what's up everybody my name is Max Feinstein and I'm an anesthesiologist in the Mount Sinai
Hospital in New York City in this video I'm gonna be walking you through all of the medications that
an anesthesiologist keeps in the medication cart in the operating room. keep in mind that these
are the non-controlled substances. controlled substances like fentanyl and also medications
like propofol are kept at the pharmacist, which are medications that I'll cover in a
future video. I also just want to point out that anesthesiology is one of the few specialties where
physicians are directly administering medications to their patients. it's one of the aspects of the
field that appealed to me and I think makes it pretty unique. many thanks to dr. Erica Fagelman,
one of the chief residents in the Mount Sinai anesthesiology program, who graciously took the
time to narrate this video for us. let's dive in! so this is our standard medication cart,
this is something that is stocked daily in between each case, and these are medications that we don't
need to pick up from the pharmacy, they are placed in here by our anesthesia techs and so
they are always available to us during every case. some of them are more emergency drugs and others
are just medications that we give routinely, so we have things like amiodarone in the case that
a patient may have heart arrhythmia that needs to be treated. we have a few different beta blockers,
usually esmolol, our shorter acting beta blocker, we have metoprolol here, and then often on this
side we'll also have a syringe of labetalol, we have 1% lidocaine and we usually elsewhere have
2% lidocaine that can be used intravenously or to help anesthetize the skin before you place an IV.
this is lubrication that can be used to assist you in preventing corneal abrasions once the patient's
asleep. it can go on their eyes. and then we usually have a few medications that can treat
hypertension which we do see under anesthesia sometimes, so typically will use hydralazine or
we'll use the labetalol that I showed you before. in terms of anti-nausea medications we have a few
different options that are typically stocked in the cart. most commonly we use ondansetron
or zofran, and we use dexamethasone. usually we give the dexamethasone at the beginning of
the case and a lot of people tend to give their zofran at the end of the case. dexamethasone is
a steroid but we also have hydrocortisone-- we don't typically use this for antiemetic purposes
but we tend to give this if somebody is on chronic steroids and needs stress dose steroids or during
transplants when we use this for suppression. we have some of our more emergency drugs I would say,
so one of which is epinephrine and in the cart here this is one milligram so obviously in the
event of cardiac arrest you might push this whole thing but you can also make dilutions of this that
will be in concentrations more appropriate for things like anaphylaxis or bronchospasm
at smaller doses. other more emergency drugs we have: norepinephrine-- and this is a very
concentrated vial but we are also able to get this in a pre-mixed bag from the pharmacy in a more
appropriate concentration to run as an infusion during particular cases- but this is here if you
need it and you don't have that bag, and as I mentioned we have atropine here, so this can
be used for bradycardia- severe bradycardia. we have ephedrine, so this is a vasopressor that will
increase the heart rate and the blood pressure and then phenylephrine which will also increase
the blood pressure. it tends to actually decrease the heart rate. other emergency drugs- we actually
have albuterol, and this will come in a metered dose inhaler, but it also comes with an adapter
so that we're able to give albuterol through the breathing tube once the patient's already asleep,
and this is very important if we have anaphylaxis or bronchospasm for any reason under anesthesia
can be life-saving. other things in here: so we have our neuromuscular blockade or our paralytic
agents most commonly succinylcholine here and rocuronium here. succinylcholine kicks in very
quickly so that's more of an emergency drug we always have drawn up and that's something we
would use in what we call a rapid sequence intubation when we want the patient to be
intubated very quickly. there are some other miscellaneous drugs in here- ketorolac or
toradol that can be used for anti-inflammatory purposes- it's a great analgesic. we have lasix
in here if we think someone is fluid-overloaded or if we're doing a kidney transplant that's part
of the protocol during a kidney transplant. there is also diphenhydramine or benadryl
so if someone is having some type of allergic reaction obviously this would be something we
can get quickly prior to resorting to epinephrine. and then we have medications that we actually use
to reverse paralysis at the end of a surgery when you want the patient to start breathing
again on their own and that's typically a combination of two different medications
glycopyrrolate and neostigmine which work together to give the patient strength again by increasing
acetylcholine, and the glycopyrrolate is used so that they don't have some of the nasty side
effects of that acetylcholine, so that will counteract things like secretions and things
like diarrhea, so that these work together to give the patient their strength without
some of this unpleasant side effects. that wraps up this tour of the anesthesiologist's
medication cart. I hope you found it interesting. thanks for watching and I'll see you next time