15.1. General anaesthesia
15.1.1. Intravenous anaesthetics
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.
15.1.2. Inhalational anaesthetics
15.1.3. Antimuscarinic drugs
15.1.4. Sedative and analgesic peri-operative drugs
15.1.4.1. Anxiolytics
15.1.4.2. Non-opioid analgesics
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
15.1.4.3. Opioid analgesics
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®
15.1.5. Neuromuscular blocking drugs
15.1.6. Drugs for reversal of neuromuscular blockade
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
15.1.7. Antagonists for central and respiratory depression
Restrictions:
Restricted to specialist initiation.
Prescribing Notes:
Excludes the combination product of oxycodone and naloxone (Targinact®).
Restrictions:
Restricted to use in accordance with the NHSGGC Take-Home Naloxone programme only when the use of naloxone injection is inappropriate.