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 Formulary Chapter 15: Anaesthesia - Full Chapter
Notes:

Chapter review date:

 Details...
15.01  Expand sub section  General anaesthesia
15.01  Expand sub section  Anaesthesia, sedation and resuscitation in dental practice
15.01  Expand sub section  Gas cylinders
15.01.01  Expand sub section  Intravenous anaesthetics
 note  RBCH: Intravenous Anaesthetics - Anaesthetist only
15.01.01  Expand sub section  Barbiturates to top
Thiopental sodium (Thiopentone)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
Injection. 
 
15.01.01  Expand sub section  Other intravenous anaesthetics
Propofol
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Red
Injection.
  • RBCH: 1% only
  • DCHFT: 1% only
  •  
     
    Etomidate (Hypnomidate®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Red
    Injection. 
     
    Controlled Drug Ketamine (Ketalar®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Red
     
     
    15.01.02  Expand sub section  Inhalational anaesthetics
    15.01.02  Expand sub section  Volatile liquid anaesthetics
    Desflurane (Suprane®)
    View adult BNF View childrens BNF  Track Changes
    Formulary
    Red
    Anaesthetic. 
     
    Isoflurane
    View adult BNF View childrens BNF  Track Changes
    Formulary
    Red
    Anaesthetic. 
     
    Sevoflurane
    View adult BNF View childrens BNF  Track Changes
    Formulary
    Red
    Anaesthetic. 
     
    15.01.02  Expand sub section  Nitrous oxide
    Entonox®
    View adult BNF View childrens BNF  Track Changes
    Formulary
    Green
    50% nitrous oxide, 50% oxygen. 
    Link  Medical Gas Data Sheet - Entonox
     
    Nitrous oxide
    View adult BNF View childrens BNF  Track Changes
    Formulary
    Red
    Anaesthetic. 
     
    15.01.03  Expand sub section  Antimuscarinic drugs to top
    Atropine
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Red
    Injection. 
     
    Glycopyrronium
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Red
    Injection. 
     
    Glycopyrronium Bromide (Sialanar®)
    View adult BNF View SPC online View SMC online View childrens BNF  Track Changes
    Formulary
    Amber

    Indicated for the symptomatic treatment of severe sialorrhoea (chronic pathological drooling) in children and adolescents aged 3-years and older with chronic neurological disorders

     
     
    Hyoscine Hydrobromide
    (Scopolamine)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Amber

    Injection.



    • Amber


    Green for use in palliative care (see chapter 21)

     
     
    15.01.04  Expand sub section  Sedative and analgesic peri-operative drugs
    15.01.04.01  Expand sub section  Benzodiazepines
    Controlled Drug Midazolam (Hypnovel®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Red
    Injection.
  • DCHFT: Higher strength products (2mg/mL or 5mg/mL) are restricted to critical care areas only.
  •  
     
    Diazepam
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Red
    Tablet, oral solution, injection.
  • Red - when used as a premedication. See section 4.1.2 for other uses.
  •  
     
    Controlled Drug Temazepam
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Red
    Tablet, oral solution.
  • Red - when used as a premedication. See section 4.1.1 for other uses.
  •  
     
    15.01.04.01  Expand sub section  Benzodiazepines
    15.01.04.02  Expand sub section  Non-opioid analgesics
    Ketorolac (Toradol®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Red
    Injection. 
     
    15.01.04.03  Expand sub section  Opioid analgesics to top
    Controlled Drug Alfentanil (Rapifen®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Red
    Injection. 
     
    Controlled Drug Fentanyl
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Red
    Injection. 
     
    Controlled Drug Remifentanil (Ultiva®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Red
    Injection. 
     
    15.01.04.04  Expand sub section  Other drugs for sedation
    Dexmedetomidine  (Dexdor®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Restricted Drug Restricted RED - Critical care use only at PHT 
     
    15.01.05  Expand sub section  Neuromuscular blocking drugs
     note  Anaesthetist only
    15.01.05  Expand sub section  Non-depolarising muscle relaxants
    Atracurium Besilate (Tracrium®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Red
    Injection. 
     
    Cisatracurium (Nimbex®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Red
  • Not RBCH.
  • DCHFT: Only stocked to cover vecuronium shortages. Used as alternative non-depolarising neuromuscular blocker with low potential for histamine release for use in those patients who are allergic/intolerant to the other more commonly used agents such as atracurium and rocuronium.


  •  
     
    Mivacurium Chloride (Mivacron®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Red
    Injection. 
     
    Rocuronium Bromide (Esmeron®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Red
    Injection. 
     
    Vecuronium Bromide (Norcuron®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Red
    Injection. 
     
    15.01.05  Expand sub section  Depolarising muscle relaxants
    Suxamethonium Chloride (Anectine®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Red
    Injection. 
     
    15.01.06  Expand sub section  Drugs for reversal of neuromuscular blockade to top
    15.01.06  Expand sub section  Anticholinesterases
    Neostigmine
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Red
    Injection. 
     
    Neostigmine with Glycopyrronium
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Red
    Injection. 
     
    15.01.06  Expand sub section  Other drugs for reversal of neuromuscular blockade
    Sugammadex (Bridion®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Red
    Injection.
  • RBCH: Emergency reversal of neuromuscular blockade induced by rocuronium only.
  • DCHFT: Consultant anaesthetist only. Emergency reversal of neuromuscular blockade induced by rocuronium or vecuronium.
  •  
     
    15.01.07  Expand sub section  Antagonists for central and respiratory depression
    Flumazenil (Anexate®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Red
    Injection. 
     
    15.01.08  Expand sub section  Drugs for malignant hyperthermia
    Dantrolene sodium (Dantrium Intravenous®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Red
    Injection. 
    Link  MHRA: IV dantrolene: risk of undissolved crystals—use a filter needle when drawing up reconstituted dantrolene solution
     
    15.01.09  Expand sub section  Prophylaxis of acid aspiration to top
    15.02  Expand sub section  Local anaesthesia
    15.02  Expand sub section  Articaine
    15.02  Expand sub section  Bupivacaine
    Bupivacaine hydrochloride (Marcain®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Red
    0.25% and 0.5% injections.
  • DCHFT: 0.5% injection only.
  • RBCH also: Bupivacaine 0.15% in Sodium Chloride 0.9% Epidural Infusion.
  •  
     
    Bupivacaine Hydrochloride with Glucose (Marcain Heavy®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Red
    0.5% Injection. 
     
    Bupivacaine and Adrenaline
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Red
    Bupivacaine 0.25% + Adrenaline 1 in 200,000 Injection.
    Bupivacaine 0.5% + Adrenaline 1 in 200,000 Injection. 
     
    15.02  Expand sub section  Levobupivacaine
    Chloroprocaine (Ampres®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Red
    Injection.
  • Restricted Item DCHFT: Spinal anaesthesia in adults where the planned surgical procedure should not exceed 40 minutes.
  •  
     
    Levobupivacaine (Chirocaine®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Red
    0.25% and 0.5% injections, 0.125% epidural infusion
     
     
    Controlled Drug Levobupivacaine with Fentanyl
    View adult BNF View SPC online View childrens BNF  Track Changes
    Unlicensed Drug Unlicensed
    Red
    Fentanyl 2 micrograms per mL & levobupivacaine 0.1% Epidural infusions.
     
     
    15.02  Expand sub section  Lidocaine to top
    Lidocaine 2% with Chlorhexidine 0.25% (Instillagel®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green
     
     
    Lidocaine 2.5% with Prilocaine 2.5% (EMLA®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green
     
     
    Lidocaine 4% cream (LMX 4®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green

    DCHFT - Paediatrics only. Cannulation in/for theatres.

     
     
    Lidocaine 5% Ointment
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green

    For perianal use only


    NB: Sensitisation may occur with ongoing use

     
     
    Lidocaine Injection
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Amber

    Injection - various strengths.



    • DCHFT: 0.5%, 1% and 2% available.


    Primary Care: for use in minor surgery and soft tissue injections

     
     
    Lidocaine with Adrenaline Injection
    View adult BNF View childrens BNF  Track Changes
    Formulary
    Amber

    • DCHFT: Lidocaine 1% and 2% with adrenaline (various strengths). Dental cartridges.


    Primary Care: for use in minor surgery and soft tissue injections

     
     
    Lidocaine 700mg plasters (5%)
    View adult BNF View SPC online  Track Changes
    Formulary
    Red

    Only within licensed indication (post herpetic neuralgia) by pain specialists. It remains non-formulary for other indications apart from restrictions listed below


     


    Restricted Item Additional Acute Trust restricted indications (off-label):
    RBCH:



    • Rib Fracture Pain: - Max 5 days supply

    • Post-amputation pain: Acute Pain Consultant only:where other analgesics or anaesthetic techniques are contra-indicated or have limited benefit - Maximum 30 days supply. Patients must be informed that this treatment is short-term before commencing therapy.


    DCH: Rib Fracture Pain: - Max 5 days supply. Patients must be informed that this treatment is short-term before commencing therapy.

    PHT: Rib Fracture Pain

     
     
    Lidocaine 10% spray  (Xylocaine®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Red

     


     

     
     
    Lidocaine 40mg/ml solution (Laryngojet®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Red
     
     
    Lidocaine 5% and Phenylephrine 0.5%
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Red
    Pump spray. 
     
    15.02  Expand sub section  Mepivacaine
    Mepivacaine (Scandonest Plain®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Red
    Injection. 
     
    15.02  Expand sub section  Prilocaine
    Prilocaine Hydrochloride (Citanest®)
    (1%)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Red
    Injection. 
     
    Prilocaine Hydrochloride (Prilotekal®)
    (2% Hyperbaric)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Red
    Injection.
  • Restricted Item  DCHFT: Day case and enhanced recovery patients only in accordance with local guideline.

    RBCH for short procedures in patients suitable for same day surgery by Consultant Anaesthetists only. 
  • Link  DCHFT: Guidelines for use of “Prilotekal” hyperbaric 2% prilocaine for use in spianl anaesthesia.
     
    Prilocaine Hydrochloride with Felypressin (Citanest with Octapressin®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Red
    Dental cartridge. 
     
    Prilocaine Hydrochloride
    (0.5%)
    View adult BNF View childrens BNF  Track Changes
    Unlicensed Drug Unlicensed
    Red
    Injection.
  • 0.5% is unlicensedunlicensed.
  •  
     
    15.02  Expand sub section  Procaine
    15.02  Expand sub section  Ropivacaine
    Ropivacaine Hydrochloride (Naropin®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Red
    Injection, infusion.
  • DCHFT: Non-formulary item.
  •  
     
    15.02  Expand sub section  Tetracaine to top
    Tetracaine (Amethocaine) (Ametop®)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Green
    Topical gel. 
     
    15.02  Expand sub section  Other local anaesthetics
    Controlled Drug Cocaine
    View adult BNF View childrens BNF  Track Changes
    Formulary
    Red
  • DCHFT Only: 10% sterile nasal solution. unlicensedUnlicensed.
  •  
     
    Ethyl Chloride (Cryogesic® Spray)
    View adult BNF View SPC online View childrens BNF  Track Changes
    Formulary
    Red
    Aerosol spray. 
     
     ....
     Non Formulary Items
    Articaine Hydrochloride with Adrenaline  (Septanest®)

    View adult BNF View childrens BNF Track Changes
    Non Formulary
    Benzocaine

    View adult BNF View childrens BNF Track Changes
    Non Formulary

     


     

    Benzocaine 20% Gel  (Ultracare® Bubble Gum)

    View adult BNF View childrens BNF Track Changes
    Non Formulary
    Controlled Drug  Bupivacaine with Fentanyl

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Controlled Drug  Cocaine with Adrenaline

    View adult BNF View childrens BNF Track Changes
    Non Formulary
    Dermogesic spray

    View adult BNF View childrens BNF Track Changes
    Non Formulary
    Etomidate  (Etomidate-Lipuro®)

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Lidocaine with Adrenaline  (Xylocaine®)

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
  • Lidocaine 1% with adrenaline 1 in 200 000

  • Lidocaine 2% with adrenaline 1 in 200 000

  • Lidocaine with tetracaine  (Pliaglis®)

    View adult BNF View childrens BNF Track Changes
    Non Formulary
    Lorazepam

    View adult BNF View childrens BNF Track Changes
    Non Formulary
    Pancuronium Bromide

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Parecoxib  (Dynastat®)

    View adult BNF View SPC online View childrens BNF Track Changes
    Non Formulary
    Procaine Hydrochloride

    View adult BNF View childrens BNF Track Changes
    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
    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
    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

    Green

    May be initiated, stabilised and maintained in primary, secondary or tertiary care  

    Amber

    Amber drug - without shared care  

    Amber SCG

    Amber drug - with shared care guideline  

    Red

    For secondary or tertiary care initiation and long-term maintenance of prescribing  

    Black

    Not recommended  

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