Episode 9: Basic Med Setup

In this episode I review the basic medication setup for the operating room including premedication, induction, neuromuscular blockade, antibiotics, reversal and antiemetics.  I discuss weight based dosing and comment on a few alternatives to consider once you have the basic setup down.  This episode should be useful for new CA-1s getting started in the OR but I would also like to ask senior residents to comment on what their basic setup is and how it may differ from what I’ve mentioned here.

 

Here is a list of the medications I discuss: Basic med setup w dosing

7 Replies to “Episode 9: Basic Med Setup”

  1. I also always have a pre-made syringe of atropine and an epinephrine bristojet (100mcg/ml) immediately available. Additionally, even if my plan is to use non-depolarizing neuromuscular blockers on induction, I keep succinylcholine immediately available. I consider it one of my rescue drugs in the event of laryngospasm or for its potentially utility for a challenging airway.

    1. Great points, Stephen, I agree. I put atropine on the sheet that is posted here with this podcast. And yes, succinylcholine should be ready available for the reasons you mention. Thanks.

  2. What is the reason vecuronium is preferred over rocuronium at Hopkins? It appears to me that rocuronium, in combination with sugammadex as a reversal agent, is an ideal neuromuscular blocking agent for most cases.

    1. Hi Paul,

      Great question. Until last week we didn’t have sugammadex at Hopkins so that wasn’t an option. Between vec and roc, the choice was made to use vec as first line because it was somewhat cheaper than roc. Now that we have sugammadex I would imagine we’ll start seeing more rocuronium used. However, I should say that, as you know, sugammadex does a fairly good job of reversing vecoronium as well, just not quite as rapidly as it reverses roc.

      Best,
      Jed

  3. Hi Dr. Wolpaw

    This is Farah, a resident in University of Toronto.

    Thank you so much for the great teachings. It’s been a daily routine for me to listen to your podcasts.
    very greatful.

    1. Hi Farah,

      Thanks so much for the comment. I’m so glad you’re enjoying the show. Good luck with the ongoing training!

      Best,
      Jed

  4. Hi Dr. Wolpaw,

    Just discovered your podcast, and this was my favorite episode yet! I’m a third year med student at OUWB about to finally begin my anesthesia rotations. This episode provides a solid framework for how I can think about the anesthetic medication plan from start to finish. I’ve listened to some more recent episodes as well and it’s cool to see how far along the podcast has come. Keep up the great work!!

    Warm regards,
    Justin

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