NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Prescribing
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15 Anaesthesia

15.1 General anaesthesia

15.1.1 Intravenous anaesthetics

Total Formulary
THIOPENTAL

Restrictions: Restricted to specialist use only.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/90110.htm

DEXMEDETOMIDINE (DEXDOR) (infusion)

Restrictions: Use for sedation in adult intensive care unit (ICU) patients requiring a sedation level not deeper than arousal in response to verbal stimulation (corresponding to Richmond Agitation-Sedation Scale [RASS] 0 to -3) is restricted to specialist use in accordance with local protocol.

Prescribing Notes:

For the relevant SMC advice click here

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/PHP8603-dexmedetomidine.htm?q=dexmedetomidine&t=search&ss=text&p=2#_hit

ETOMIDATE

Restrictions: Restricted to specialist use only.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/6564.htm

KETAMINE

Restrictions: Restricted to specialist use only.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/6566.htm

PROPOFOL

Restrictions: Restricted to specialist use only.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/6570.htm

15.1.2 Inhalational anaesthetics

Total Formulary
NITROUS OXIDE

Restrictions: Restricted to specialist use only.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/6582.htm

SEVOFLURANE

Restrictions: Restricted to specialist use only.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/37118.htm

DESFLURANE

Restrictions: Restricted to specialist use only.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/6891.htm

ENTONOX

Restrictions: Restricted to specialist use only.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/6582.htm

ISOFLURANE

Restrictions: Restricted to specialist use only.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/6579.htm

15.1.3 Antimuscarinic drugs

Total Formulary
ATROPINE

Restrictions: Restricted to specialist use only.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/6584.htm

GLYCOPYRRONIUM (injection)

Restrictions: Restricted to specialist use only.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/6588.htm

HYOSCINE HYDROBROMIDE (INJECTION)

Restrictions: Restricted to specialist use only.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/6591.htm

15.1.4 Sedative and analgesic peri-operative drugs

15.1.4.1 Anxiolytics

Total Formulary
MIDAZOLAM

Restrictions: Restricted to specialist initiation.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/6601.htm

TEMAZEPAM (TABLETS)

Restrictions: Restricted to specialist initiation.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/6603.htm

ALIMEMAZINE

Restrictions: Restricted to specialist initiation.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/3109.htm

CHLORPROMAZINE

Restrictions: Restricted to specialist initiation.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/3210.htm

DIAZEPAM

Restrictions: Restricted to specialist initiation.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/6597.htm

LORAZEPAM

Restrictions: Restricted to specialist initiation.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/6599.htm

15.1.4.2 Non-opioid analgesics

Total Formulary
DICLOFENAC (injection)

Restrictions: Restricted to specialist initiation.

Prescribing Notes:

In June 2013, the MHRA issued new contraindications and warnings for diclofenac following a review of the cardiovascular risk, which it states is similar to that of the selective COX-2 inhibitors.  A summary of the guidance on the MHRA website is available HERE

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/6618.htm

KETOROLAC (INJECTION)

Restrictions: Restricted to specialist initiation.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/6619.htm

15.1.4.3 Opioid analgesics

Total Formulary
PAPAVERETUM

Restrictions: Restricted to specialist initiation.

PETHIDINE

Restrictions: Restricted to specialist initiation.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/3542.htm

REMIFENTANIL

Restrictions: Restricted to use under direct supervision of a consultant anaesthetist.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/57717.htm

ALFENTANIL

Restrictions: Restricted to specialist use only.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/6622.htm

FENTANYL (INJECTION)

Restrictions: Restricted to specialist use only.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/6626.htm

MORPHINE

Restrictions: Restricted to specialist initiation.

Prescribing Notes:

Excludes Depodur® preparations.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/3502.htm

15.1.5 Neuromuscular blocking drugs

Total Formulary
PANCURONIUM

Restrictions: Restricted to specialist use only.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/6656.htm

ROCURONIUM

Restrictions: Restricted to specialist use only.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/18840.htm

VECURONIUM

Restrictions: Restricted to specialist use only.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/6660.htm

SUXAMETHONIUM

Restrictions: Restricted to specialist use only.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/6663.htm

ATRACURIUM

Restrictions: Restricted to specialist use only.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/6650.htm

CISATRACURIUM

Restrictions: Restricted to specialist use only.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/38919.htm

MIVACURIUM

Restrictions: Restricted to specialist use only.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/6654.htm

15.1.6 Drugs for reversal of neuromuscular blockade

Total Formulary
EDROPHONIUM

Restrictions: Restricted to specialist use only.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/6667.htm

NEOSTIGMINE

Restrictions: Restricted to specialist use only.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/6669.htm

SUGAMMADEX

Restrictions: The immediate reversal of rocuronium-induced neuromuscular blockade in adults is restricted to use according to local protocol. Use for the routine reversal of neuromuscular blockade induced by rocuronium or vecuronium is restricted to specialist use only in adults considered to be high risk (see prescribing notes below).

Prescribing Notes:

High risk patients are defined as:

  • morbid obesity
  • significant respiratory disease or reduced respiratory reserve 
  • significant coronary disease 
  • major abdominal/chest surgery

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/201174.htm

15.1.7 Antagonists for central and respiratory depression

Total Formulary
DOXAPRAM

Restrictions: Restricted to specialist use only.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/6672.htm

FLUMAZENIL

Restrictions: Restricted to specialist initiation.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/6675.htm

NALOXONE

Restrictions: Restricted to specialist initiation.

Prescribing Notes:

Excludes the combination product of oxycodone and naloxone (Targinact®).

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/6677.htm

15.1.8 Drugs for malignant hyperthermia

Total Formulary
DANTROLENE

Restrictions: Restricted to specialist use only.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/6682.htm