M – Machine Check
The specifics will vary depending on the anesthesia machine, but the principle remains the same: verify that your machine is functioning properly before the patient enters the room.
Most commonly I see is the Dräger Apollo, which requires a machine restart and self-test. The Perseus models streamline this process, while the older Fabius machines require additional manual checks. Regardless of the model, simply follow the machine prompts and complete the full checkout.
Additional items to verify:
- Oxygen tank pressure on the back of the machine
- AMBU bag availability
- CO₂ absorber condition
- Sampling line and water trap
- Adequate volatile anesthetic levels
S – Suction
Simple but essential.
Ensure you have:
- Yankauer suction tip
- Suction tubing
- Collection canister
- Functional wall suction
Always confirm that suction is working before the patient arrives.
M – Monitors
Remember the ASA standards: oxygenation, ventilation, circulation, and temperature.
Common monitor setup includes:
- ECG leads
- Blood pressure monitoring (NIBP or arterial line setup)
- Pulse oximeter and sensor
- Temperature probe
- Neuromuscular monitoring (twitch monitor)
Taking a few extra seconds to organize monitor cables
A – Airway
Prepare for the expected airway while remaining ready for the unexpected.
Basic setup:
Endotracheal Tube
- 7.0 mm tube commonly for adult females
- 8.0 mm tube commonly for adult males
- Stylet
- 10 mL syringe for cuff inflation
Laryngoscopes
- Macintosh blades
- Miller blades
Some people joke that “real anesthesiologists use Miller blades.” (or vice versa based on your institution) In reality, a true anesthesiologist is proficient with whichever tool the situation requires.
Additional airway equipment:
- Face mask connected to the circuit
- Eye tape
- Bite block
- Oral airway
- Tongue depressor
- Tube securing tape
Depending on the patient and procedure, consider having:
- LMA
- Video laryngoscope
- Bougie
- Fiberoptic bronchoscope
- Other advanced airway equipment
I – IV Access
At many institutions, standard IV supplies can be found in a dedicated cart or supply area.
Prepare:
- IV catheters
- Extension tubing
- Flushes
- Pressure bags if needed
For higher-acuity cases, anticipate additional vascular access requirements:
- Rapid infusion catheter (RIC)
- Central venous catheter (CVC)
- Arterial line supplies
The goal is to have everything available before induction rather than scrambling afterward.
D – Drugs
A note for trainees: Drug preparation varies significantly between providers and institutions. As you gain experience, you’ll often prepare only what is necessary for a specific case, reducing waste and improving efficiency. Early in training, however, it is often helpful to have a more comprehensive setup.
A common general anesthesia setup might include:
| Medication | Typical Concentration | Syringe Size |
|---|---|---|
| Propofol | 10 mg/mL | 20 mL × 2 |
| Ephedrine | 5 mg/mL | 10 mL |
| Phenylephrine | 80 mcg/mL | 10 mL |
| Succinylcholine | 20 mg/mL | 10 mL |
| Cefazolin (Ancef) | Institution-dependent | 10 mL |
| Lidocaine | 20 mg/mL | 5 mL |
| Rocuronium | 10 mg/mL | 5 mL |
| Fentanyl | 50 mcg/mL | 3 mL |
| Ondansetron | 2 mg/mL | 3 mL |
| Dexamethasone | 4 mg/mL | 3 mL |
Always verify concentrations and label syrgines.
S – Special Equipment
Finally, consider any procedure-specific equipment that may be required.
Examples include:
- Orogastric (OG) or nasogastric (NG) tubes
- Bair Hugger warming system
- Arterial line setup
- Central venous catheter kit
- Triple transducer setup
- Pulmonary artery catheter (Swan-Ganz)
- Ultrasound machine
The list is nearly limitless and depends on the patient, procedure, and anticipated challenges.