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Area Prescribing Committee Formulary  
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 Formulary Chapter 15: Anaesthesia - Full Chapter
15.01  General anaesthesia
15.01  Anaesthesia, sedation and resuscitation in dental practice
15.01  Gas cylinders
15.01.01  Intravenous anaesthetics
15.01.01  Barbiturates to top
15.01.01  Other intravenous anaesthetics
Propofol
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First Choice
Red
  • 1% (10mg/ml) injections (Propofol Lipuro®) available as 200mg in 20ml ampoules.
  • 500mg in 50ml and 1g in 100ml bottles.
  • 1% (10mg/ml) 50ml (500mg) prefilled syringes for use in Diprifusor pumps (Diprivan®).
  • 2% (20mg/ml) injection - 1g in 50ml bottles for ITU use only.
 
Etomidate 20mg/10ml injection
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Alternatives
Red
 
   
Controlled Drug Ketamine
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Alternatives
Red
  • 200mg in 20ml (10mg/ml), 500mg in 10ml (50mg/ml) & 1g in 10ml (100mg/ml) injections
  • 50mg in 5ml oral solution unlicensedunlicensed
    • Often used as an analgesic in the management of neuropathic pain by specialist pain teams Red Traffic Light
    • Also for palliative care Amber Traffic Light
 
   
Thiopental Sodium 500mg/20ml injection
(Thiopentone)
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Alternatives
Red
 
   
15.01.02  Inhalational anaesthetics
Isoflurane
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First Choice
Red
 
Desflurane (Suprane®)
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Alternatives
Red
  • For use in neurosurgery patients as an alternative to sevoflurane or desflurane and in the following groups of patients as an alternative to sevoflurane/ isoflurane in:
    • Bariatric surgery. 
    • Prolonged procedures over 2 hours e.g. oesophagectomy. 
    • Surgery in the elderly where there are concerns of cognitive impairment. 
    • Major surgery in the elderly with or without cognitive dysfunction.

  • Subject to the following limitations: 
    • Desflurane is not for use in day surgery unless the patient is morbidly obese. 
    • There is no role at present for its use in paediatrics or cardio-thoracic surgery.
    • Desflurane must be used in conjunction with low fresh gas flow.

  • Its use should be monitored and audited.
 
   
Haltothane
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Alternatives
Red

unlicensedunlicensed
For use in elective and emergency airway anaesthesia only (mainly paediatrics)

 
   
Sevoflurane
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Alternatives
Red
 
   
15.01.02  Volatile liquid anaesthetics
15.01.02  Nitrous oxide
Entonox®
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Alternatives
Red

50% nitrous oxide and 50% oxygen mixture used for analgesia

 
   
Nitrous oxide
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Alternatives
Red
 
   
15.01.03  Antimuscarinic drugs to top
Atropine 600microgram injection
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Formulary
Red
 
   
Atropine pre-filled syringes (minijet®)
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Formulary
Red
  • 1mg in 5ml and 3mg in 30ml injections in prefilled syringes used in cardiac resuscitation.
 
   
Glycopyrronium injection
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Formulary
  • 200 microgram in 1ml Green plus
  • 600 microgram in 3ml injections Red
 
   
Hyoscine Hydrobromide 400microgram injection
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Formulary
Green plus
 
   
15.01.04  Sedative and analgesic peri-operative drugs
15.01.04.01  Benzodiazepines
Diazepam
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Formulary
Green
  • 2mg, 5mg tablets – 10mg tablets should no longer be used.
  • 2mg in 5ml oral solution.
  • 10mg in 2ml injection (plain & emulsion) Red Traffic Light.
    • For use in epilepsy see section 4.8.2 and use in anxiety see
      section 4.1.2.

 
   
Lorazepam
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Formulary
Green
  • See section 04.01.02.
 
   
Midazolam
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Formulary
Green plus
  • 5mg in 5ml (1mg/ml) injection – for general use
  • 10mg in 2ml & 10mg in 5ml injections
    • these higher strengths are restricted to use in general anaesthesia, intensive care, palliative medicine and where its use has been formally risk assessed and agreed, for example, where syringe drivers are used

  • 50mg in 50ml prefilled syringes Red Traffic Light - ITU use only 
  • 2.5mg in 1ml oral solution unlicensedunlicensed
  • Intranasal midazolam 40mg/ml + lidocaine 20mg/ml Red Traffic Light
    • approved for use prior to cannulation for adult patients with
      special needs receiving dental treatment under IV sedation.

 
   
Controlled Drug Temazepam
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Formulary
Green
  • see section 04.01.01
 
   
Alimeazine
(Trimeprazine)
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Formulary
Green
  • 30mg/5ml syrup.
    • see section 03.04.01 for other formulations.

 
   
15.01.04.01  Benzodiazepines
15.01.04.02  Non-opioid analgesics
Diclofenac 75mg/1ml injection (Dyloject)
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Formulary
Red
  • Mainly for use in post-operative analgesia - see section 10.01.01 for other formulations
 
   
Parecoxib 40mg injection (Dynastat®)
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Formulary
Red
  • For peri-operative use only.
 
   
Ketorolac injection
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Alternatives
Red
  • 10mg/1ml & 30mg/1ml injection
    • the use of this is no longer recommended, other parenteral analgesics are now preferred

 
   
15.01.04.03  Opioid analgesics to top
Controlled Drug Alfentanil
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Formulary
Green plus
  • 1mg in 2ml, 5mg in 10ml & 5mg in 1ml injections - approved for initiation by specialists in palliative care
 
   
Controlled Drug Fentanyl
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Formulary
Green plus
  • 100 microgram in 2ml & 500 microgram in 10ml injections Green Traffic Light
  • 2.5mg in 50ml (50 micrograms/ml) syringe unlicensedunlicensed Red Traffic Light
 
   
Controlled Drug Levobupivacaine with Fentanyl
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Formulary
Red
  • 2 micrograms/ml with levobupivacaine 0.1% in sodium chloride 0.9% infusion, 100ml, 250ml & 500ml unlicensedunlicensed
  • 4 micrograms/ml with levobupivacaine 0.125% in sodium chloride 0.9% infusion, 500ml (RVI) unlicensedunlicensed
 
   
Controlled Drug Remifentanil
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Formulary
Red
  • 1mg, 2mg & 5mg injections.
 
   
15.01.04.04  Other drugs for sedation
Dexmedetomidine  (Dexdor®)
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Formulary
Red
  • 100 micrograms in 1ml injection approved for use in patients:
    • with traumatic brain injury, have no respiratory problems but require prolonged ventilatory support due to severe agitation, confusion and requirement for propofol/midazolam; and
    • who are difficult to sedate e.g. with overdose of MDMA/PMA/”legal highs” or who have pre-existing drug or alcohol dependence or who have failed conventional methods of treatment.
    • Paediatric patients undergoing cardiac surgery with a high risk of post-operative Junctional Ectopic Tachyarrhythmia (JET) or those suitable for fast-track surgery.
  • 100 micgrograms in 1ml injection (intranasal) unlicensedunlicensed route
    • approved for pre-operative sedation in anxious children at risk of respiratory depression in whom midazolam is contraindicated or those who have failed pre-operative sedation with other agents.
 
   
15.01.05  Neuromuscular blocking drugs
Suxamethonium Chloride
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Formulary
Red
  • 100mg/2ml injection
 
   
15.01.05  Non-depolarising muscle relaxants
Atracurium
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Formulary
Red
  • 25mg in 2.5ml
  • 50mg in 5ml  
  • 250mg in 25ml injection
 
   
Cisatracurium (Nimbex®)
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Formulary
Red
  • 20mg in 10ml (2mg/ml) injection
  • 150mg in 30ml (5mg/ml) injection
 
   
Mivacurium (Mivacron®)
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Formulary
Red
  • 10mg in 5ml injection
  • 20mg in 10ml injection
 
   
Pancuronium
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Formulary
Red
  • 4mg in 2ml injection
 
   
Papaverine
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Formulary
Red
  • 30mg/2ml injection unlicensedunlicensed
 
   
Rocuronium (Esmeron®)
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Formulary
Red
  • 50mg in 5ml injection
 
   
Vecuronium (Norcuron®)
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Formulary
Red
  • 10mg in 5ml injection
 
   
15.01.05  Depolarising muscle relaxants
15.01.06  Drugs for reversal of neuromuscular blockade to top
15.01.06  Anticholinesterases
Edrophonium
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Formulary
Red
  • 10mg in 1ml injection
 
   
Neostigmine
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Formulary
Red
  • 2.5mg in 1ml injection
 
   
Neostigmine with Glycopyrronium
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Formulary
Red
  • Glycopyrronium 500 microgram & neostigmine 2.5mg in 1ml injection (Robinul – neostigmine)
 
   
Physostigmine
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Formulary
Red
  • 1mg in 1ml injection unlicensedunlicensed
 
   
15.01.06  Other drugs for reversal of neuromuscular blockade
Sugammadex (Bridion®)
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Formulary
Red
  • 200mg in 2ml & 500mg in 5ml injections
    • Approved for the emergency reversal of blockade in cases of failed intubation in patients who are undergoing rapid sequence induction anaesthesia with rocuronium because of contra-indications to suxamethonium.
    • Approved for the reversal of rocuronium blockade in obstetric general anaesthesia for caesarean sections.

 
   
15.01.07  Antagonists for central and respiratory depression
Doxapram
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Formulary
Red
  • 100mg in 5ml injection
  • 2mg/ml 500ml intravenous infusion in glucose 5%
    see section 03.05.01
 
   
Flumazenil
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Formulary
Red
  • 500 microgram in 5ml injection
 
   
Naloxone
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Formulary
Red
  • 400 microgram in 1ml injection (ampoules).
  • 2mg/2ml pre-filled syringes (as per ACMD guidance).
 
   
15.01.08  Drugs for malignant hyperthermia
Dantrolene Sodium (Dantrium Intravenous®)
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Formulary
Red
  • 20mg injection
 
   
15.01.09  Prophylaxis of acid aspiration to top
Sodium citrate
(50ml packs)
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Formulary
Red
  •  0.3 molar peppermint falvoured solution.
 
   
15.02  Local anaesthesia
15.02  Articaine
15.02  Bupivacaine
Bupivacaine Hydrochloride
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Formulary
Red
  • 0.25% & 0.5% injection 10ml
  • 0.25% & 0.5% + adrenaline 1 in 200,000 inj. 10ml
  • 0.5% in glucose 8% injection (Marcain Heavy)
  • 0.1% & 0.125% unlicensedunlicensed in sodium chloride 0.9% infusions
 
   
15.02  Levobupivacaine
Levobupivacaine (Chirocaine®)
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Formulary
Red
  • 0.25%, 25mg in 10ml & 0.5%, 50mg in 10ml & 0.75%, 75mg in 10ml injections 
  • 0.625mg/ml & 1.25mg/ml infusion bags Red Traffic Light
    - for local infiltration in hip and knee replacement surgery.
 
   
15.02  Lidocaine to top
Lidocaine
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Formulary
Green plus
  • Injections (plain)
  • 0.5% 10ml
  • 1% 2ml, 5ml, & 10ml (10mg/ml)
    • approved for use in post-operative pain management subject to local protocols with a review of adverse events to be submitted by October 2018

  • 2% 2ml, 5ml & 20ml injection (20mg/ml)
  • 5% 2ml Heavy injection (50mg/ml)
  • 5% 10ml injection (50mg/ml) unlicensedunlicensed
  • Injections (with Adrenaline)
  • 1% & adrenaline 1 in 200,000, 20ml
  • 2% & adrenaline 1 in 200,000, 20ml
  • 2% & adrenaline 1 in 80,000, 2ml cartridges
    Topical preparations
  • 1% & 2% gel with chlorhexidine 0.25%
  • 4% topical solution (some packs unlicensed)
  • 5% ointment
  • Metered dose spray (10mg/spray)
  • 2% spray unlicensedunlicensed
  • 100mg lollipops unlicensedunlicensed
  • Lidocaine 4%, adrenaline 0.1% & tetracaine 0.5% (LAT gel®) unlicensedunlicensed
    - approved for use in anaesthetising lacerations particularly in the paediatric population – not to be used in children
    weighing under 15kg.
 
   
Lidocaine 2.5% with Prilocaine 2.5% (EMLA®)
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Formulary
Green
 
   
Lidocaine 4% cream (LMX4®)
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Formulary
Red
 
   
Lidocaine 5% and Phenylephrine 0.5%
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Formulary
Red
  • 5% lidocaine & 0.5% phenylephrine solution with
    applicator
 
   
15.02  Mepivacaine
15.02  Prilocaine
Prilocaine Hydrochloride
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Formulary
Green plus
  • 0.5% 10ml injection unlicensedunlicensed, 1% 20ml injection.
  • 4% 2ml injection (cartridges).
  • 2% 5ml injection (cartridges) Red Traffic Light
    • Only to be used in patients undergoing spinal anaesthesia for day surgery where the procedure is anticipated to last less than 90 minutes.
  • 3% & felypressin injection (cartridges).
 
   
15.02  Chloroprocaine
Procaine Hydrochloride
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Formulary
Green
  • 1% 5ml injection unlicensedunlicensed.
  • 2% 2ml injection.
  • 0.1% 500ml infusion unlicensedunlicensed.
 
   
15.02  Ropivacaine
Ropivacaine Hydrochloride
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Formulary
Red
  • 0.2% (200mL) infusion 
    • approved for peripheral nerve block infusions for post-operative pain
  • 0.75% (10mL)
    • approved for use in setting of conversion from labour epidural analgesia to surgical analgesia for emergency caesarean section
  • 0.2% (10mL) solution for injection
    • approved as an option for ambulatory day case hand surgery
 
   
15.02  Tetracaine to top
Tetracaine (Amethocaine) (Ametop®)
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Formulary
Green
  • 4% gel
 
   
15.02  Other local anaesthetics
Articaine Hydrochloride with Adrenaline
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Formulary
Red
  • Articaine 4% & adrenaline 1 in 100,000 injection
    • approved for mandibular procedures in patients in whom nerve blocks are contraindicated.

 
   
Controlled Drug Cocaine
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Formulary
Red
  • 4% nasal solution (drops) unlicensedunlicensed
    25% paste (1g syringe pack) unlicensedunlicensed
 
   
Controlled Drug Cocaine with Adrenaline
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Formulary
Red
  • 4% solution with adrenaline unlicensedunlicensed
 
   
Ethyl Chloride Spray
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Formulary
Green
 
   
Mepivacaine
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Formulary
Green
  • 3% 2.2 ml cartridges
 
   
PR Freeze Spray
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Formulary
Green
 
   
 ....
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
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to children's 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

Traffic Light Status Information

Status Description

Red

Drugs for hospital use only. The responsibility for initiation and monitoring treatment should rest with an appropriate hospital clinician and the drug should be supplied through the hospital throughout the duration of treatment. In some very exceptional circumstances (e.g. due to distance from the hospital, storage, supply or mobility/transport problems) it may be appropriate for the GP to be asked to prescribe a Red drug. This should be negotiated on an individual patient basis and should only be done with the GP’s prior informed agreement where the roles of the GP and hospital services are clearly defined and agreed. The GP should not feel under pressure to prescribe in these circumstances.   

Amber

Drugs initiated by hospital specialist, but where continuing treatment by GPs may be appropriate under a shared care arrangement. The specialist should send the GP a copy of the shared care agreement to sign. The GP should sign the shared care agreement, or indicate they do not want to be part of such an agreement, and return a copy back to the specialist. Shared care guidelines are available or are being developed for most of the drugs listed as Amber. If no shared care guideline is available, the hospital specialist should provide the patient’s GP with sufficient information and support to allow treatment to be continued and managed safely in primary care.  

Green plus

Drugs normally recommended or initiated by hospital specialist, but where the provision of an information leaflet may be appropriate to facilitate continuing treatment by GPs. Many of these information sheets are in the process of development.  

Green

Drugs where prescribing by GPs is appropriate. Drugs not classified as Red, Amber or Green Plus (formerly blue in North of Tyne) are generally classified as ‘Green’ by default. The Green drugs listed here include those products normally initiated by hospital specialists where there was a need for discussion and debate as to the category in which they should be placed.  

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