01Match the syringe to the dose
Syringe size isn't arbitrary — you pick the size that fits the volume and titration of the drug. Too big and you can't dose precisely; too small and you're constantly refilling.
This is a typical adult set, induction through reversal. Concentrations are standard stock — always confirm against your vial, and exact syringe sizes vary by institution.
| Drug | Syringe | Concentration | Class |
|---|---|---|---|
| Propofol | 20 mL | 10 mg/mL | Induction |
| Fentanyl | 3–5 mL | 50 mcg/mL | Opioid |
| Midazolam | 3 mL | 1 mg/mL | Benzodiazepine |
| Lidocaine | 5 mL | 10 mg/mL (1%) | Local — blunts propofol burn |
| Succinylcholine | 10 mL | 20 mg/mL | Depolarizing relaxant |
| Rocuronium | 5 mL | 10 mg/mL | Non-depolarizing relaxant |
| Neostigmine (+ glyco) | 5 mL | 1 mg/mL | Reversal |
| Sugammadex | 2–5 mL | 100 mg/mL | Reversal (roc/vec) |
| Phenylephrine | 10 mL | 100 mcg/mL | Vasopressor |
| Ephedrine | 10 mL | 5 mg/mL | Vasopressor |
| Glycopyrrolate | 3 mL | 0.2 mg/mL | Anticholinergic |
Fentanyl is drawn undiluted at 50 mcg/mL (from a 100 mcg/2 mL or 250 mcg/5 mL vial) into a small 3–5 mL syringe — not a big, diluted one. Reversal (neostigmine + glycopyrrolate, or sugammadex) is usually drawn up toward the end of the case.
- Propofol comes in a 20 mL syringe because a 70 kg induction dose (~140 mg = 14 mL) plus titration fits perfectly.
- Succinylcholine is 20 mg/mL — double rocuronium's 10 mg/mL — so the same volume is a very different dose. Read the label, not the volume.
- Keep pressors in 10 mL syringes diluted to round numbers (phenylephrine 100 mcg/mL) so the math is instant in an emergency.
02The color-code system (ISO 26825 / ASTM)
Pre-printed anesthesia labels are color-coded by drug class so you can recognize a class at a glance — even upside down across the room. The color tells you the class, the text tells you the drug.
| Color | Drug class | Examples |
|---|---|---|
| Yellow | Induction agents | Propofol, etomidate, ketamine |
| Orange | Benzodiazepines | Midazolam |
| Blue | Opioids | Fentanyl, hydromorphone |
| Fluorescent red | Muscle relaxants | Rocuronium, succinylcholine, vecuronium |
| Red w/ stripes | Relaxant antagonists | Neostigmine, sugammadex |
| Violet | Vasopressors | Phenylephrine, ephedrine, epinephrine |
| Green | Anticholinergics | Glycopyrrolate, atropine |
| Salmon/tan | Hypotensives / others | (varies) |
| Grey | Local anesthetics | Lidocaine |
The color is a backup recognition system. It does not replace reading the actual drug name. Two violet syringes (phenylephrine vs. epinephrine) are very different drugs.
- Trusting the color band alone — fluorescent red is both succinylcholine and rocuronium; you must read the text.
- Using a generic blank label and scribbling — use the pre-printed class label whenever available.
03How to label — every time, no exceptions
Every syringe must carry: drug name, concentration, your initials, and date/time (and expiration for infusions). Label immediately after drawing up — before you set it down.
The discipline that prevents wrong-drug errors:
- Read the vial label when you pick it up.
- Read it again as you draw it up.
- Read it a third time as you discard the vial.
- Label before the syringe leaves your hand.
An ampoule of a paralytic and an antiemetic can look identical. The label and the triple-check are what stand between you and a never-event.
- Draw drugs up in a consistent left-to-right order on your tray so position itself is a second cue.
- Propofol supports bacterial growth — strict asepsis and a 6–12 h expiration on the label.
- Drawing up several drugs and labeling them all at the end — that's exactly when two get swapped.
- Borrowing a syringe a colleague drew up that isn't labeled. Discard it.
04Have your rescue drugs ready before you need them
Induction drops blood pressure. Don't wait for the hypotension to start drawing up a pressor.
Before induction, have drawn and labeled: - Phenylephrine 100 mcg/mL (bolus 50–100 mcg) - Ephedrine 5 mg/mL (bolus 5–10 mg) - Atropine/glycopyrrolate for bradycardia - Know where the emergency epinephrine and the code cart are.
For longer or sicker cases, also have your infusions spiked, primed, labeled with concentration, and loaded in the pump before the patient is asleep.