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BNSSG Adult Joint Formulary

15.1 General Anaesthesia

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Last edited: 16-02-2024

First line drugs

Second line drugs

Specialist drugs

Secondary care drugs

Anaesthetics (General, intravenous)

Propofol 1% (10mg/mL) (TLS Red)

Etomidate (TLS Red)

Thiopental sodium (TLS Red)

Specific Indications: (TLS Red)

Propofol 2% (20mg/mL)

Methohexitone

Named patient for ECT

Anaesthetics (Volatile liquid)

Nitrous oxide (TLS Red)

Volatile halogenated anaesthetics

Desflurane (TLS Red)

Only in ultra low-flow closed circuit breathing systems (typical total gas flow 500mL or less) for surgery anticipated to last over 1 hour

Isoflurane (TLS Red)

Sevoflurane (TLS Red)

15.1.1 Anaesthetic adjuvants

Antimuscarinics

Atropine (TLS Green)

Glycopyrronium (TLS Red)

Please see 12.3 Oropharynx for further information on Glycopyrronium for hypersalivation

15.1.2 Malignant hyperthermia

Dantrolene (TLS Red)

15.1.3 Neuromuscular blockade

Neuromuscular blocking drugs (Depolarising)

Suxamethonium (TLS Red)

Neuromuscular blocking drugs (Non-Depolarising)

Atracurium (TLS Red)

Mivacurium (TLS Red)

Pancuronium (TLS Red)

Rocuronium (TLS Red)

Vecuronium (TLS Red)

Alternative:

Cisatracurium (TLS Red)

15.1.4 Neuromuscular blockade reversal

Anticholinesterases used in Anaesthesia

Neostigmine (TLS Red)

Neostigmine / Glycopyrronium (TLS Red)

Sugammadex (TLS Red)

15.1.5 Perioperative analgesia

Non-opioid Analgesics

Diclofenac injection (TLS Green)

Paracetamol injection (TLS Green)

Parecoxib (TLS Red)

Ketorolac injection (TLS Red)

Opioids

Alfentanil (TLS Red*)

Fentanyl (TLS Red*)

Morphine (TLS Red*)

*Except for use in palliative care

Specific Indication:

Remifentanil (TLS Red)

Remifentanil is normally only indicated where cardiovascular stability is critically important or rapid recovery forms an integral part of the surgical procedure

Volatile Halogenated Ethers

Methoxyflurane (inhaled) (Penthrox^®) (TLS Red)

For acute pain relief for burns dressing changes reserved for patients where short and medium acting analgesia has not provided adequate pain relief

Methoxyflurane (inhaled) (Penthrox^®) (TLS Red)

For acute pain relief of moderate to severe pain for use in the emergency department, Urgent Treatment Centres and Minor Injury Units

Methoxyflurane (inhaled) (Penthrox^®) (TLS Red)

Adjunct for moderate to severe pain for women undergoing ambulatory gynaecology procedures

Methoxyflurane (inhaled) (Penthrox^®) (TLS Red)

For pain relief for brachytherapy applicator removal and pre-radiotherapy rectal spacer insertion

Methoxyflurane (inhaled) (Penthrox^®) (TLS Red)

For pain relief for painful dressings changes for patients with painful leg ulcers who require rapid onset analgesia for a short duration

15.1.6 Perioperative sedation

Dexmedetomidine (TLS Red)

For those patients failing to wean from invasive ventilation with traditional management due to agitation. UHB and Weston only
For use during awake craniotomy. NBT only
For use in Paediatric intensive care for use in long stay patients who are experiencing difficult sedation, particularly those with life threatening pulmonary hypertension or intractable withdrawal from sedation/analgesic drugs
For sedation during awake fibre-optic intubation for patients with opioid dependence or who are at higher risk of respiratory depression, hypoxia and over-sedation

Ketamine (TLS Red)

Some preparations are unlicensed

Antagonists for central and respiratory depression

Flumazenil (TLS Green)

Naloxone (TLS Green)

Benzodiazepines

Diazepam (TLS Green)

Lorazepam (TLS Green)

Midazolam (TLS Green)

Temazepam (TLS Green)

The use of high strength midazolam (5mg/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.

Specific indication:

Midazolam 40mg/mL / Lignocaine 20mg/mL nasal solution (TLS Red)

For use in adult patients when cannulation cannot be achieved due to patient phobia, learning difficulties (LD), or another disability and/or when inhalation sedation with nitrous oxide does not provide sufficient relaxation or the patient has been assessed as being too anxious for this to be successful. UNLICENSED
(Midazolam and Lignocaine)

Sedation

Clonidine (TLS Red)

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15.1 General Anaesthesia

Anaesthetics (General, intravenous)

Propofol 1% (10mg/mL) (TLS Red)

Etomidate (TLS Red)

Thiopental sodium (TLS Red)

Propofol 2% (20mg/mL)

Methohexitone

Anaesthetics (Volatile liquid)

Nitrous oxide (TLS Red)

Volatile halogenated anaesthetics

Desflurane (TLS Red)

Isoflurane (TLS Red)

Sevoflurane (TLS Red)

15.1.1 Anaesthetic adjuvants

Antimuscarinics

Atropine (TLS Green)

Glycopyrronium (TLS Red)

15.1.2 Malignant hyperthermia

Dantrolene (TLS Red)

15.1.3 Neuromuscular blockade

Neuromuscular blocking drugs (Depolarising)

Suxamethonium (TLS Red)

Neuromuscular blocking drugs (Non-Depolarising)

Atracurium (TLS Red)

Mivacurium (TLS Red)

Pancuronium (TLS Red)

Rocuronium (TLS Red)

Vecuronium (TLS Red)

Cisatracurium (TLS Red)

15.1.4 Neuromuscular blockade reversal

Anticholinesterases used in Anaesthesia

Neostigmine (TLS Red)

Neostigmine / Glycopyrronium (TLS Red)

Sugammadex (TLS Red)

15.1.5 Perioperative analgesia

Non-opioid Analgesics

Diclofenac injection (TLS Green)

Paracetamol injection (TLS Green)

Parecoxib (TLS Red)

Ketorolac injection (TLS Red)

Opioids

Alfentanil (TLS Red*)

Fentanyl (TLS Red*)

Morphine (TLS Red*)

Remifentanil (TLS Red)

Volatile Halogenated Ethers

Methoxyflurane (inhaled) (Penthrox®) (TLS Red)

Methoxyflurane (inhaled) (Penthrox®) (TLS Red)

Methoxyflurane (inhaled) (Penthrox®) (TLS Red)

Methoxyflurane (inhaled) (Penthrox®) (TLS Red)

Methoxyflurane (inhaled) (Penthrox®) (TLS Red)

15.1.6 Perioperative sedation

Dexmedetomidine (TLS Red)

Ketamine (TLS Red)

Antagonists for central and respiratory depression

Flumazenil (TLS Green)

Naloxone (TLS Green)

Benzodiazepines

Diazepam (TLS Green)

Lorazepam (TLS Green)

Midazolam (TLS Green)

Temazepam (TLS Green)

Midazolam 40mg/mL / Lignocaine 20mg/mL nasal solution (TLS Red)

Sedation

Clonidine (TLS Red)

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Methoxyflurane (inhaled) (Penthrox^®) (TLS Red)

Methoxyflurane (inhaled) (Penthrox^®) (TLS Red)

Methoxyflurane (inhaled) (Penthrox^®) (TLS Red)

Methoxyflurane (inhaled) (Penthrox^®) (TLS Red)

Methoxyflurane (inhaled) (Penthrox^®) (TLS Red)