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15. Anaesthesia

CD&D APC Patient Decision Aids Resource available at: http://medicines.necsu.nhs.uk/guidelines/durham-darlington/

CD&D APC “Do Not Prescribe List” and “Grey List – drugs prescribed under limited circumstances” available at: http://medicines.necsu.nhs.uk/guidelines/durham-darlington/

Propofol
BNF | BNFC | SPC
Etomidate
BNF | BNFC | SPC

2mg injection

Ketamine
BNF | BNFC | SPC

200mg in 20mL, 500mg in 10mL and 1g in 10mL solution for injection

Use in mental health in ECT suite also considered RED

Ketamine (Palliative Care)
BNF | BNFC | SPC

50mg in 5mL unlicensed oral solution

Thiopental Sodium
BNF | BNFC | SPC

500mg in 20mL powder for solution for injection

Isoflurane
BNF | BNFC | SPC
Nitrous Oxide
BNF | BNFC | SPC

MHRA Drug Safety Update December 2008: Nitrous oxide: neurological and haematological side-effects

Entonox
BNF | BNFC | SPC

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

MHRA Drug Safety Update December 2008: Nitrous oxide: neurological and haematological side-effects

Sevoflurane
BNF | BNFC | SPC
Desflurane
BNF | BNFC | SPC
Atropine Sulphate
BNF | BNFC | SPC

600mcg injection

Glycopyrronium Bromide
BNF | BNFC | SPC

200mcg in 1mL and 600mcg in 3mL injection

Hyoscine Hydrobromide
BNF | BNFC | SPC

400mcg injection

Diazepam
BNF | BNFC | SPC

2mg and 5mg tabs, 2mg in 5mL oral solution

Midazolam
BNF | BNFC | SPC

5mg in 5ml (1mg/ml) injection 

10mg in 2ml injections 

50mg in 5mL pre-filled syringes (ITU Use Only)

2.5mg in 1mL oral solution (unlicensed)

Intranasal midazolam 40mg in 1mL and lidocaine 20mg in 1mL (Only for use prior to  cannulation for adult patients with special needs receiving dental treatment under IV sedation

MHRA Letters sent to healthcare professionals (January 2018): Buccolam (midazolam) – risk of inhalation / ingestion of tip cap of prefilled plastic syringes.

Temazepam
BNF | BNFC | SPC

10mg, 20mg tablets

NICE TA77

Lorazepam
BNF | BNFC | SPC

1mg tablets

NICE TA77

MHRA Drug Safety Update (October 2007): Lorazepam: reduction of maximum daily dose.

Alimemazine
BNF | BNFC | SPC

30mg in 5mL syrup

Midazolam Palliative Care
BNF | BNFC | SPC

10mg/2ml injection for palliative care use.

Diclofenac
BNF | BNFC | SPC

75mg injection

MHRA Drug safety Update (October 2012): Non-steroidal anti-inflammatory drugs (NSAIDs): cardiovascular risks.

MHRA Drug Safety Update (December 2007): NSAIDs and coxibs: balancing of cardiovascular and gastrointestinal risks.

MHRA Guidance (January 2015): Cox-2 selective inhibitors and non-steroidal anti-inflammatory drugs (NSAIDs): Cardiovascular safety.

Parecoxib
BNF | BNFC | SPC

40mg injection. For perioperative use only

Alfentanil
BNF | BNFC | SPC
Alfentanil (Palliative Care)
BNF | BNFC | SPC

1mg in 2mL, 5mg in 10mL and 5mg in 1mL injection

Fentanyl
BNF | BNFC | SPC

100mcg in 2mL, 500mcg in 10mL injection

Fentanyl with levobupivacaine
BNF | BNFC | SPC
Remifentanil
BNF | BNFC | SPC

1mg, 2mg and 5mg injection

Dexmedetomidine
BNF | BNFC | SPC

100mcg in 1mL injection

Atracurium
BNF | BNFC | SPC

25mg in 2.5mL, 50mg in 5mL and 250mg in 25mL injection

– first line

Cisatracurium
BNF | BNFC | SPC

20mg in 10mL and 150mg in 30mL injection

Reserved for patients at risk of bronchospasm

Mivacurium
BNF | BNFC | SPC

10mg in 5mL injection and 20mg in 10mL injection

Reserved for ENT

Rocuronium
BNF | BNFC | SPC

50mg in 5mL injection

Suxamethonium
BNF | BNFC | SPC

100mg in 2mL injection

Vecuronium
BNF | BNFC | SPC

10mg in 5mL injection

Papaverine
BNF | BNFC | SPC

30mg in 2mL injection (unlicensed)

Glycopyrronium
BNF | BNFC | SPC
Neostigmine
BNF | BNFC | SPC

2.5mg in 1mL injection

Sugammadex
BNF | BNFC | SPC

200mg in 2mL and 500mg in 5mL injection

Restricted to named patient only

Doxapram
BNF | BNFC | SPC

100mg in 5mL injection

Flumazenil
BNF | BNFC | SPC

500mcg in 5mL injection

Naloxone
BNF | BNFC | SPC

400mcg in 1mL injection. 2mg in 2mL pre-filled syringe

Dantrolene Sodium
BNF | BNFC | SPC

20mg injection

MHRA Drug Safety Update (July 2014): Intravenous dantrolene: risk of undissolved crystals. 

Sodium Citrate 0.3 molar peppermint flavoured solution
BNF | BNFC | SPC

50ml pack

Lidocaine Injections
BNF | BNFC | SPC
Lidocaine with Adrenaline Injections
BNF | BNFC | SPC
Lidocaine 10% Spray
BNF | BNFC | SPC
Bupivacaine
BNF | BNFC | SPC
Levobupivacaine IV
BNF | BNFC | SPC
Mepivacaine IV
BNF | BNFC | SPC

3% 2.2ml cartridges

Prilocaine IV
BNF | BNFC | SPC
Tetracaine 4% gel (Ametop®)
BNF | BNFC | SPC
Lidocaine 4% cream (LMX4)
BNF | BNFC | SPC
Lidocaine with prilocaine cream (EMLA)
BNF | BNFC | SPC
Lidocaine 5% with Phenylephrine 0.5% nasal – UNLICENSED
BNF | BNFC | SPC
PR Freeze Spray
BNF | BNFC | SPC