BNF for Children 2011-2012

628 BNFC 2011–201215 Anaesthesia15.1 General anaesthesia 62815.1.1 Intravenous anaesthetics 62915.1.2 Inhalational anaesthetics 63215.1.3 Antimuscarinic drugs 63515.1.4 Sedative and analgesic perioperativedrugs 63715.1.4.1 Anxiolytics 63715.1.4.2 Non-opioid analgesics 63915.1.4.3 Opioid analgesics 64015.1.5 Neuromuscular blocking drugs 64215.1.6 Drugs for reversal of neuromuscularblockade 64615.1.7 Antagonists for central andrespiratory depression 64715.1.8 Drugs for malignant hyperthermia64815.2 Local anaesthesia 64915.1 General anaesthesia15.1.1 Intravenous anaesthetics15.1.2 Inhalational anaesthetics15.1.3 Antimuscarinic drugs15.1.4 Sedative and analgesic peri-operativedrugs15.1.5 Neuromuscular blocking drugs15.1.6 Drugs for reversal of neuromuscularblockade15.1.7 Antagonists for central andrespiratory depression15.1.8 Drugs for malignant hyperthermiaImportantThe drugs in section 15.1 should be used by experiencedpersonnel only and when resuscitation equipmentis available.15 AnaesthesiaSeveral different types of drug are given together duringgeneral anaesthesia. Anaesthesia is induced with eithera volatile drug given by inhalation (section 15.1.2) orwith an intravenously administered drug (section15.1.1); anaesthesia is maintained with an intravenousor inhalational anaesthetic. Analgesics (section 15.1.4),usually short-acting opioids, are also used. The use ofneuromuscular blocking drugs (section 15.1.5) necessitatesintermittent positive-pressure ventilation. Followingsurgery, anticholinesterases (section 15.1.6) can begiven to reverse the effects of neuromuscular blockingdrugs; specific antagonists (section 15.1.7) can be usedto reverse central and respiratory depression caused bysome drugs used in surgery. A topical local anaesthetic(section 15.2) can be used to reduce pain at the injectionsite.Individual requirements vary considerably and therecommended doses are only a guide. Smaller dosesare indicated in ill, shocked, or debilitated children andin significant hepatic impairment, while robust individualsmay require larger doses. The required dose ofinduction agent may be less if the patient has beenpremedicated with a sedative agent (section 15.1.4) orif an opioid analgesic has been used.Surgery and long-term medication The risk oflosing disease control on stopping long-term medicationbefore surgery is often greater than the risk posed bycontinuing it during surgery. It is vital that the anaesthetistknows about all drugs that a child is (or has been)taking.Children with adrenal atrophy resulting from long-termcorticosteroid use (section 6.3.2) may suffer a precipi-