Set-Up

Room Set-Up using the acronym MSMAIDS

• Anesthesia Machine Check as per protocol
• Suction
• Monitors
  • Required (BP, ECG, SpO₂, gas analyzer)
  • Other (temperature, peripheral nerve stimulator)
• Airway
  • Laryngoscope, alternate blade
  • Oral, nasal airway
  • Appropriate ETT, cut, checked, +/- stylet, syringe, tape
  • Alternative airway device(s)
  • Backup plan
• Intravenous tubing set-up with appropriate solution, bag de-aired, +/- stopcocks, extensions
  • Supplies for insertion considering access points, catheter gauge
• Drugs
  • Emergency (atropine, ephedrine, phenylephrine)
  • Induction
  • Adjuncts (sedation, antiemetics, antifibrinolytics, anticoagulants, antibiotics, LA’s etc.)
  • Maintenance infusions
• Other Supplies
  • Eye protection
  • Head rests, gel pads, positioning devices
  • Fluid warmer
  • Body warmer
  • Infusion pumps (single channel, triple channel, syringe, PCA/PCEA)
  • Transducers, Invasive monitoring supplies (arterial, CVP)
  • Nerve block stimulator and supplies
  • Supplies for epidural/spinal insertion
  • Alternate breathing circuit
  • Difficult Airway Cart
  • CPDA-1 blood collection bags, blood collection mixer, ANH
  • Cell saver
  • Point-of-Care Glucometer, Hemachron, ABG
  • BIS/ICP monitor
  • Rapid infuser devices (Level 1, pneumatic device, pressure bag)
  • Pulmonary Artery Catheters/Cardiac Output set-up/TEE
  • MH cart

Cardiac Anesthesia Checklist

Room Set-Up

• ETT 7.5/8.0, MAC and Miller blades
• 18F OG tube
• BIS sensor, cerebral oximeter
• Esophageal temp probe
• Hot line (fluid warmer)
• Confirm order in for TEE
• PA Cath – Discuss w/attending night before (generally for Dr. Martin’s cases PAC is preferred)
  • PA cath should have in vitro SvO₂ calibration performed
• Ventilator should be set to VCV mode with TV 6-8/kg. Do NOT leave in PC default with ΔP of 12. PC-VG okay.

Drugs for Induction: 3 Categories of Syringes

1. Anesthetics
   • Fentanyl 50 mcg/mL – 10 mL syringe (x2)
   • Midazolam 1 mg/mL – 5 mL syringe
   • Lidocaine 100 mg
   • Roc 10 mg/mL – 5-10 mL syringe
   • Etomidate – 2 mg/cc in 20cc syringe
   • Sux – only if difficult airway
2. Vasoactive Drugs
   • Phenylephrine 100 mcg/mL pre-made syringe
   • Ephedrine 5 mg/mL
   • Epi 4 mcg/mL – 10 mL syringe
3. Other
   • Heparin 1,000 IU/mL – 20mL syringe x 2
   • Cefazolin 2 gm (3 grams if > 120 kg)
   • Amicar 5 gram/20 mL
   • Calcium chloride 1 gram pre-made

Drips to Set-Up

• Carrier – Plasmalyte
• Amicar 1 gram/hr
• Insulin
• Epi
• NTG (default unless clevidipine discussed)

Drips to Discuss with Attending

• Milrinone infusion (mitral valve cases)