
50mcg/ml injection: 2ml, 10ml
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).
22.214.171.124 Other drugs for sedation
DCC, Post-op multimodal analgesia, Caudal use in orthopaedic surgery for children
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
126.96.36.199 Non-depolarising neuromuscular blocking drugs
188.8.131.52 Depolarising neuromuscular blocking drugs
15.1.6 Drugs for reversal of neuromuscular blockade
Neostigmine with glycopyrronium
184.108.40.206 Other drugs for reversal of neuromuscular blockade
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
15.1.8 Drugs for malignant hyperthermia
15.2 Local Anaesthesia
Lidocaine 1% and 2%
Lidocaine with adrenaline 1% / 1 in 200,000
Lidocaine with adrenaline 2% / 1 in 200,000
Lidocaine with adrenaline 2% / 1 in 80,000
Cartridge – dental use
Cream (LMX 4®)
Lidocaine 2.5% and prilocaine 2.5%
Lidocaine 2% and chlorhexidine 0.25%
Lidocaine 10% (10mg / dose)
Lidocaine 5% with phenylephrine 0.5%
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
Bupivacaine with adrenaline 0.25% / 1 in 200,000
Bupivacaine with adrenaline 0.5% / 1 in 200,000
Bupivacaine with glucose 5mg/80mg/ml
Injection (Marcain Heavy®): 4ml
Chloroprocaine 10 mg/ml solution for injection
Levobupivacaine 0.25% and 0.5%
Levobupivacaine with fentanyl 0.1%/2mcg/ml
Infusion: 250ml, 500ml
Levobupivacaine with fentanyl 0.125%/4mcg/ml
Prilocaine with felypressin 30mg/0.03 unit/ml
Prilocaine with glucose 20mg/60mg/ml
Injection (Prilotekal®): 5ml
Ropivacaine with adrenaline 400mg/1mg
Infusion: 201ml (unlicensed)
Ropivacaine with adrenaline and ketorolac
Infusion: 203ml (unlicensed)