MTW NHS Trust West Kent CCG

Drug Status Key

  • Preferred
  • Second Line
  • Third Line
  • Specialist Initiation
  • Hospital Only
  • Not Approved for Formulary

Intravenous Anaesthetics

Important safety information

Anaesthetics should only be administered by, or under the direct supervision of, personnel experienced in its use, with adequate training in anaesthesia and airway management, and when resuscitation equipment is available.

Propofol is the most widely used intravenous anaesthetic; it is associated with rapid recovery and less hangover effect than other intravenous anaesthetics. Pain on IV injection can be reduced using lidocaine 1%. Convulsions can occur after propofol administration. The CSM has advised special caution in day surgery as convulsions may be delayed.

Etomidate is an intravenous agent associated with rapid recovery without a hangover effect. Etomidate causes less hypotension than thiopental and propofol during induction. It produces a high incidence of extraneous muscle movements, which can be minimised by an opioid analgesic or a short-acting benzodiazepine given just before induction. Etomidate suppresses adrenocortical function, particularly during continuous administration, and it should not be used for maintenance of anaesthesia.

Thiopental sodium is a barbiturate that is used for induction of anaesthesia, but has no analgesic properties. Induction is generally smooth and rapid, but dose-related cardiovascular and respiratory depression can occur. Awakening from a moderate dose of thiopental is rapid because the drug redistributes into other tissues, particularly fat. However, metabolism is slow and sedative effects can persist for 24 hours. Repeated doses have a cumulative effect and recovery is much slower.