# Anesthesia OR Readiness & Pre-Induction Checklist (educational)

> **Educational work by a pre-medical student — not medical advice.** Not a clinical protocol, prescription, or patient handout, and not for patient care. See [DISCLAIMER](DISCLAIMER.md).

### Generic educational pre-case setup guide — not institution-validated — November 2026

## Purpose
This checklist illustrates how an anesthesia team typically prepares a room before a case: equipment, medications, crisis readiness and communication. It is a study aid. It does not replace the institution's approved checklist, the machine manufacturer's checkout, or the team's judgment. An observer must not prepare drugs, handle equipment or take part in patient care on the basis of this document. Numbers are tagged to [DOSING_SOURCES.md](DOSING_SOURCES.md).

*v2.0 called this checklist "standardized" and gave an oxygen-cylinder pressure and a push-dose epinephrine concentration. Those numbers were removed (no acceptable source was verified); follow the manufacturer's checkout and institutional pharmacy preparation.*

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## I. Room and workstation
- Correct room and case; table locked; safety straps available
- Suction working with a rigid suction tip
- Lighting, waste and sharps containers ready

## II. Anesthesia machine (manufacturer and institutional checkout)
- Automated self-test completed
- Circuit leak test; APL valve; reservoir bag
- Backup oxygen cylinder present and adequately filled; self-inflating manual ventilation device available
- CO₂ absorbent status; vaporizers filled and seated
- Capnography sampling line working

## III. Airway equipment
- Laryngoscope handles and blades; video laryngoscope tested
- Oral and nasal airways; endotracheal tubes (planned size, one smaller, one larger); stylet, bougie
- Supraglottic airway
- Cuff syringe
- Difficult-airway cart location known

## IV. IV access and fluids
- Primary IV planned **away from any lymphedema or axillary-dissection-side arm**; secondary access if anticipated
- Balanced crystalloid primed; blood availability per type and screen if indicated

## V. Medications (drawn up and labeled per institutional policy)
- Induction agent; neuromuscular blocker; reversal agent, with dose selected by quantitative monitoring [S10](DOSING_SOURCES.md#s10), [S11](DOSING_SOURCES.md#s11), [S12](DOSING_SOURCES.md#s12)
- Emergency drugs immediately available: epinephrine, phenylephrine, ephedrine, atropine, glycopyrrolate (label bolus values: phenylephrine [S28](DOSING_SOURCES.md#s28), ephedrine [S29](DOSING_SOURCES.md#s29), glycopyrrolate [S13](DOSING_SOURCES.md#s13))
- Antibiotic and its timing window: cefazolin or clindamycin within 60 min before incision; vancomycin within 120 min [S6](DOSING_SOURCES.md#s6)
- PONV prophylaxis agents per risk [S7](DOSING_SOURCES.md#s7), [S8](DOSING_SOURCES.md#s8)
- Analgesic plan per the selected approach ([03](03_Anesthesia_Protocols/README.md))
- **Naloxone** available if opioids are planned [S22](DOSING_SOURCES.md#s22)
- All syringes labeled with drug, concentration, date/time and initials

## VI. Monitoring (ASA basic standards [S35](DOSING_SOURCES.md#s35))
- ECG; pulse oximetry; capnography; temperature
- NIBP cycling at least every 5 min [S35](DOSING_SOURCES.md#s35). The cuff is correctly sized and placed **away from the lymphedema/ALND side** (alternative sites if bilateral) and away from the operative field.
- Quantitative neuromuscular monitor [S10](DOSING_SOURCES.md#s10)
- Processed EEG if planned (for example, TIVA with neuromuscular blockade)

## VII. Regional anesthesia setup (approach 1)
- Ultrasound, sterile probe cover, block tray, needles
- Local anesthetic labeled; **total mg calculated against the label maximum** before draw-up [S4](DOSING_SOURCES.md#s4), [S5](DOSING_SOURCES.md#s5), including planned surgeon infiltration
- **20% lipid emulsion immediately available** [S3](DOSING_SOURCES.md#s3). ASRA checklist dosing: >70 kg, 100 mL over 2–3 min, then 200–250 mL over 15–20 min; ≤70 kg, 1.5 mL/kg over 2–3 min, then ~0.25 mL/kg/min; ~12 mL/kg upper limit [S3](DOSING_SOURCES.md#s3)
- No IV lidocaine infusion planned alongside the block or infiltration [S1](DOSING_SOURCES.md#s1)

## VIII. Crisis readiness
- Airway rescue: supraglottic airway, video laryngoscope, bougie, suction
- Hemodynamic rescue drugs available
- Defibrillator and code cart location known
- Malignant hyperthermia cart location known, with dantrolene available
- LAST checklist accessible [S3](DOSING_SOURCES.md#s3)

## IX. Team huddle (surgeon, anesthesia, circulator)
- Analgesic approach and opioid plan
- Airway plan and anticipated difficulty
- Positioning and padding; lymphedema-side arm restrictions
- Anticipated blood loss
- Antibiotic timing [S6](DOSING_SOURCES.md#s6)
- Local-anesthetic budget shared between block and infiltration [S4](DOSING_SOURCES.md#s4), [S5](DOSING_SOURCES.md#s5)
- PONV plan [S7](DOSING_SOURCES.md#s7), [S8](DOSING_SOURCES.md#s8)
- Disposition; special equipment and implants

## X. Before the patient enters
Machine checked · monitors ready · drugs labeled · airway equipment ready · suction on · fluids ready · documentation open · team briefed.

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*Educational resource only. Doses are illustrative and must be individualized; see [DOSING_SOURCES.md](DOSING_SOURCES.md). Author: Collin B. George, pre-medical student. License: CC BY 4.0.*