Greater Glasgow and Clyde Medicines
Key to symbols The medicine should be initiated by, or on the advice of a specialist, but is suitable for continuation by a GP The medicine should only be used and prescribed by a specialist Indicates the preferred choice within a class or group of medicines
The medicine should be initiated by, or on the advice of a specialist, but is suitable for continuation by a GP
The medicine should only be used and prescribed by a specialist
Indicates the preferred choice within a class or group of medicines
15. Anaesthesia

15.1. General anaesthesia

15.1.1. Intravenous anaesthetics

Total Formulary
Specialist Only
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. For the relevant SMC advice click here

Prescribing Notes:

The following indications are not recommended for use by the SMC and are non-Formulary:

  • Sedation of non-intubated adults prior to and/or during diagnostic or surgical procedures requiring sedation, i.e. procedural/awake sedation.

BNF Link

Specialist Only
THIOPENTAL

Restrictions: Restricted to specialist use only.

BNF Link

Specialist Only
PROPOFOL

Restrictions: Restricted to specialist use only.

BNF Link

Specialist Only
KETAMINE

Restrictions: Restricted to specialist use only.

BNF Link

Specialist Only
ETOMIDATE

Restrictions: Restricted to specialist use only.

BNF Link

15.1.2. Inhalational anaesthetics

Total Formulary
Specialist Only
SEVOFLURANE

Restrictions: Restricted to specialist use only.

BNF Link

Specialist Only
NITROUS OXIDE

Restrictions: Restricted to specialist use only.

BNF Link

Specialist Only
ISOFLURANE

Restrictions: Restricted to specialist use only.

BNF Link

Specialist Only
ENTONOX

Restrictions: Restricted to specialist use only.

BNF Link

Specialist Only
DESFLURANE

Restrictions: Restricted to specialist use only.

BNF Link

15.1.3. Antimuscarinic drugs

Total Formulary
Specialist Only
HYOSCINE HYDROBROMIDE (INJECTION)

Restrictions: Restricted to specialist use only.

BNF Link

Specialist Only
GLYCOPYRRONIUM (injection)

Restrictions: Restricted to specialist use only.

BNF Link

Specialist Only
ATROPINE

Restrictions: Restricted to specialist use only.

BNF Link

15.1.4. Sedative and analgesic peri-operative drugs

15.1.4.1. Anxiolytics

Total Formulary
Specialist and GP
TEMAZEPAM (TABLETS)

Restrictions: Restricted to specialist initiation.

BNF Link

Specialist and GP
MIDAZOLAM

Restrictions: Restricted to specialist initiation.

BNF Link

Specialist and GP
LORAZEPAM

Restrictions: Restricted to specialist initiation.

BNF Link

Specialist and GP
DIAZEPAM

Restrictions: Restricted to specialist initiation.

BNF Link

Specialist and GP
CHLORPROMAZINE

Restrictions: Restricted to specialist initiation.

BNF Link

15.1.4.2. Non-opioid analgesics

Total Formulary
Specialist and GP
KETOROLAC (INJECTION)

Restrictions: Restricted to specialist initiation.

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Specialist and GP
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

15.1.4.3. Opioid analgesics

Total Formulary
Specialist Only
REMIFENTANIL

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

BNF Link

Specialist and GP
PETHIDINE

Restrictions: Restricted to specialist initiation.

BNF Link

Specialist and GP
PAPAVERETUM

Restrictions: Restricted to specialist initiation.

BNF Link

Specialist and GP
MORPHINE

Restrictions:

Restricted to specialist initiation.

Prescribing Notes:

Excludes Depodur® preparations.  Modified-release preparations should be prescribed by brand name.  The preferred choice of solid morphine sulphate MR across primary and secondary care in NHSGGC is Zomorph®

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Specialist Only
FENTANYL (INJECTION)

Restrictions: Restricted to specialist use only.

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Specialist Only
ALFENTANIL

Restrictions: Restricted to specialist use only.

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15.1.5. Neuromuscular blocking drugs

Total Formulary
Specialist Only
SUXAMETHONIUM

Restrictions: Restricted to specialist use only.

BNF Link

Specialist Only
VECURONIUM

Restrictions: Restricted to specialist use only.

BNF Link

Specialist Only
ROCURONIUM

Restrictions: Restricted to specialist use only.

BNF Link

Specialist Only
PANCURONIUM

Restrictions: Restricted to specialist use only.

BNF Link

Specialist Only
MIVACURIUM

Restrictions: Restricted to specialist use only.

BNF Link

Specialist Only
CISATRACURIUM

Restrictions: Restricted to specialist use only.

BNF Link

Specialist Only
ATRACURIUM

Restrictions: Restricted to specialist use only.

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15.1.6. Drugs for reversal of neuromuscular blockade

Total Formulary
Specialist Only
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

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Specialist Only
NEOSTIGMINE

Restrictions: Restricted to specialist use only.

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Specialist Only
EDROPHONIUM

Restrictions: Restricted to specialist use only.

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15.1.7. Antagonists for central and respiratory depression

Total Formulary
Specialist and GP
NALOXONE (NYXOID) (nasal spray)

Restrictions:

Restricted to use in accordance with the NHSGGC Take-Home Naloxone programme only when the use of naloxone injection is inappropriate.

BNF Link

Specialist and GP
NALOXONE (injection)

Restrictions:

Restricted to specialist initiation.

Prescribing Notes:

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

BNF Link

Specialist and GP
FLUMAZENIL

Restrictions: Restricted to specialist initiation.

BNF Link

Specialist Only
DOXAPRAM

Restrictions: Restricted to specialist use only.

BNF Link

15.1.8. Drugs for malignant hyperthermia

Total Formulary
Specialist Only
DANTROLENE

Restrictions: Restricted to specialist use only.

BNF Link