01Monitor Setup
- BP cuff: cycle q1 min for induction (then q3–5 min once stable)
- Add waveforms for arterial line, CVP, PAP as needed
- Patient age and weight entered on monitor → machine auto-calculates MAC
- Perfusion index = ratio of pulsatile to non-pulsatile flow; low PI = poor perfusion
- PVI (or PPV if A-line) as surrogate for volume responsiveness
- 500P ORs can route C-MAC video to room monitors
02Alaris Infusion Pump Basics
- Power on → Options → Anesthesia mode → Enable
- Channel select → Guardrails drugs (common meds) → enter patient weight → start rate
- If not in Guardrails, search "All drugs"
- Use lean body weight in obese patients (IBW = 22 × height²m; LBW = IBW × 1.2)
- Pause to leave drips on standby
- With ≥ 2 simultaneous drips, request fluid carrier from anesthesia tech
03Drip Concentrations — Opioids & Sedation
| Medication | Dilution | Typical infusion |
|---|---|---|
| Remifentanil | 1 mg / 20 mL = 50 mcg/mL | 0.05–0.2 mcg/kg/min |
| Sufentanil | 250 mcg / 50 mL = 5 mcg/mL | 0.1–0.5 mcg/kg/HR (often 0.3 → 0.2 → 0.1) |
| Dexmedetomidine | 0.2 mg / 50 mL = 4 mcg/mL | Load 1 mcg/kg over 10 min; 0.2–1 mcg/kg/h |
| Lidocaine | 500 mg (50 mL of 1%) into 50 mL syringe = 10 mg/mL | 1 mg/kg/h; check plasma level q8h |
04Drip Concentrations — Pressors & Inotropes
| Medication | Dilution | Typical infusion |
|---|---|---|
| Phenylephrine | 40 mg / 250 mL = 160 mcg/mL (or 10 mg / 100 mL = 100 mcg/mL) | 0.2–1 mcg/kg/min |
| Norepinephrine | 4 mg / 250 mL = 16 mcg/mL | 0.02–0.1 mcg/kg/min |
| Vasopressin | 60 U / 100 mL = 0.6 U/mL (bolus syringe always 1 U/mL) | 0.01–0.04 U/min |
| Epinephrine | 4 mg / 250 mL = 16 mcg/mL | 0.02–0.1 mcg/kg/min |
| Dopamine | 400 mg / 250 mL = 1600 mcg/mL | 1–10 mcg/kg/min |
| Milrinone | 20 mg / 100 mL = 200 mcg/mL | Load 50 mcg/kg over 10 min; 0.125–0.5 mcg/kg/min |
05Drip Concentrations — Antihypertensives
| Medication | Dilution | Typical infusion |
|---|---|---|
| Clevidipine | 25 mg / 50 mL = 0.5 mg/mL | 1–20 mg/h (bolus 0.05 mg) |
| Esmolol | 2500 mg / 250 mL = 10 mg/mL | 50–300 mcg/kg/min |
| Nicardipine | 25 mg / 250 mL = 0.1 mg/mL | 1–15 mg/h (bolus 50–100 mcg) |
| Nitroglycerin | 50 mg / 250 mL = 200 mcg/mL | 0.1–1 mcg/kg/min |
| Nitroprusside | 50 mg / 250 mL = 200 mcg/mL | 0.1–1 mcg/kg/min |
06Minimum Airway Setup
Before EVERY case have ready: - ETT with stylet and 10 mL syringe for cuff - Video and/or standard laryngoscope with appropriate blades - Suction (Yankauer) with working canister - Bag-mask with reservoir + O₂ - Backup ETT (smaller and bigger) - LMA as backup - Oral and nasal airways - Capnography confirmed working - Difficult airway cart known location