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Bedfordshire and Luton Joint Formulary
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Bedfordshire CCG
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 Formulary Chapter 15: Anaesthesia - Full Chapter
Notes:

Any drug not listed on the Formulary should be considered Non-Formulary - Not recommended for prescribing

 Details...
15.01  General anaesthesia
15.01  Anaesthesia, sedation and resuscitation in dental practice
15.01  Gas cylinders
15.01.01  Intravenous anaesthetics
15.01.01  Barbiturates to top
Thiopental 500mg
(Injection)
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Formulary
Red
 
   
15.01.01  Other intravenous anaesthetics
Etomidate
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Formulary
Red
20mg/10mL Injection  
   
Controlled Drug Ketamine injection
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Restricted Drug Restricted
Red
500mg/10mL, 200mg/ 20mL Injection

 
   
Propofol
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Formulary
Red
1% & 2% Injection
1% Pre-filled Syringe
200mg/20mL Injection
 
   
15.01.02  Inhalational anaesthetics
15.01.02  Volatile liquid anaesthetics
Desflurane
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Formulary
Red
 
   
Isoflurane
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Formulary
Red
 
   
Methoxyflurane 99.9% (Penthrox)
(3mL Liquid, Inhalation vapour)
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Restricted Drug Restricted
Red

For use in single episodes of trauma in the Emergency Department only, for patients with Colles fracture or dislocation.

 
   
Sevoflurane
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Formulary
Red
 
   
15.01.02  Nitrous oxide
Nitrous oxide
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Formulary
Red
High Cost Medicine

FOR ALL PRESCRIBING – Blueteq or High cost drug form required – see link from Formulary homepage.

 
Link  MHRA Drug Safety Update (February 2015) - INOmax (nitric oxide) cylinders: valve defect might stop gas delivery early in some cylinders
   
Nitrous Oxide 50%/Oxygen 50% (Entonox)
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Formulary
Red
 
   
15.01.03  Antimuscarinic drugs to top
Atropine
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Formulary
Red
600microgram/1mL Injection
3mg/10mL Pre-filled Syringe  
   
Glycopyrronium
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Formulary
Red
200microgram/1mL Injection
600microgram/3mL Injection
 
   
Hyoscine Hydrobromide
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Formulary
Red
400microgram/1mL Injection  
   
15.01.04  Sedative and analgesic peri-operative drugs
15.01.04.01  Benzodiazepines
Controlled Drug Midazolam
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Formulary
Red
5mg/5mL, 10mg/2mL & 10mg/2mL Injection

N.B.: always prescribe 10mg/2mL strength for palliative care. 
   
Controlled Drug Midazolam 10mg in 2mL (Buccolam)
(Oromucosal solution, pre-filled syringe)
View adult BNF View SPC online View childrens BNF
Restricted Drug Restricted
Red

Approved by DTC for adult patients with severe pre-operative anxiety where alternatives cannot be given (e.g. needle phobic patients).

 
   
15.01.04.01  Benzodiazepines
15.01.04.02  Non-opioid analgesics
Ketorolac
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Formulary
Red
30mg/1mL Injection  
   
15.01.04.03  Opioid analgesics to top
Controlled Drug Alfentanil (Rapifen)
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Restricted Drug Restricted
Red
1mg/2mL & 5mg/10mL Injection
5mg/1mL Injection - Restricted for ITU Only  
   
Controlled Drug Fentanyl
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Formulary
Red
100microgram/2mL, 500microgram/10mL Injection  
   
Controlled Drug Remifentanil (Ultiva)
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Formulary
Red
1mg, 2mg & 5mg Injection  
   
15.01.04.04  Other drugs for sedation
Dexmedetomidine  (Dexdor)
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Restricted Drug Restricted
Red
200micrograms/2mL, 400micrograms/4mL

Restricted - prescribing by Consultant Anaesthetists on ITU. 
   
15.01.05  Neuromuscular blocking drugs
15.01.05  Non-depolarising muscle relaxants
Atracurium Besilate
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Formulary
Red
25mg/2.5mL, 50mg/5mL & 250mg/25mL Injection  
   
Cisatracurium
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Formulary
Red
20mg/10mL Injection  
   
Mivacurium Chloride
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Formulary
Red
10mg/5mL & 20mg/10mL Injection  
   
Pancuronium Bromide
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Formulary
Red
4mg/2mL Injection
 
   
Rocuronium Bromide
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Formulary
Red
50mg/5mL & 100mg/10mL Injection  
   
Vecuronium Bromide
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Formulary
Red
10mg Injection 
   
15.01.05  Depolarising muscle relaxants
Suxamethonium Chloride
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Formulary
Red
100mg/2mL Injection
100mg/2mL Pre-filled Syringe  
   
15.01.06  Drugs for reversal of neuromuscular blockade to top
15.01.06  Anticholinesterases
Edrophonium
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Formulary
Red

unlicensedunlicensed 10mg/1mL Injection 


N.B. not routinely stocked. 

 
   
Neostigmine
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Formulary
Red
2.5mg/1mL Injection  
   
Neostigmine with Glycopyrronium
(Injection)
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Formulary
Red

Neostimine 2.5mg/Glycopyrronium 500microgram Injection

 
   
15.01.06  Other drugs for reversal of neuromuscular blockade
Sugammadex (Bridion)
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Restricted Drug Restricted
Red
100mg/1mL Injection

Restricted to licensed indications: sign out of CD cupboard. 
   
15.01.07  Antagonists for central and respiratory depression
Flumazenil
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Formulary
Red
500microgram/5mL Injection
 
   
Naloxone
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Formulary
Red
400microgram/1mL Injection  
Link  L&D Guidelines for IV administration of Naloxone for reversal of opiate / opioid overdose in Adults
   
15.01.08  Drugs for malignant hyperthermia
Dantrolene Sodium 20mg
(Injection)
View adult BNF View SPC online View childrens BNF
Formulary
Red

Neuroleptic malignant syndrome (NMS)

Other drug-related hyperpyrexia (consult TOXBASE)

Kept in Pharmacy EDC and in theatres.

 
Link  MHRA Drug Safety Update (July 2014) - Intravenous dantrolene: risk of undissolved crystals
   
15.02  Local anaesthesia to top
15.02  Articaine
15.02  Bupivacaine
Bupivacaine Hydrochloride
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Formulary
Red
0.25% & 0.5% Injection  
   
Bupivacaine Hydrochloride with Glucose (Marcain Heavy)
(Injection, epidural)
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Formulary
Red
 
   
Bupivacaine With Adrenaline
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Formulary
Red
Bupivacaine 0.25%/Adrenaline 1 in 200,000 Injection
Bupivacaine 0.5%/Adrenaline 1 in 200,000 Injection  
   
15.02  Levobupivacaine
Levobupivacaine (Chirocaine)
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Restricted Drug Restricted
Red
For use in theatres for selected nerve block procedures. 
   
15.02  Lidocaine
Lidocaine
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Formulary
Red
0.5% & 1% Injection (10mL)
1% & 2% Injection (5mL)
1% Injection Ampoule

 
   
Lidocaine 10% (laryngojet)
(Spray)
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Formulary
Green
10mg/dose 
   
Lidocaine 2.5% with Prilocaine 2.5% (EMLA)
(Cream)
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Formulary
Green
 
   
Lidocaine 5% and Phenylephrine 0.5%
(Topical Spray )
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Formulary
Red
 
   
Lidocaine 5% Plaster (Versatis)
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Restricted Drug Restricted
Amber

Restricted - Must be initiated  only for the licensed indication: post herpetic neuralgia,  in line with the JPC guideline.

The evidence for the effectiveness of lidocaine medicated plasters is limited, of low quality, and the clinical effectiveness remains unclear. However, low quality individual studies indicate that it may have a role in pain relief.

Response to treatment should be evaluated after 4 weeks of treatment. Patients with an inadequate initial response after 4 weeks, (improvement after this time is unlikely) – DISCONTINUE treatment.

The therapeutic benefit should be reassessed regularly at least every three months.

The DTC previously approved for palliative patients for neuropathic pain where systemic treatment is not tolerated. This indication is under review.

 
Link  Primary Care Guidelines for the Management of Chronic Non-cancer Pain in Adults (Sep 2018)
   
Lidocaine with Adrenaline (1% / 1:200,000)
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Formulary
Red
 
   
Lidocaine2% with Chlorhexidine 0.25%
(Gel)
View adult BNF View SPC online View childrens BNF
Formulary
Green
Brands include Instillagel.

N.B. Available from Main Stores (not Pharmacy). 
   
LMX Lidocaine
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Formulary
Red
Lidocaine W/W 4% Cream  
   
LAT
(Gel)
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Restricted Drug Restricted
Red
LAT Gel

Restricted - To be used prior to suturing of wounds in children only  
   
15.02  Mepivacaine to top
15.02  Prilocaine
Prilocaine Hydrochloride 1% (Citanest)
(50mL glass vial)
View adult BNF View SPC online View childrens BNF
Formulary
Red
 
   
Prilocaine Hydrochloride 20mg/mL (Prilotekal)
(Injection)
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Formulary
Red

For use in adults for spinal anaesthesia for short term surgical procedures in day case surgery

5mL ampoule

 
   
15.02  Procaine
15.02  Ropivacaine
15.02  Tetracaine
15.02  Other local anaesthetics to top
Controlled Drug Cocaine
View adult BNF View SPC online View childrens BNF
Unlicensed Drug Unlicensed
Red
10% Topical Solution  
   
 ....
 Non Formulary Items
Articaine Hydrochloride with Adrenaline  (Septanest)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Benzocaine

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Non Formulary
 
Benzocaine 20% Gel  (Ultracare Bubble Gum)

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Non Formulary
 
Controlled Drug  Bupivacaine with Fentanyl

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Non Formulary
 
Chloroprocaine hydrochloride  (Ampres)

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Non Formulary
 
Controlled Drug  Cocaine with Adrenaline

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Non Formulary
 
Dermogesic spray

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Ethyl Chloride  (Cryogesic Spray)

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Non Formulary
 
Etomidate  (Etomidate-Lipuro)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Controlled Drug  Levobupivacaine with Fentanyl

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Lidocaine with tetracaine  (Pliaglis)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Mepivacaine  (Scandonest Plain)

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

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Non Formulary
 
Prilocaine Hydrochloride with Felypressin  (Citanest with Octapressin)

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

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Ropivacaine Hydrochloride  (Naropin)

View adult BNF View SPC online View childrens BNF
Non Formulary
 
Tetracaine (Amethocaine)  (Ametop)

View adult BNF View SPC online View childrens BNF
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
SMC
Scottish Medicines Consortium
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

Red

RED - Hospital only to be prescribed by a specialist and supplied from secondary care ONLY throughout treatment  

Amber

Amber medicines are considered suitable for GP prescribing following specialist initiation.  

Green

These medicines are appropriate for initiation in both primary and secondary care. Prescribing is appropriate within licensed or local recommendations   

Amber SCG

Shared Care - these medicines require specialist initiation and stabilisation. Ongoing division of responsibility for drug and disease monitoring between specialist and GP by a Shared Care Guideline (SCG). If no SCG in place status reverts to red.   

Black

A decision has been made by either or both the local or national NHS not to routinely commission this preparation for its licensed indications. Do not prescribe.   

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