Important: Drugs in this section should be used only by doctors with anaesthetic training and when resuscitation equipment is available.

15.1.1 Intravenous anaesthetics

Drugs used not listed here:

• Thiopental See section 4.8.2 Drugs used in status epilepticus

Etomidate

• Injection (emulsion) 2mg in 1ml, 10ml ampoule

Notes

1. Etomidate does cause adrenal suppression.

Ketamine

• Injection 50mg in 5ml ampoule preservative free (unlicensed preparation)
• Injection 10mg in 1ml, 20ml vial
• Injection 50mg in 1ml, 10ml vial

Notes

1. Ketamine may be used as an analgesic in low doses. Within UHPNT ketamine should be treated as a Schedule 3 CD.

Propofol

• 1% injection 10mg in 1ml, 20ml ampoule
• 1% injection 10mg in 1ml, 50ml bottle
• 1% injection 10mg in 1ml, 100ml bottle

15.1.2 Inhalational anaesthetics

Volatile halogenated anaesthetics

Isoflurane

• 250ml

Methoxyflurane

• Inhalation vapour 3ml

Sevoflurane

• 250ml

Nitrous oxide

Nitrous oxide cylinders size D, E, G

• Nitrous oxide 50% with oxygen 50% (Entonox) cylinders size D,E,G

Notes

1. 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.

15.1.3 Antimuscarinic drugs

Drugs used not listed here:

• Hyoscine Hydrobromide, and Glycopyrronium Bromide see section 1.2 Antispasmodics and other drugs altering gut motility

Atropine sulfate

• Injection 600micrograms/1ml ampoule (£1.17 = 1 ampoule)
• Injection 1mg/1ml ampoule (£16.81 = 1 ampoule)
• Injection 600 micrograms/1ml pre-filled syringe (unlicensed preparation)

15.1.4 Sedative and analgesic peri-operative drugs

15.1.4.1 Benzodiazepines

• There have been reports of overdose when high strength midazolam has been used for conscious sedation. Use should be restricted to general anaesthesia, intensive care, palliative care or other situations where the risk has been assessed.
• Flumazenil must be kept in all departments that use IV or SC midazolam (NPSA/2008/RRR011).
• Midazolam is a Schedule 3 CD and must be ordered in the CD order book.
• Temazepam See section 4.1.1 Hypnotics

15.1.4.2 Non-opioid analgesics

Ketorolac trometamol

• Injection 30mg in 1ml, 1ml ampoule

Notes

1. Licensed for use in short-term management of moderate to severe post operative pain only.

Parecoxib

• Injection powder for reconstitution 40mg vial

Notes

1. Contraindicated in treatment of post operative pain following coronary artery bypass graft (CABG surgery)
2. Caution in patients with increased risk of cardiovascular events.

15.1.4.3 Opioid analgesics

Drugs used not listed here:

• Alfentanil, see section 4.7.2 Opioid analgesics
• Fentanyl, see section 4.7.2 Opioid analgesics

Bupivacaine with fentanyl

• 0.1% with fentanyl 2 micrograms in 1ml 250ml, 500ml for epidural infusion
• 0.1% with fentanyl 1mg in 1ml, 500ml (unlicensed) for epidural infusion

Bupivacaine with diamorphine

• 0.167% with diamorphine 50 micrograms in 1ml, 500ml (unlicensed) for epidural infusion
• Diamorphine 5mg and 10mg injection: supplies will be unpredictable for the foreseeable future (DSHC, March 2020). Contact the pharmacy department before prescribing to determine whether there is stock available
  

Remifentanil

• Injection powder for reconstitution 1mg, 2mg, 5mg vials

Notes

1. Intravenous use by anaesthetists and intensive care physicians only due to rapid and profound respiratory depression.

15.1.4.4 Other drugs for sedation

Dexmedetomidine

• Injection 100 micrograms in 1ml, 4ml vial, 10ml vial

15.1.5 Neuromuscular blocking drugs

Non-depolarising neuromuscular blocking drugs

Atracurium besilate

• Injection 10mg in 1ml, 2.5ml, 5ml, 25ml vials

Rocuronium bromide

• Injection 10mg in 1ml, 5ml vial

Vecuronium bromide

• Injection powder for reconstitution 10mg vial

Depolarising neuromuscular blocking drugs

Suxamethonium chloride

• Injection 50mg in 1ml, 2ml ampoule

15.1.6 Drugs for reversal of neuromuscular blockade

Neostigmine metilsulphate

• Injection 2.5mg in 1ml, 1ml ampoule

Neostigmine with glycopyrronium bromide

• Injection neostigmine 2.5mg with glycopyrronium bromide 500 micrograms in 1ml

Sugammadex

• Injection 100mg in 1ml, 5ml vial

15.1.7 Antagonists for central and respiratory depression

Naloxone hydrochloride

• Solution for injection ampoules 400micrograms/1ml (£4.05 = 1 ampoule)

Flumazenil

• Injection 100mg in 1ml, 5ml ampoule

Nyxoid

(Naloxone hydrochloride)

• 1.8mg in 0.1ml nasal spray, single use
• Each pack contains two nasal sprays

Prenoxad

(Naloxone hydrochloride)

• 2mg in 2ml solution for injection pre-filled syringe, for intramuscular injection
• Each pack contains one 2ml syringe (five 0.4ml doses) and two needles

Notes

1. CAS alert 10 November 2022: Prenoxad 1mg/ml Solution for Injection in a pre-filled syringe, Macarthys Laboratories, (Aurum Pharmaceuticals Ltd), caution due to potential needles in sealed kits.