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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  Expand sub section  General anaesthesia
15.01.01  Expand sub section  Intravenous anaesthetics
Methohexital
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Unlicensed Drug Unlicensed
traffic lightRed
  • GWH ONLY for use by appropriated trained staff, and ONLY for the induction of anaesthesia prior to ECT (unlicensed use).

 
 
15.01.01  Expand sub section  Barbiturates
Thiopental
(injection)
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Formulary
traffic lightRed
  • 500mg vial
 
 
15.01.01  Expand sub section  Other intravenous anaesthetics
Etomidate
(injection)
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Formulary
traffic lightRed
  • 20mg/10ml amps
 
 
Controlled Drug Ketamine
(injection)
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Formulary
traffic lightRed
  • 200mg in 20ml vial
  • 500mg in 10ml vial
 
 
Propofol
(injection)
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Formulary
traffic lightRed
  • 200mg in 20ml amp
  • 500mg in 50ml vial
  • 1g in 100ml vial
 
 
15.01.02  Expand sub section  Inhalational anaesthetics to top
15.01.02  Expand sub section  Volatile liquid anaesthetics
Desflurane
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Formulary
traffic lightRed
  • 240ml
 
 
Isoflurane
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Formulary
traffic lightRed
  • 250ml
 
 
Sevoflurane
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Formulary
traffic lightRed
  • 250ml
 
 
15.01.02  Expand sub section  Nitrous oxide
Nitrous oxide
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Formulary
traffic lightRed
  • Nitrous oxide cylinders size D, E, G
 
Link  MHRA safety notice Nitrous oxide: neurological and haematological toxic effects Dec 2014
 
Nitrous oxide 50% with oxygen 50%
(Entonox )
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Formulary
traffic lightRed
  • 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.
 
Link  MHRA safety notice Nitrous oxide: neurological and haematological toxic effects Dec 2014
 
15.01.03  Expand sub section  Antimuscarinic drugs
 note 
  • Please see the palliative care section for information and traffic light status relevent to use in palliative care.
Atropine Sulphate
(injection)
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Formulary
  • Red for use within secondary care
  • Green 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)
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Formulary
traffic lightRed
  • 200 micrograms in 1ml amp
  • 600 micrograms in 3ml amp
 
 
Hyoscine Hydrobromide (injection)
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Formulary
traffic lightRed
  •  400 micrograms in 1ml amps
 
 
15.01.04  Expand sub section  Sedative and analgesic peri-operative drugs
15.01.04.01  Expand sub section  Benzodiazepines to top
 note 
  • 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)
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Formulary
traffic lightRed
  • 10mg in 2ml Injection (emulsion - Diazemuls®
 
 
Lorazepam
(injection)
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Formulary
traffic lightRed
  •  4mg in 1ml Injection
 
Link  SPS memo Oct 2020 - Shortage of Ativan (lorazepam) Injection 4 mg in 1 ml
 
Midazolam
(injection)
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Formulary
traffic lightRed
  • 5mg in 5ml injection
  • 10mg/2ml injection
 
 
Controlled Drug Temazepam
(oral)
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Formulary
traffic lightRed
  • Tablets 10mg, 20mg
  • Oral solutionSF 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  Expand sub section  Benzodiazepines
15.01.04.02  Expand sub section  Non-opioid analgesics
Ketorolac
(injection)
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Formulary
traffic lightRed
  • 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  Expand sub section  Opioid analgesics
Controlled Drug Alfentanil
(injection)
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Formulary
traffic lightRed
  • 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
 
 
Controlled Drug Fentanyl
(Injection)
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Formulary
traffic lightRed
  • 100 micrograms in 2ml amp
  • 500 micrograms in 10ml amp
 
 
Controlled Drug Remifentanil
(injection)
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Formulary
traffic lightRed
  • 1mg vial
  • 2mg vial
  • 5mg vial
 
 
15.01.04.04  Expand sub section  Other drugs for sedation
Dexmedetomidine
(IV)
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Formulary
traffic lightRed
  • GWH ICU/theatres only 
  • 100 micrograms/ml concentrate for solution for infusion, various ampoule sizes
 
 
15.01.05  Expand sub section  Neuromuscular blocking drugs to top
15.01.05  Expand sub section  Non-depolarising muscle relaxants
Atracurium Besilate (injection)
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Formulary
traffic lightRed
  • 25mg in 2.5ml amp
  • 50mg in 5ml amp
  • 250mg in 25ml vial
 
 
Cisatracurium
(Injection)
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Formulary
traffic lightRed
  • SFT only
  • 2mg/ml or 5mg/ml
 
 
Mivacurium
(IV)
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Formulary
traffic lightRed
  • GWH only
  • Injection 2 mg/ml
 
 
Pancuronium
(injection)
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Formulary
traffic lightRed
  • 2mg in 1ml
  • 4mg in 2ml
 
 
Rocuronium
(injection)
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Formulary
traffic lightRed
  •  50mg in 5ml vial
 
 
Vecuronium
(IV)
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Formulary
traffic lightRed
  • 10mg injection vial

 

 
 
15.01.05  Expand sub section  Depolarising muscle relaxants
Suxamethonium Chloride (injection)
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Formulary
traffic lightRed
  • 100mg in 2ml amp 

 

 
 
15.01.06  Expand sub section  Drugs for reversal of neuromuscular blockade
15.01.06  Expand sub section  Anticholinesterases
Neostigmine
(injection)
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Formulary
traffic lightRed
  •  2.5mg in 1ml injection
 
 
Neostigmine with Glycopyrronium
(injection)
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Formulary
traffic lightRed
  • 500 micrograms in 1ml amp 

 

 
 
15.01.06  Expand sub section  Other drugs for reversal of neuromuscular blockade to top
Sugammadex
(injection)
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Formulary
traffic lightRed
  •  100mg/ml injection 1ml, 2ml or 5ml vials
 
 
15.01.07  Expand sub section  Antagonists for central and respiratory depression
Flumazenil
(injection)
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Formulary
traffic lightGreen
  • 500 micrograms in 5ml amp 
  • Used to reverse the effects of benzodiazepines. See SPC for full information on safe use.
 
 
Naloxone
(injection)
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Formulary
traffic lightGreen
  •  400mcg in 1ml ampoule
 
Link  NHSE Patient safety alert: Risk of Distress and Death from inappropriate doses of naloxone
 
15.01.08  Expand sub section  Drugs for malignant hyperthermia
Dantrolene Sodium
(injection)
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Formulary
traffic lightRed
  •  20mg vial
 
 
 ....
 Non Formulary Items
Doxapram (Dopram)

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Non Formulary
 
Edrophonium

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Non Formulary
 
Naloxone pre-filled syringes
(Prenoxad)

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Non Formulary
 
Parecoxib (Dynastat)

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Non Formulary
 
  
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
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Link to adult BNF
click to search medicines.org.uk
Link to SPCs
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG
Blueteq
High Cost Drug Approval System

Traffic Light Status Information

Status Description

Traffic LightRed

RED - Hospital only to be prescribed by a specialist and supplied from secondary care ONLY throughout treatment.  

Traffic LightAmber

Amber medicines are considered suitable for GP prescribing following specialist initiation or recommendation.  

Traffic LightAmber with Shared Care

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.  

Traffic LightGreen

These medicines are appropriate for initiation in both primary and secondary care. Prescribing is appropriate within licensed or local recommendations.  

Traffic LightSelf

Suitable for patient to be directed to buy themselves  

Traffic LightGrey

Not currently used. We intend to include this TLS in future to highlight where a decision to use this medicine is under review.   

Traffic LightBlack

(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.   

Traffic LightRed Specialist Centre

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.  

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