15.0 Anaesthesia

Anaesthesia

Important: the drugs in this section should only be administered by, or under the direct supervision of, personnel experienced in their use, with adequate training in anaesthesia and airway management, and when resuscitation equipment is available.

15.1.1 Drugs used for intravenous anaesthesia

RED Etomidate injection, 2mg/mL

RED Ketamine injection, 10mg/mL, 50mg/mL, 100mg/mL

RED Propofol injection, 5mg/mL, 10mg/mL, 20mg/mL

RED Thiopental Sodium injection, 500mg vial

15.1.2 Inhalation anaesthetics

RED Desflurane

RED Isoflurane

RED Sevoflurane

RED Nitrous Oxide

15.1.3 Antimuscarinic drugs

RED Atropine Sulfate injection, 600mcg/mL

pre-filled disposable syringe 100mcg/mL, 200mcg/mL, 300mcg/mL

RED Glycopyrronium bromide injection 200mcg/mL

RED Hyoscine Hydrobromide injection, 400mcg/mL, 600mcg/mL

GREEN Glycopyrronium bromide injection 200mcg/mL (Palliative care use only)

15.1.4 Sedative and analgesic peri-operative drugs

15.1.4.1 Benzodiazepines

RED Diazepam injection (solution), 5mg/5mL

RED Diazepam injection (emulsion), 5mg/5mL

RED Lorazepam injection, 4mg/mL

RED Midazolam injection, 2mg/mL, 5mg/mL

GREEN Midazolam injection, 2mg/mL, 5mg/mL [AGITATION / TERMINAL RESTLESSNESS IN THE LAST DAYS OF LIFE]*

*Refer to Palliative Care and Syringe Drivers page [here]

15.1.4.2 Non-opioid analgesics

RED Ketorolac Trometamol injection, 30mg/mL

15.1.4.3 Opioid analgesics

RED Alfentanil injection, 500mcg/mL

RED Remifentanil injection, 1mg vial, 2mg vial and 5mg vial

15.1.4.4 Other drugs for sedation

RED Dexmedetomidine injection 100mcg/ml Second line agent in ITU only

15.1.5 Neuromuscular blocking drugs

RED Atracurium besilate injection, 10mg/mL

RED Mivacurium injection, 2mg/mL

RED Rocuronium bromide, 10mg/mL

RED Suxemethonium chloride injection, 50mg/mL

15.1.6. Drugs used for reversal of neuromuscular blockade

RED Edrophonium Choride injection 10mg/mL

RED Neostigmine metilsulfate injection, 2.5mg/mL

RED Sugammadex injection 100mg/ml - restricted to specific use

15.1.7 Antagonists for central and respiratory depression

RED Flumazenil injection, 100mcg/mL

RED Naloxone hydrochloride injection, 20mcg/mL, 400mcg/mL, 1mg/mL

(for post operative respiratory depression)

15.1.8 Drugs used for malignant hyperthermia

RED Dantrolene sodium injection, 20mg vial

All material in this section is aimed at health care professionals, but is information currently held in the public domain, members of the public seeking advice on medicine-related matters are advised to speak with their GP,

pharmacist, nurse or contact NHS111 Service.

Email: info.elmmb@nhs.net

Artecaine

Artecaine is an amide-type local anaesthetic used for dental anaesthesia

RED Articaine hydrochloride with adrenaline injection,

40mg/mL with 1 in 200,000 and 40mg/mL with 1 in 100,000

Bupivacaine

This has a longer duration of action than other local anaesthetics. It has a slow onset of action, taking up to

30 minutes for full effect

RED Bupivacaine hydrochloride

injection, 2.5mg/mL, and 5mg/mL

Infusion, 1mg/mL. 1.25mg/mL

RED Liposomal Bupivacaine [Exparel®} 133mg/10mL, 266mg/20mL

For use in TAP block in minimal colorectal surgery/resections

Chloroprocaine hydrochloride

More rapid onset and regression post surgery of spinal block. Less urinary retention.

RED Chloroprocaine Hcl 1% solution for injection, 10mg/5mL [Ampres® 10mg/5mL]

Levobupivacaine

This is an isomer of bupivacaine, has anaesthetic and analgesic properties similar to bupivacaine but is thought

to have fewer adverse effects

RED Levobupivacaine hydrochloride injection, 2.5mg/mL, 5mg/mL and 7.5mg/mL

Lidocaine

Lidocaine is effectively absorbed from mucous membranes and is a useful surface anaesthetic.

RED Lidocaine Hydrochloride injection, 5mg/mL, 10mg/mL, 20mg/mL

Lidocaine and phenylephrine nasal spray

Anaesthesia before nasal surgery, endoscopy, laryngoscopy, or removal of foreign bodies from the nose.

For use by ENT and Max Fax specialist only

RED Lidocaine 5%/Phenylephrine 0.5% nasal spray

Lidocaine and prilocaine cream

Anaesthesia to help with irritation caused by use of Aldara cream in women witj Vulval intraepithelial neoplasia

RED Lidocaine 25mg/1g, Prilocaine 25mg/1g cream [Emla® 5% cream]

Mepivacaine

This is an amide-type local anaesthetic used for dental anaesthesia. To avoid excessive dosage in obese patients,

dose may need to be calculated on the basis of ideal body weight.

RED Mepivacaine hydrochloride injection, 30mg/mL

Prilocaine

This is a local anaesthetic of low toxicity which is similar to lidocaine.

RED Prilocaine hydrochloride (Prilotekal®) in glucose injection 20mg/mL

Ropivacaine

This is an amide-type local anaesthetic agent similar to bupivacaine. It is less cardiotoxic than bupivacaine,

but also less potent.

RED Ropivacaine hydrochloride injection, 2mg/mL, 7.5mg/mL and 10mg/mL

Infusion, 2mg/mL

Tetracaine

This is an effective local anaesthetic for topical application prior to venepuncture.

GREEN Tetracaine gel 4% (Ametop gel ®) [for use when taking bloods in children only]

pharmacist, nurse or contact NHS111 Service.

Email: info.elmmb@nhs.net