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.

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.

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.

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, S11, S12
Emergency drugs immediately available: epinephrine, phenylephrine, ephedrine, atropine, glycopyrrolate (label bolus values: phenylephrine S28, ephedrine S29, glycopyrrolate S13)
Antibiotic and its timing window: cefazolin or clindamycin within 60 min before incision; vancomycin within 120 min S6
PONV prophylaxis agents per risk S7, S8
Analgesic plan per the selected approach (03)
Naloxone available if opioids are planned S22
All syringes labeled with drug, concentration, date/time and initials

VI. Monitoring (ASA basic standards S35)

ECG; pulse oximetry; capnography; temperature
NIBP cycling at least every 5 min 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
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, S5, including planned surgeon infiltration
20% lipid emulsion immediately available 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
No IV lidocaine infusion planned alongside the block or infiltration 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

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
Local-anesthetic budget shared between block and infiltration S4, S5
PONV plan S7, 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.

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