How an Anesthesiologist Sets Up an Operating Room for Surgery

what's up everybody my name is max feinstein and 
i'm an anesthesia resident at the mount sinai   hospital in new york city today i'm going to show 
you how i set up my operating room to get ready to   start a case i'm going to be using the standard ms 
maids mnemonic which i'll go ahead and narrate for   you so you can follow along if you find this video 
interesting or helpful really appreciate it if you   like it and subscribe to the channel got about 
20 minutes here so let's go ahead and get started i don't exactly have a bunch of pro audio and 
video recording equipment but i do have this handy   iv pole so i'll go ahead and get my camera set 
up here so you can see everything that i'm doing   and the first part of getting ready for my 
case is going with the m in the ms maids   mnemonic which stands for machine and so 
the first thing that i'm going to do with   my machine is actually go around to the back 
and i'm going to open up the oxygen tank so   this isn't actually where the oxygen normally 
comes from from the machine this is a backup   tank but in the event that there's any sort of 
issue with the oxygen coming off of the wall   then i'll have this tank as a backup that's 
available and it's important to make sure   at the beginning of each day that there's an 
adequate amount of oxygen in the tank and then   once that's open i can walk around the front of 
the machine and i can pull up and see what the   gauge pressure is on that tank and this tank 
when full of oxygen is about 2100 or 2200 psi   i can see this is 1649 and i want it to be more 
than half so that should be fine the next part of   making sure that my machine is ready to go is 
doing a machine test so i'm going to go ahead   and start a full test which requires that i'm on 
vent mode and that i've got my y pipe disconnected and so that test is gonna run with the rest of my machine check which is gonna 
include looking at gases to make sure that my   volatile cartridges are full and then i also 
need to get to the back of the machine again   and turn my o2 tank off because if i don't do 
that there's a possibility that it may actually   leak throughout the course of the day and become 
empty when i actually need it next up is s for   suction which is a simple and quick part of 
the setup but definitely not to be overlooked   they say that the two most important things to 
save somebody's life are suction and an ambu bag   which i'll get to soon and the suction works so 
we'll move along to the next letter which is m   again and this time it's for monitors so i'm going 
to get my american society of anesthesiologists   standard monitor setup here i've got an ekg 
lead i'm going to have five ekg leads set up next is a temperature probe this 
one is a stick on temperature probe   but i can also take the sticker off to 
insert for example in somebody's nostril next is a blood pressure cuff and i don't 
show it here but also capnography for end   tidal co2 monitoring i'm also not 
showing it here but we have pulse   ox imagery that's bundled in with all the 
rest of these cables next to my ekg leads   and this is personal preference here but i do 
like to get my ekg stickers attached to the   cables so that i can quickly attach them once a 
patient comes into the room but watch out because   once these stickers are attached to the cables 
they can very quickly become tangled next up   is a for airway so i'll start with a mac 3 blade 
which you'll choose your blade size depending on   your patient's height and weight and gender and 
also an endotracheal tube this is a 7.0 internal   diameter tube also dependent on patient's height 
weight and gender and then i've got a stylet which   is not necessary but depending on your preference 
may make intubation easier and then a 10cc syringe   which i'm going to fill with air so that i 
can inflate the cuff in my endotracheal tube   and an oral airway is essential for 
both the beginning and end of the case   and eye tape and tape for the endotracheal tube 
it's also important to go ahead and open up your   endotracheal tube and test the cuff to make sure 
that there aren't any leaks because that could be   a huge problem if there was a leak from 
the manufacturer and you didn't discover it   until the middle of the case this one's 
good i'll go ahead and deflate the cuff   and since personally i like to use a stylet 
to intubate i'll go ahead and get my stylet   placed and then i'll make the classic hockey stick 
shape which is what i've gotten used to intubating   patients with i always like to have my eye 
tape ready to go i tape a patient's eyes closed   pretty much immediately after induction and then 
i get my oral airway open so it's ready for use   the last part of my airway check 
is i make sure my ambu bag works   like i said this can be an essential part of 
saving someone's life next up on the list is i   for iv so i'm going to start with this bag of 
crystalloid in this case i'm using plasmalite   i like to keep a couple stopcocks in between my 
iv tubing so that i can easily add new lines or   inject medication or disconnect and reconnect 
the tubing really easily so i'm just being extra   careful to not touch any part of the tubing that 
will touch any medication that will go into the   patient now i'll go ahead and spike this iv which 
is important because i want to run fluid through   the iv tubing so that i don't have any air by the 
time that i connect it to the patient the next   part of the iv setup is i like to put together 
little iv kits so i'll start with some 4×4 gauze   and get three of these laid out for three 
different iv kits i've got rubber bands   that i use for tourniquets as well as tape to 
tape down my ivs i'll also get out alcohol pads   and tegaderms which in addition to the tape 
will keep the iv nice and secure i like to go   ahead and get all of this laid out then i'll 
go ahead and get out two 20 gauge needles   for each iv kit bundle everything up put some 
tape on top and then rubber banded all together   at your institution you may have pre-made iv kits 
or different equipment or other people may do your   ivs for you so this is really just a matter of 
personal preference but either way you need to   make sure that you've got adequate iv equipment in 
order to take care of your patient next is drugs   which for me begins with getting out all of my 
syringes so as i'm getting all this out i've got   in mind exactly what medications i'm going 
to want to have drawn again it's important   to maintain sterility here which means either 
wearing gloves or making sure not to touch the   part of the syringe or the needle that it will 
come into contact with any substance that will   come into contact with the patient for the case 
i'm doing today i want to start with rocuronium   a non-depolarizing muscular blocker i'd also 
like to have succinylcholine drawn up which is   a depolarizing neuromuscular blocker i'd like 
to have reversal agents so i'll start with   glycopyrrolate and then a little later on i'll 
also get some neostigmine yellow sticker here   for propofol which will be part of my induction 
i also typically drop some fentanyl which is   helpful for pain control and reducing the amount 
of anesthetic gas that i need to give a patient   next is midazolam also known as versed which we 
typically use for anxiolysis just before induction   and here's neostigmine which will be part of 
my reversal of neuromuscular blockade next   is dexamethasone which is a helpful antiemetic 
that i give at the beginning of cases generally   next is ondansetron or zofran which is also an 
antiemetic but i tend to give that at the end   of the case when i give it and here's a label 
for some lidocaine which can be helpful for   reducing the amount of discomfort that's caused 
by propofol and then in this particular card i've   got pre-made syringes of phenylephrine 
and ephedrine which i like to get out   and now i'm going to go ahead and pull out all 
the vials of the drugs that i'm about to draw up   when i draw up drugs i always triple 
check everything that i'm drawing up   so i start by comparing the labeled syringe with 
the labeled vial and make sure they're the same   and so with that i'll go ahead and 
draw it up and as i'm drawing it up   i'm again checking the labeled syringe against 
the vial to make sure that it's the same   and then i always do a third check right here at 
the end just making sure that both labels pair up   i realize that this is extremely redundant but i 
would much rather spend a little bit of extra time   to make sure that i've got the right 
medication because this is a place   where medication errors can happen 
extremely easily here's my rocuranium here's my glycopyrrolate and also if you're 
interested in learning more details about the   medications that are stocked in this cart you can 
check out this video narrated by dr erica fagelman   one of the former chief residents and current 
liver transplant anesthesia fellows at mount   sinai hospital next up is neostigmine here 
i've got dexamethasone more dexamethasone   here's my ondansetron or zofran this is two 
percent lidocaine i'm going to draw five   milliliters of it now i'll go ahead and put all my 
drugs in a lock box and some controlled substances   i'll need to drop later once the pharmacy opens 
and the last part of the mnemonic is s for special   which really entails any special equipment that's 
going to be needed for the case and in this case   i'm grabbing an ultrasound because i'm going to 
be doing a transversus abdominis plane block now   that i've got the ultrasound in the room i want 
to make sure that i've got my cleaning solution   syringes needles stopcock and then i'll also 
have to go ahead and grab my local anesthetic   from the room next door alright well that's 
everything that i need to get started with this   case i use the ms maids mnemonic every day and 
most of my colleagues do the same thing it's an   essential part of the anesthesiologist toolbox 
thanks for watching and i'll see you next time

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