Formulary


	NHS Bath and North East Somerset, Swindon and Wiltshire CCG Royal United Hospitals Bath NHS Foundation Trust Great Western Hospitals NHS Foundation Trust Salisbury NHS Foundation Trust

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Formulary Chapter 15: Anaesthesia - Full Chapter

15.01

General anaesthesia

15.01.01

Intravenous anaesthetics

Methohexital

Unlicensed

GWH ONLY for use by appropriated trained staff, and ONLY for the induction of anaesthesia prior to ECT (unlicensed use).

15.01.01

Barbiturates

Thiopental
(injection)

Formulary

500mg vial

15.01.01

Other intravenous anaesthetics

Etomidate
(injection)

Formulary

20mg/10ml amps

Ketamine
(injection)

Formulary

200mg in 20ml vial
500mg in 10ml vial

Propofol
(injection)

Formulary

200mg in 20ml amp
500mg in 50ml vial
1g in 100ml vial

15.01.02

Inhalational anaesthetics

15.01.02

Volatile liquid anaesthetics

Desflurane

Formulary

240ml

Isoflurane

Formulary

250ml

Sevoflurane

Formulary

250ml

15.01.02

Nitrous oxide

Formulary

Nitrous oxide cylinders size D, E, G

MHRA safety notice Nitrous oxide: neurological and haematological toxic effects Dec 2014

Nitrous oxide 50% with oxygen 50%
(Entonox ^®)

Formulary

Nitrous oxide 50% with oxygen 50% (Entonox) cylinders size D,F,G
Note: MHRA safety notice Neurological and haematological toxic effects can occur with prolonged use of nitrous oxide. Neurological effects can occur without preceding overt haematological changes.
Assessment of vitamin B12 levels should be considered before nitrous oxide anaesthesia in people with risk factors for deficiency.

MHRA safety notice Nitrous oxide: neurological and haematological toxic effects Dec 2014

15.01.03

Antimuscarinic drugs

Please see the palliative care section for information and traffic light status relevent to use in palliative care.

Atropine Sulphate
(injection)

Formulary

for use within secondary care
very rarely some GPs need to use this for emergencies in primary care.
600 micrograms in 1ml amp
1mg in 1ml amp
1mg in 10ml PFS

Glycopyrronium Bromide (injection)

Formulary

200 micrograms in 1ml amp
600 micrograms in 3ml amp

Hyoscine Hydrobromide (injection)

Formulary

400 micrograms in 1ml amps

15.01.04

Sedative and analgesic peri-operative drugs

15.01.04.01

Benzodiazepines

This section covers the use of benzodiazepines as a pre-medication prior to surgery and procedures.
See chapter 4 for other use of benzodiazepines.
See relevent seperate chapter for traffic light status for use in palliative care.

Diazepam
(injection)

Formulary

10mg in 2ml Injection (emulsion - Diazemuls^®)

Lorazepam
(injection)

Formulary

4mg in 1ml Injection

SPS memo Oct 2020 - Shortage of Ativan (lorazepam) Injection 4 mg in 1 ml

Midazolam
(injection)

Formulary

5mg in 5ml injection
10mg/2ml injection

Temazepam
(oral)

Formulary

Tablets 10mg, 20mg
Oral solution^SF 10mg in 5ml prohibitively expensive (Aug 19)
Notes:
- Loprazolam & temazepam both have short duration of action and have no active metabolites.
- Temazepam is a Schedule 3 controlled drug; a maximum of 30 days supply for all controlled drugs is the good practice advice from the Department of Health. Ref: Safer Management of Controlled Drugs, May 2007

15.01.04.01

Benzodiazepines

15.01.04.02

Non-opioid analgesics

Ketorolac
(injection)

Formulary

30mg in 1ml amp
Licensed for use in short-term management of moderate to severe post operative pain only.
Contains a small amount of ethanol per dose (100mg)
See palliative care section Chapter 21

15.01.04.03

Opioid analgesics

Alfentanil
(injection)

Formulary

1mg in 2ml amp
5mg in 10ml amp
5mg in 1ml amp intensive care injection
Note - also included as an AMBER TLS drug in SWINDON ONLY for use in palliative care. See here

Fentanyl
(Injection)

Formulary

100 micrograms in 2ml amp
500 micrograms in 10ml amp

Remifentanil
(injection)

Formulary

1mg vial
2mg vial
5mg vial

15.01.04.04

Other drugs for sedation

Dexmedetomidine
(IV)

Formulary

GWH ICU/theatres only
100 micrograms/ml concentrate for solution for infusion, various ampoule sizes

15.01.05

Neuromuscular blocking drugs

15.01.05

Non-depolarising muscle relaxants

Atracurium Besilate (injection)

Formulary

25mg in 2.5ml amp
50mg in 5ml amp
250mg in 25ml vial

Cisatracurium
(Injection)

Formulary

SFT only
2mg/ml or 5mg/ml

Mivacurium
(IV)

Formulary

GWH only
Injection 2 mg/ml

Pancuronium
(injection)

Formulary

2mg in 1ml
4mg in 2ml

Rocuronium
(injection)

Formulary

50mg in 5ml vial

Vecuronium
(IV)

Formulary

10mg injection vial

15.01.05

Depolarising muscle relaxants

Suxamethonium Chloride (injection)

Formulary

100mg in 2ml amp

15.01.06

Drugs for reversal of neuromuscular blockade

15.01.06

Anticholinesterases

Neostigmine
(injection)

Formulary

2.5mg in 1ml injection

Neostigmine with Glycopyrronium
(injection)

Formulary

500 micrograms in 1ml amp

15.01.06

Other drugs for reversal of neuromuscular blockade

Sugammadex
(injection)

Formulary

100mg/ml injection 1ml, 2ml or 5ml vials

15.01.07

Antagonists for central and respiratory depression

Flumazenil
(injection)

Formulary

500 micrograms in 5ml amp
Used to reverse the effects of benzodiazepines. See SPC for full information on safe use.

Naloxone
(injection)

Formulary

400mcg in 1ml ampoule

NHSE Patient safety alert: Risk of Distress and Death from inappropriate doses of naloxone

15.01.08

Drugs for malignant hyperthermia

Dantrolene Sodium
(injection)

Formulary

20mg vial

15.02

Local anaesthesia

15.02

Bupivacaine

Bupivacaine and Adrenaline
(injection)

Formulary

0.25% w/v
0.5% w/v
1 in 200,000

Bupivacaine Hydrochloride
(injection)

Formulary

25mg in 10ml (0.25%) amp
50mg in 10ml (0.5%) amp
75mg in 10ml (0.75%) amp
GWH only: 0.1% and 0.125% epidural infusion bags used.

Bupivacaine Hydrochloride with Glucose
(injection)

Formulary

0.5% solution for injection, 4ml ampoule
Not routinely stocked at RUH

15.02

Levobupivacaine

Levobupivacaine
(injection)

Formulary

25mg in 10ml (0.25%) amp
50mg in 10ml (0.5%) amp

Levobupivacaine with Fentanyl
(IV)

Formulary

GWH only.
Epidural

15.02

Lidocaine

Lidocaine (Xylocaine)
(Spray 10%)

Formulary

SFT only
This product is non-sterile and therefore not recommended for use prior to procedures that require aseptic techniques
Lidocaine 10 mg/metered dose.
Used for the prevention of pain related to specific procedures
Contains ethanol
50 ml glass spray bottles (approx. 500 spray doses) with a metering spray pump.

Lidocaine 2.5% with Prilocaine 2.5%
(EMLA^®)
(cream)

Formulary

Lidocaine 2.5%, Priolocaine 2.5%, 30g, 5g with dressings

Lidocaine 5% and Phenylephrine 0.5%
(spray)

Formulary

Each bottle contains 2.5ml of solution to be used as a spray, equivalent to 125mg lidocaine and 12.5mg phenylephrine hydrochloride.

Lidocaine Hydrochloride (injection)

Formulary

50mg in 10ml (0.5%) vial
20mg in 2ml (1%) amp
50mg in 5ml (1%) amp
200mg in 20ml (1%) amp
200mg in 20ml (1%) vial preserved
100mg in 5ml (2%) amp
100mg in 5ml (2%) prefilled syringe
400mg in 20ml (2%) amp

Lidocaine with Adrenaline
(injection)

Formulary

Xylocaine 1% with adrenaline 1:200,000 multi-dose vial, 20ml and xylocaine 2% with adrenaline 1:200,000 multidose vial, 20ml.
for use in acute trusts
for use by GPs in primary care undertaking minor procedures/surgery
for GWH only: Lidocaine dental cartridges -Lignospan Special® (Lidocaine hydrochloride 2% + adrenaline 1:80000).

Lidocaine2% with Chlorhexidine 0.25%
(Instillagel^®)

Formulary

Lidocaine 20mg/ml and chlorhexidine gluconate 500mcg/ml. 60ml or 110ml

15.02

Prilocaine

Prilocaine Hydrochloride
(injection)

Formulary

Spinal anaesthesia 20mg/ml for injection, 5ml ampoule

Prilocaine Hydrochloride with Felypressin
(injection)

Formulary

54mg (3%) with felypressin 0.03 units/ml 1.8ml cartridges

Prilocaine (+ glucose)
(Prilotekal®)
(IV)

Formulary

GWH only
Due to the glucose content Prilotekal is only to be used for spinal anaesthesia. It is not recommended for the use in epidural anaesthesia.

15.02

Tetracaine

Tetracaine (Amethocaine)
(Ametop^®)
(gel)

Formulary

Gel 4% 1.5g

15.02

Other local anaesthetics

Articaine Hydrochloride with Adrenaline
(injection)

Formulary

Articaine hydrochloride 40mg/ml, adrenaline 1 in 100,000 (10 micrograms/ml), 2.2ml cartridge for dental use

Cocaine HCl
(Solution 10% w/v)

Formulary

GWH only
Sterile oromucosal solution 10%
For topical use only. Not for injection or to be taken.
Cocaine Hydrochloride Solution is indicated to provide local anaesthesia and vasoconstriction of accessible mucous membranes prior to surgery especially in the oral, laryngeal, and nasal cavities.

Ethyl Chloride
(Spray)

Formulary

100ml
CAUTION: Extremely flammable liquified gas under pressure. Stable at room temperature 8ºC-20ºC. Use only with good ventilation. Avoid use near electrical equipment, naked flames or high temperature surfaces. Store in a metal cupboard in a ventilated room- never in a refridgerator. All empty or unused containers must be returned to pharmacy for destruction.

Ropivacaine hydrochloride
(Injection)

Formulary

SFT only
2mg/ml, 7.5mg/ml or 10mg/ml

Cocaine 5% with adrenaline 1:2000
(Topical gel)

Unlicensed

GWH A&E only

....

Non Formulary Items

Benzocaine

Non Formulary

Benzocaine 20% Gel
(Ultracare^® Bubble Gum)

Non Formulary

Bupivacaine with Fentanyl

Non Formulary

Dermogesic spray

Non Formulary

Doxapram (Dopram^®)

Non Formulary

Edrophonium

Non Formulary

Lidocaine
(laryngojet^®)

Non Formulary

Lidocaine 4% cream
(LMX4^®)

Non Formulary

Lidocaine with Adrenaline
(Lignospan^®)

Non Formulary

Lidocaine with Prilocaine
(Fortacin^®)

Non Formulary

Lidocaine with tetracaine
(Pliaglis^®)

Non Formulary

Lignocaine

Non Formulary

Mepivacaine
(Scandonest Plain^®)

Non Formulary

Naloxone pre-filled syringes
(Prenoxad^®)

Non Formulary

Parecoxib (Dynastat^®)

Non Formulary

Key

	Notes
	Section Title (top level)
	Section Title (sub level)
	First Choice item
	Non Formulary section
	Restricted Drug
	Unlicensed
	Display tracking information
	Link to adult BNF
	Link to SPCs
	Scottish Medicines Consortium

	Cytotoxic Drug
	Controlled Drug
	High Cost Medicine
	Cancer Drugs Fund
	NHS England
	Homecare
	CCG
	High Cost Drug Approval System

Traffic Light Status Information

Status	Description
	RED - Hospital only – to be prescribed by a specialist and supplied from secondary care ONLY throughout treatment.
	Amber medicines are considered suitable for GP prescribing following specialist initiation or recommendation.
	Shared Care - these medicines require specialist initiation and stabilisation. Ongoing division of responsibility for drug and disease monitoring between specialist and GP by a Shared Care Guideline (SCG). If no SCG in place status reverts to red.
	These medicines are appropriate for initiation in both primary and secondary care. Prescribing is appropriate within licensed or local recommendations.
	Suitable for patient to be directed to buy themselves
	Not currently used. We intend to include this TLS in future to highlight where a decision to use this medicine is under review.
	(In use from Oct 2020) Used where a decision has been made by the BSW APC not to routinely commission this preparation for its licensed indications. Do not prescribe.
	Not currently used. We intend to include this TLS in future to highlight where this medicine and indication is ONLY available through a Specialist Centre according to a NICE Highly Specialised Technology or NHSE Specialised Commission Circular / Policy.