Formulary Chapter 15: Anaesthesia - Full Chapter
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15.01.04 |
Sedative and analgesic peri-operative drugs |
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15.01.04.01 |
Benzodiazepines |
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Diazepam
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Formulary
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- 2mg, 5mg tablets – 10mg tablets should no longer be used.
- 2mg in 5ml oral solution.
- 10mg in 2ml injection (plain & emulsion) .
- For use in epilepsy see section 4.8.2 and use in anxiety see
section 4.1.2.
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Lorazepam
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Formulary
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Midazolam
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Formulary
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- 5mg in 5ml, 10mg in 2ml injections
- 50mg in 50ml prefilled syringes - ITU use only
- Intranasal midazolam 40mg/ml + lidocaine 20mg/ml
- approved for use prior to cannulation for adult patients with
special needs receiving dental treatment under IV sedation.
- Miprosed® 5mg in 1ml (7.5ml) oral solution is approved for use as a sedative and pre-medication in children
Palliative care
- 10mg/2ml injection
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Temazepam
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Formulary
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Alimemazine (Trimeprazine)
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Formulary
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- 30mg/5ml syrup.
- see section 03.04.01 for other formulations.
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15.01.04.01 |
Benzodiazepines |
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15.01.04.02 |
Non-opioid analgesics |
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Diclofenac 75mg/1ml injection
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Formulary
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- Mainly for use in post-operative analgesia - see section 10.01.01 for other formulations
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MHRA Drug Safety Update (June 2013): Diclofenac: new contraindications and warnings
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Parecoxib 40mg injection (Dynastat®)
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Formulary
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- For peri-operative use only.
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Ketorolac injection
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Alternatives
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- 10mg/1ml & 30mg/1ml injection
- the use of this is no longer recommended, other parenteral analgesics are now preferred
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15.01.04.03 |
Opioid analgesics |
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Alfentanil
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Formulary
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- All non-palliative care indications
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Alfentanil (Palliative Care)
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Formulary
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- 500micrograms in 1ml [ST&S], 1mg in 2ml, 5mg in 10ml & 5mg in 1ml injection ampouless - approved for initiation by specialists in palliative care
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Fentanyl
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Formulary
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- 100 microgram in 2ml & 500 microgram in 10ml injections
- 2.5mg in 50ml (50 micrograms/ml) syringe unlicensed
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Levobupivacaine with Fentanyl
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Formulary
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- 2 micrograms/ml with levobupivacaine 0.1% in sodium chloride 0.9% infusion, 100ml, 250ml & 500ml unlicensed
- 4 micrograms/ml with levobupivacaine 0.125% in sodium chloride 0.9% infusion, 500ml (RVI) unlicensed
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Remifentanil
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Formulary
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- 1mg, 2mg & 5mg injections.
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15.01.04.04 |
Other drugs for sedation |
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Dexmedetomidine (Dexdor®)
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Formulary
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- 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) unlicensed 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.
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Key |
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Cytotoxic Drug
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Controlled Drug
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High Cost Medicine
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NHS England |
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Homecare |
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CCG |
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Traffic Light Status Information
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Description |
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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.
For all RED drugs automatically added to the formulary in response to a positive NICE TA: Prescribers need to ensure that local Trust new drug governance procedures and pharmacy processes are followed before any prescribing. |
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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. |
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Drugs normally recommended or initiated by a specialist (hospital or GP with an extended role https://www.rcgp.org.uk/gpwer), but can be safely maintained in primary care with very little or no monitoring required. In some cases there may be a further restriction for use outlined - these will be defined in each case. Provision of additional information, or an information leaflet, may be appropriate in some cases to facilitate continuing treatment by GPs. |
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Drugs where prescribing by GPs is appropriate. Can be initiated and prescribed in all care settings, and if appropriate, discontinued without recourse to secondary care. |
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NOT APPROVED: Drugs that have been considered by NTAG or the NENC ICB Medicines Subcommittee (or other approved body) and are not approved for prescribing within the North East and North Cumbria. |
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UNDER REVIEW: drugs whose current formulary status or RAG status is currently under review. |
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NOT REVIEWED: Drugs that haven not been reviewed yet. This usually means that an application is in progress. These drugs are not normally considered appropriate for prescribing in the North East and North Cumbria until such time that a decision is taken on their formulary status. |
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