1. Actrapid

    A fast acting human insulin product, which is used to reduce the high blood sugar level in patients with diabetes mellitus. Actrapid® will start to lower your blood sugar approximately 30 minutes after injection, and the effect will last for approximately 8 hours.

    Insulin infusion:
    100 IU/ml: dilution is 50 IU (0.5 ml) in 50 ml Saline (Luer lock syringe), giving 1 IU/ml.
    A typical dose is 0.3 - 1 IU/kg/day.
    Shelf life: before opening - 30 months;
    after opening - stored for a maximum of 6 weeks.
    (Store at 2-8°C)   NHS choices
  2. Adrenaline

    A hormone neurotransmitter of the sympathetic nervous system, secreted by the medulla of the adrenal gland, in response to stimulation of the sympathetic nervous system, causing vasoconstriction and increase in cardiac output.

    • Promotes fight-or-flight response
    • Relaxes smooth muscle in the airways (dilating bronchioles)
    • Vasoconstriction of most arterioles - raising blood pressure
    • Stimulates cardiac output, and increases heart rate
    • Increases blood flow to the brain
    • Causes the liver to release glycogen

    Pharmacological Adrenaline (Epinephrine) is administered in cases of asthma, anaphylactic shock, cardiac arrest, and collapse.

    Adrenaline administration:
    Cardiac arrest Acute anaphylaxis
    RouteIntravenous Intramuscular
    Strength1:10,000 1:1,000
    Concentrations 1g in 10,000 ml
    1 mg in 10 ml
    1g in 1,000 ml
    1 mg in 1 ml
    Dose1 mg (10 ml) 0.5 mg (0.5 ml)
    If repeated:Every 3-5 mins At 5 mins

    Side effects:
    • Nausea
    • Vomiting
    • Tachycardia
    • Arrhythmia
    • Palpitation
    • Hypertension
    • Anxiety
    • Sweating
    • Headache
    • Weakness
    • Pulmonary oedema

  3. Alfentanil

    Intra-operative opioid (quick acting, 10-15 mins ½ life) with an onset which is 4 times faster than Fentanyl, a ¼ the potency, and about a 1/3 of the duration. Respiratory depression may be a side-effect.
  4. Amikacin

    A demi-synthetic aminoglycoside antibiotic for treating hospital-acquired broad spectrum infections.
  5. Aminophylline

    Antimuscarinic bronchodilator, to reverse airway obstruction, and treatment for acute severe asthma. Brand name: Phyllocontin.
  6. Amiodarone

    An anti-arrhythmic agent, which causes peripheral vasodilation. Hypotension occurs when given I.V.
    For shockable rhythms, an initial bolus of 5 mg/kg should be given, after the third shock. If still in VF/VT, a repeat dose is to be given after the fifth shock. If given peripherally, flush with normal saline.
  7. Anti-Diuretic Hormone

    ADH aka Vasopressin: Peptide hormone from the pituitary gland, causing reabsorption of water in the renal tubules, with consequent reducion in urine output. In larger doses, ADH also causes constriction (vasoconstriction) of plain muscle, which increases peripheral vascular resistance, resulting in increased arterial blood pressure.
  8. Aspirin

    A non steroidal anti-inflammatory agent, which is used to treat fever, pain, and inflammation. Also, has an anti-platelet effect, by stopping the binding of platelets, thus preventing the patching over damaged blood vessel walls.
  9. Atracurium

    Short/medium duration muscle relaxation. Brand name: Tracrium.
    (G.A. potentiates use, so can reduce dose)
    > 2 years old: 0.3 - 0.6 mg/kg IV over 60 seconds, then 0.08 - 0.1 mg/kg 20-45 minutes, after initial dose. To maintain neuromuscular block, repeat maintenance dose 15-25 min.
    1 month - 2 years: 0.3 - 0.4 mg/kg IV.

    Spontaneous recovery from full block takes approximately 35 minutes.
  10. Atropine

    A parasympathetic antagonist, which blocks the action of the Vagus nerve. An emergency antimuscarinic and antispasmodic, used to counter bradycardia resulting from a reversal agent (Neostigmine). It is no longer recommended for asystole or cardiac arrest.

    A competitive antagonist of muscarinic cholinergic receptors (an antimuscarinic drug which antagonises (blocks) the action of Acetylcholine at receptors). It blocks the effect of the vagus nerve on both the sinoatrial (SA) and atrioventricular (AV) nodes, which increases the sinus rate and, thereby, the heart rate. Atropine ampoules should be stored away from light.

    When used as premedication for anaesthesia, Atropine decreases bronchial and salivary secretions, and blocks the bradycardia associated with some drugs, such as Halothane, Suxamethonium, and Neostigmine.

    Contraindicated in glaucoma.

    Bradycardia dose (I.V.):
    Ampoule: 0.6 mg in 1 ml.     Adult: 0.3 - 0.6 mg.
    Paediatric (1 yr+): 0.01 - 0.03 mg/kg (max 100 mcg).
  11. Augmentin (Co-amoxiclav)

    A broad spectrum penicillin antibiotic, composed of Amoxicillin and Clavulanate Potassium, used in the treatment (and propholaxysis) of infections of the ear, urinary tract, skin, and bacterial infections such as bronchitis, sinusitis, pneumonia. Augment is often used for treating infections caused by bacteria which are resistant to Amoxicillin.

    Augmentin should be used with caution in patients with:
    • Kidney disfunction
    • Liver disfunction
    • Allergies
    • Glandular fever
    • Lymphoid Leukaemia
  12. Benzodiazepines

    Anxiolytic agents, such as: Diazepam, Lorazepam, Midazolam, and Temazepam, which are antagonised by Flumazenil.
  13. Benzylpenicillin sodium

    600 mg
    I.M.: 1.6-2 ml WFI or 0.9% Saline
    I.V.: 4-10 ml WFI or 0.9% Saline
  14. Bupivacaine

    Aka Marcaine: An analgesic and peripheral nerve block, for patients over 12 years old. Longer lasting effect (2-6 hours) than Lignocaine. The addition of Adrenaline causes vasoconstriction, resulting in reduced blood loss.
    Maximum safe doses...
    Without Adrenaline (epinephrine): 2 mg/kg (equivalent to 0.8 ml/kg of 0.25% solution)
    For maximum volume, dilute with Saline to 1.25 ml/kg
    With Adrenaline: 2.5 mg/kg
  15. Buscopan

    Aka Scopolamine Butylbromide: An anticholinergic, containing the active ingredient Hyoscine Butylbromide, used as an antispasmodic to relieve colicky abdominal pain caused by painful spasms in the muscles of the gastro-intestinal or genito-urinary tract.
    Hyoscine works by relaxing smoothe (involuntary ) muscle in the walls of the stomach, intestines, bowel, bile duct, and urinary tract, whose contractions are caused by acetylcholine (neurotransmitter). Hyoscine stops the spasms in the smooth muscle by preventing acetylcholine from acting on the muscle, through the blocking of the receptors on the muscle cells which acetylcholine would normally act upon.
  16. Calcium

    Increases myocardial excitability, contractility, and peripheral resistance. Used in severe hyperkalaemia, and severe hypocalcaemia. Calcium Chloride is the response to hyperkalaemia.
  17. Cefuroxime

    A cephalosporin antibiotic against Gram positive & negative bacteria. Brand name: Zinacef.
  18. Chlorphenamine

    An antihistamine to treat allergies, urticaria, and anaphylaxis.
  19. Clarithromycin

    A macrolide antibiotic used to treat pharyngitis, tonsillitis, acute maxillary sinusitis, acute bacterial exacerbation of chronic bronchitis, pneumonia (especially atypical pneumonias associated with Chlamydophila pneumoniae), skin and skin structure infections. It is also sometimes used to treat legionellosis.
  20. Clindamycin

    Antibacterial against Gram positive cocci, Penicillin resistant staphylococcal, and bone/joint infection.
  21. Clonadine, Catapres

    Lowers blood pressure by decreasing the levels of certain chemicals in the blood, which allows the blood vessels to relax, and the heart to beat more slowly and easily.
  22. Clopidogrel

    An antiplatelet agent, to lower the risk of blood clot formation. Clopidogrel may be given to patients who have had:

    • A heart attack
    • A stroke
    • Acute coronary syndrome (minor heart attack or unstable angina)
    • A coronary stent (device to open up a blocked artery to the heart)

    Clopidogrel may also be given to patients who are at risk or heart attack or stroke, and are allergic to Aspirin. For example, patients who:

    • Have high cholesterol
    • Have high blood pressure
    • Have diabetes
    • Smoke
  23. Cocaine

    A topical local analgesic and vasoconstrictor, which readily penetrates mucous membranes.
  24. Co-codamol

    As a non-proprietary name used to denote a particular compound analgesic - codeine phosphate and paracetamol. Co-codamol tablets are used for the relief of mild to moderate pain when paracetamol or NSAIDS, such as ibuprofen, aspirin or naproxen alone do not sufficiently relieve a patient's symptoms.
  25. Codeine Phosphate

    Opioid analgesic, for mild to moderate pain, or coughing. Also, antitussive (relieves coughs) and antidiarrheal.
  26. Controlled drug

    Any substance or product specified in Part I, II, or III of Schedule 2 of the Misuse of Drugs Act,1971.
  27. Cyclizine

    Antihistamine and broad spectrum treatment for PONV and vertigo. Brand name: Valoid.
  28. Dantrolene

    Intravenous treatment of Malignant Hyperthermia. Brand name: Dantrium.
    Ampoule: 20 mg; dilute with 60 ml WFI.   Dose: 2-3 mg/kg. Repeat doses of 1 mg/kg, until tachycardia and pyrexis reduced, and CO2 stabilised.
  29. Desflurane

    Inhalational volatile liquid anaesthetic which is quick acting and, because of it's low solubility, allows rapid recovery. A maintenance agent, which is a respiratory irritant, so unsuitable for induction.
  30. Dexamethasone

    A corticosteroid which suppresses the release of substances which cause inflammation. Also used to treat allergy, cerebral oedema, croup, nausea, and vomiting.
    Contraindications: hypertension, peptic ulcer, diabetes, infectious diseases.
  31. Diamorphine

    Opioid analgesic, which causes less hypotension and nausea than Morphine.
  32. Diazemuls

    A Benzodiazepine, containing an injectable form of Diazepam.
  33. Diclofenac

    Non steroidal anti-inflammatory agent for treating rheaumatic disease, and post operative pain. Brand names include: Voltarol, Arthrotec.
  34. Digoxin

    A cardiac glycoside drug which increases the force of heart muscle contractions, and reduces conductivity in the Atrio-Ventricular Node. Often used to treat Atrial Fibrillation. Brand name: Lanoxin.
  35. Dobutamine

    A sympathomimetic which stimulates the β-1 receptors of the sympathetic nervous system, having a positive inotropic effect. Used in the treatment of heart failure.
  36. Doxapram

    Stimulates the respiratory centre in the brain, to counter respiratory failure and postoperative respiratory depression. Brand name is Dopram.
  37. Drug reference

      Medicines Org
  38. Ephedrine

    A sympathomimetic amine, routinely used to treat hypotension associated with anaesthesia. Works by constricting peripheral blood vessels. Also used as a bronchodilator.

    Ampoule: 30 mg in 1 ml; dilute to 3 mg/ml (add 9 ml NaCl).   Dose: 6 mg bolus every few minutes.
    Contraindications: ischaemic heart disease, hyperthyroidism, hypertension.
  39. Ergometrine

    A type of medicine called an ergot alkaloid, used to help prevent and control bleeding after childbirth. Ergometrine acts on three different types of receptor in the walls of the blood vessels and in the uterus. When these receptors are stimulated by Ergometrine (500 mcg), they cause the blood vessels to constrict, and the uterus to contract. The contractions help the placenta to be pushed out.
  40. Erythromycin

    A macrolide antibiotic with an antimicrobial spectrum, similar to that of penicillin, often used for patients who are allergic to penicillins.
  41. Etomidate

    Induction agent, with rapid action and recovery, without hangover effects. No analgesic properties. The hypotension associated with induction is less severe than which occurs with Propofol or Thiopentone. Extraneous muscle movement can be minimised by administration of a pre-induction opioid, or short acting benzodiazepine (Loprazolam, Temazepam). Should not be used as a maintenance agent. Reduces intracranial pressure. 0.3 mg/kg.
  42. Fentanyl

    Synthetic opioid for intra-operative analgesia and enhancement of anaesthesia, with short duration (½ life: 20-30 minutes).
    Strength: 50 mcg/ml.     Induction dose: 2mcg/kg.
  43. Flumazenil

    Reversal agent for sedative affects of Benzodiazepines. Has shorter half-life and duration than Diazepam or Midazolam, so may need several doses.
  44. Fragmin

    Used with aspirin to prevent blood vessel complications in people with certain types of angina, or heart attack.
    Also used to prevent a type of blood clot (deep vein thrombosis), which can lead to blood clots in the lungs (pulmonary embolism). A DVT can occur after certain types of surgery, or in people who are bed-ridden due to a prolonged illness.
    Fragmin is also used, long-term, to treat venous thromboembolism (blood clot) in people with cancer.
  45. Furosemide

    Loop diuretic having peak effect within 30 minutes, and 6 hour total duration.
  46. Glycopyrrolate

    Aka Glycopyrronium: An antimuscarinic, typically given to counter bradycardia resulting when Neostigmine is given to reverse non-depolarising muscle block.
    For intra-operative bradycardia: 4-5 mcg/kg (iv).   Ampoule: 600 mcg in 3 ml.
  47. Glyceryl Trinitrate (GTN)

    A nitrate, used in the short term treatment of angina (chest pain, caused by a lack of oxygen reaching the heart), and left ventricular failure. The two effects are:
    (1) Vasodilation of arteries leading to the heart, and
    (2) Relaxation the veins which return blood to the heart.
    Together these actions allow more oxygen to reach the heart muscle, and reduce the work of the heart.
  48. Haloperidol

    The preferred anti-emetic for opioid induced nausea, or nausea resulting from hypercalcaemia.
  49. Halothane

    Induction & maintenance of anaesthesia.
  50. Heparin

    Anti-coagulant treatment and prophylaxis for blood clotting. Brand names: Calciparine, Monoparin.
  51. Hydrocortisone

    Shock; anaphylactic shock. Brand names: Efcortesol, Solu-Cortef.
  52. Hyoscine

    aka Scopolamine: An antimuscarinic which is used to dry secretions, treat motion sickness, nausea, and vomiting.
  53. Isoflurane

    Volatile anaesthetic for induction & maintenance.
  54. Isoprenaline

    Increases myocardial contractility, and heart rate, in bradycardic episodes where temporary electronic pacing is inappropraite.
  55. Ketamine

    Intravenous phenycyclidine induction agent, with good analgesic properties, amd less hypotension than Propofol or Thiopentone. Mainly used in paediatric anaesthesia. Raises BP and heart rate, but maintains ventolation and laryngeal reflexes. Recovery is slow, and side-effects include hallucinations and extraneous muscle movements. Causes bronchodilation (infusions possible for those with severe asthma). Contra-indicated for patients with head injury or intra-cranial pressure. Side-effects: respiratory depression, nausea, laryngospasm, tachy/bradycardia, hypo/hypertension.
    Ampoule: 500 mg in 10 ml. Dose: 1-4 mg/kg.
  56. Labetalol

    β-blocker: treatment for hypertension in myocardial infarction, and to control blood pressure during anaesthesia. Brand name: Trandate.
  57. Lignocaine

    aka Lidocaine: A sodium channel blocker, used as a local anaesthetic, and as treatment for arrhythmia following myocardial infarction. As a local anaesthetic, Lignocaine is supplied in 1% (10 mg/ml) and 2% solutions. The addition of Adrenaline to Lignocaine causes vasoconstriction, resulting in reduced blood loss. Brand/other names are: Lidocaine, Instillagel, Xylocaine.

    Also available with Adrenaline (1:100,000), which causes local vasoconstriction and limits local spread of the drug, thereby allowing a larger dose to be infiltrated without causing systemic toxicity.

    Duration=1 hour. The maximum dose of 1% lidocaine with epinephrine is 7 mg/kg.
  58. Lorazepam

    A benzodiazepine anxiolytic, with slow onset (90 minutes), but longer lasting than Temazepam.
  59. Magnesium

    Reduces Acetylcholine release from nerve terminals; Used as a bronchodilator and antiarrhythmic agent. It also tends to lower the BP.
  60. Marcaine

    Trade name for Bupivacaine
  61. Metaraminol

    Vasoconstrictor sympathomimetic; To treat acute hypotension.
    Ampoule: 10 mg in 1 ml.   Dilution: 10 mg in 20 ml NaCl (add 19 ml).   Dose: 0.5 mg bolus, to effect.
  62. Metoclopramide

    Antiemetic treatment of severe PONV in adults. Brand name: Maxolon.
  63. Metronidazole

    A first line antibiotic, used against anaerobic bacteria, and protozoa, and Clostridium Difficile. Metronidazole is used in places where bacteria do not need oxygen to thrive, such as the pelvic cavity, gut, gums, and bones.

    If Metronidazole proves ineffective, Vancomycin may be used as a second line therapy.
  64. Midazolam

    A short acting (wears off quickly) benzodiazepine anxiolytic, with rapid onset; produces sedation with amnesia. Also used as premedication, induction support, muscle relaxation, and as an anti-convulsant.
  65. Milirinone (Primicor)

    Increases contractility, and dilates vessels; used to combat the decreased contractility of cardiomyocytes (heart cells).
  66. Mivacurium

    The shortest acting non-depolarising neuromuscular blocking agent. The advantage over Suxamethonium are that it does not cause muscle pains after administration. It can be used for short procedures which require full muscle relaxation for airway manipulation, but not for cases which require rapid sequence induction, because onset time is slow, just as with other non-depolarising muscle relaxants. Mivacurium is metabolised by plasma cholinesterase.
    A reversal agent, such as Neostigmine (anticholinesterase), increases the concentration of acetylcholine at the neuromuscular junction, thereby reversing the blockade. If a patient has low levels of plasma cholinesterase (inherited or acquired), the duration of action of Mivacurium is increased - similar to Suxamethonium apnoea.
  67. Morphine

    Analgesic with slow onset and long duration of action.
  68. Naloxone

    A narcotic antagonist: reversal agent for respiratory depression caused by opiates. Brand name is Narcan.
  69. Neostigmine

    An anticholinesterase which reverses the effect of competitive non-depolarising neuromuscular blocking agents (relaxant antagonist), such as Atracurium, and is used in the treatment of myasthenia gravis, and urinary retention. Also prolongs the effects of Suxamethonium. Brand name is Robinul.
  70. Neuromuscular blocking agents

    Muscle relaxants: Block neuromuscular transmission at the neuromuscular junction, acting postsynaptically at the Acetylcholine (ACh) receptors of the motor nerve end-plate, causing paralysis of the affected muscles. NM blocking agents relax the diaphragm, abdomen, and vocal chords, therefore the patient will require assisted ventilation during anaesthesia.
    Agent classifications:

    Constitute the majority of the clinically relevant NM blocking agents. They act by competitively blocking the binding of Acetylcholine to nicotinic receptors, preventing depolarisation of muscle membrane. In some cases, they also directly block the ionotropic activity of the Acetylcholine receptors. Can be reversed with anticholinesterases, such as Neostigmine.

    • Atracurium
    • Mivacurium
    • Rocuronium
    • Vecuronium

    Principally, Suxamethonium: Acts by depolarizing the plasma membrane of the skeletal muscle fiber. This persistent depolarization makes the muscle fiber resistant to further stimulation by Acetylcholine.
  71. Nitrous Oxide

    A chemical compound (N2O), of Nitrogen and Oxygen, which provides analgesia and anaesthesia. N2O increases cerebral blood flow, so is unsuitable for patients with raised intracranial pressure. Additionally, it is unsuitable in cases of bowel obstruction, pneumothorax, sinus and middle ear problems.
    Its high MAC value (greater then 100) means it is not readily dissolved in the blood. Because nitrous oxide is not soluble in blood, its rapid absorption from alveoli causes an abrupt rise in the alveolar concentration of the other inhalation anesthetic. This means that, if the gas is in equilibrium, the concentration in blood will be 1.4 times higher than the concentration in the alveoli.
  72. Noradrenaline

    Aka Norepinephrine: Vasoconstrictor sympathomimetic hormone and neurotransmitter of the sympathetic nervous system, which increases vascular muscle tone.
    • Increases heart rate
    • Increases blood pressure (vasoconstriction)
    • Causes release of glucose
    • Increases brain's oxygen supply
    • Restores peripheral vascular resistance
  73. NSAID

    Non steroidal anti-inflammatory drug, eg, Diclofenac.
  74. Ondansetron

    Antiemetic for PONV. Brand name is Zofran.
  75. Opiates - IV

    Analgesics given at induction (Fentanyl, Alfentanil etc).
    • Respiratory depression
    • Cardiovascular depression
    • Nausea
    • vomiting
  76. Opioid

    A chemical which works by binding to opioid receptors, found principally in the central and peripheral nervous system and the GI tract, with good analgesic properties.
  77. Oxytocin

    A human hormone, produced in the hypothalamus, which causes the uterus to contract.
  78. Paracetamol

    Analgesic for mild/moderate pain, which works by affecting prostaglandins (chemicals). Prostaglandins are substances released in response to illness or injury. Paracetamol blocks the production of prostaglandins, making the body less aware of the pain or injury. Paracetamol also reduces temperature, by acting on the area of the brain responsible for controlling temperature.
    The onset of analgesia is approximately 11 minutes after oral administration of Paracetamol, with half-life of 1–4 hours. Though Paracetamol is used to treat inflammatory pain, it is not generally classified as an NSAID because it exhibits only weak anti-inflammatory activity.
    Contraindications: severe renal or hepatic impairment.
    Dose: 15 mg/kg
  79. Paracoxib

    Non-opioid analgesic, used for short term management of post operative pain.
  80. Phentolamine

    A vasodilator, to treat hypertension in cardiac patients.
  81. Phenylephrine

    Vasoconstrictor Sympathomimetic, treatment for hypotension.
  82. Prilocaine

    Infiltration anaesthetic. Brand name: Citanest.
  83. Prochlorperazine

    A Phenothiazine for severe cases of PONV or vertigo. Brand name: Stematil.
  84. Propofol

    A short acting (a few minutes) phenol IV administered hypnotic agent, used for the induction and maintenance of general anesthesia, and sedation for mechanically ventilated adults. Propofol has largely replaced Thiopentone (Sodium Thiopental) for induction of anesthesia, because recovery is more rapid, and does not seem to cause nausea. Propofol is also used for sedation, for example, prior to endoscopic procedures, and has less prolonged sedation and faster recovery time than Midazolam.
    Side effects:
    • Pain on injection
    • Transient apnea
    • Convulsions
    • Hypotension (due to vasodilation)
    • Bradycardia
    • Extraneous muscle movement
    • Anaphylaxis
    • Flushing
    • Hyperventilation
    • Coughing
    Strength: 10 mg/ml.     Induction dose: 1-2mg/kg.
  85. Protamine

    A Heparin antagonist, which reverses the anticoagulant effects of Heparin, by binding to it. Used in cardiopulmonary bypass surgery to:
    • Reverse the anti-clotting effects of Heparin
    • Increase pulmonary artery pressure
    • Decrease peripheral blood pressure
    • Decrease myocardial oxygen consumption
    • Decrease cardiac output
    • Decrease heart rate
  86. Ranitidine

    A histamine H2 receptor antagonist, used to inhibit gastric acid secretion, in the treatment of gastric and duodenal ulcer, gastroesophageal reflux disease, and conditions which cause gastric hypersecretion. Dilute with 20 ml saline.
  87. Remifentanil

    Remifentanil Hydrochloride is an agonist of opioid μ-receptors, providing a very short acting (1 minute) analgesic, and is 3-4 times faster acting than Fentanyl. ½ life is ≅5 minutes, 5-10 minutes of effect, and a quick recovery. Given intra-operatively by continuous I.V. Common side effects are nausea, vomiting, and headaches. These effects can be lessened if Midazolam is also administered, but this dual use increases the risk of respiratory depression. A typical dose is 1 microgram/kg/minute. Infusion dilution: 1 mg in 20 ml saline. Brand name: Ultiva.
  88. Reversal agents

    Drugs which antagonise or otherwise modify the effects of other drugs, such as opiates, muscle relaxants, and anticoagulants.
  89. Rocuronium

    Muscle relaxation with intermediate duration. Brand name is Esmeron.
    Strength: 10 mg/ml.     Induction dose: 600 mcg/kg.
  90. Salbutamol

    Myometrial relaxant, bronchodilator; for asthma, bronchospasm, airway obstruction, and premature labour.
  91. Sevoflurane

    Induction and maintenance of general anaesthesia.
  92. Sodium bicarbonate

    A systemic alkalising agent, used in severe metabolic acidosis, hyperkalaemia, and prolonged arrests.
  93. Sodium Citrate

    Reduces gastric acidity - typically given prior to rapid sequence induction.
  94. Sugammadex

    (Tradename Bridion) is an agent for reversal of Rocuronium (neuromuscular) blockade, in general anaesthesia. It is the first selective relaxant binding agent (SRBA).
  95. Suxamethonium

    Aka Succinylcholine: Depolarising short acting muscle relaxant, with quick onset. The main use in anaesthesia is to allow intubation of the trachea. Similar structure to Acetylcholine, so non-competitively binds to cholinergic receptors at the neuromuscular junction, preventing Acetylcholine from binding. Action within 60 seconds, with 3-6 minute duration.

    Can cause cardiac problems in patients with muscle disease or severe burns. Metabolised in plasma by Pseudocholinesterase. An anticholinesterase, such as Neostigmine, will prolong the action of Suxamethonium, by inhibiting Pseudocholinesterase, and so should not be given with Suxamethonium.

    Side effects:
    • Muscle fasciculations
    • Hypertension
    • Tachycardia
    • Intra-cranial pressure
    • Intra-abdominal pressure
    • Post-operative muscle pain

    Suxamethonium should be stored in a refrigerator at 4°.
    Ampoule: 100 mg/2 ml.     Dose: 1-2 mg/kg (0.02 - 0.04 ml/kg)
  96. Sympathomimetic

    Agents which produce effects similar to those caused by stimulation of the sympathetic nervous system. There are inotropic and vasoconstrictor sympathomimetics.

    Inotropic: Dobutamine, Dopamine, Dopexamine.
    Vasoconstrictor: Metaraminol, Ephedrine, Noradrenaline, Phenylepherine.
  97. Syntocinon

    The synthetic form of Oxytocin. Syntocinon induces or stimulates labour, prevents postpartum haemorrhage, and stimulates contractions which help push out the placenta, after delivery.   More
  98. Temazepam

    A long lasting (up to 12 hours) benzodiazepine anxiolytic, given 30 - 120 minutes before surgery.
  99. Terbutaline

    To treat asthma and bronchospasm, by relaxing the muscles in the passages of the lungs.
  100. Thiopentone

    Aka Thiopental sodium: A smooth and rapidly acting barbiturate, mainly used for induction of anaesthesia, by slow (IV) injection. Has no analgesic properties.

    Thiopentone is prepared by dissolving a yellowish powder in sterile water, to provide a 2.5% solution (25 mg/ml, 500 mg/20 ml). The solution should be kept cool, and used within 24 hours of preparation. The solution has a pH greater than 10 (alkaline), and can be irritating and painful if accidentally injected into tissues. Because of the alkalinity, Thiopentone should not be mixed in the same syringe as other drugs.

    Thiopentone crosses the placenta, but is considered safe for induction in obstetric anaesthesia. IV injection causes loss of consciousness within 15 to 30 seconds, and lasts for 5 to 10 minutes. A short period of breath holding can follow induction.

    Metabolism of Thiopentone is quite slow, and rapid recovery is due to initial redistribution into muscle and skin, followed by redistribution into body fat. Metabolised in the liver, less than 1% of the drug is unchanged in the urine.

    Return of consciousness from a moderate does is rapid, with prompt return of airway protective reflexes. Metabolising Thiopentone is slow, so there may be residual sedative effects for up to 24 hours.

    Side effects:
    • Depression of the heart's contractile force
    • Cardiorespiratory depression
    • Arrhythmias
    • Laryngospasm
    • Coughing
    • Sneezing
    • Allergic reactions
    • Rashes
    • Inflammation at injection site
    Dose: 3-5 mg/kg.
  101. Tranexamic acid

    An antifibrinolytic (inhibits fibrinolysis), which promotes blood clotting. The acid stops the breakdown of clots, by halting the breakdown of fibrin. In obstetric cases, tranexamic acid is used after delivery, to reduce bleeding. Tranexamic acid competitively inhibits the activation of plasminogen to plasmin, by binding to specific sites of both plasminogen and plasmin, a molecule responsible for the degradation of fibrin, a protein that forms the framework of blood clots. Used to control heavy menstrual bleeding.
  102. Vancomycin

    An antibiotic against Gram-positive bacteria, typically used as a last line treatment, because other agents have been ineffective, given as an infusion (not bolus).

    Adult infusion: Thrombophlebitis may be induced, as well as flushing and a transient rash over the neck and shoulders.
    The usual dose is 1 - 1.5 g every 12 hours.
  103. Vasoconstrictor sympathomimetic

    An agent which raises blood pressure by vasoconstricion.
  104. Vasopressin

    See  ADH
  105. Vecuronium

    Muscle relaxant with intermediate duration. Brand name is Norcuron.
    Supply: 10 mg powder. Strength: 5 mg/ 5 ml WFI.
    Draw up: 10 mg + 5 ml WFI. Induction dose: 100 mcg/kg.
  106. Warfarin

    An anticoagulant; used as a prophylactic for venous thrombolism. Usage should be stopped 2-4 days before surgery. Reversal, after 3-6 hours, is possible with vitamin K.