Drugs trolley setup

What the drugs trolley is for (and why setup matters)

• Holds the medicines and equipment you need for induction, maintenance, emergence and common intra-op problems.
• A consistent layout reduces delays and drug errors (wrong drug, wrong dose, wrong route).
• Your setup should match local policy and the department’s standard layout where possible—ask if you’re new to the area.
• You are responsible for what you draw up and give: always check the ampoule/vial yourself.

Before you start: basic safety checks

• Check the trolley is clean, stocked, and not cluttered with old syringes/ampoules.
• Check tamper seals (if used) and expiry dates on commonly used items (especially emergency drugs).
• Confirm controlled drugs (CDs) are stored and recorded according to local policy (usually separate cupboard/register).
• Know where the anaphylaxis box, malignant hyperthermia (MH) kit, and intralipid are kept (may be separate from the trolley).
• Ensure you have a working sharps bin nearby and a safe area for drawing up medicines.

Core principles of drug preparation (drawing up)

• One drug at a time: pick up the ampoule/vial, read the label, draw up, label immediately, then put the ampoule down.
• Label every syringe (even if you think it’s ‘obvious’). Use standard colour-coded labels where available.
• Use the right syringe size: smaller syringes for potent drugs (e.g., 10 mL for opioids/vasopressors) to reduce dosing mistakes.
• Dilute carefully: calculate dose and concentration before drawing up; if unsure, stop and ask.
• Keep a ‘clean’ area for prepared, labelled syringes; discard any unlabelled syringe immediately.
• Avoid pre-drawing up drugs you are unlikely to use (waste + risk of mix-ups), unless local policy requires standard trays.

Suggested layout: how to organise the trolley top

• Keep the top surface for current case only: labelled syringes, flushes, and immediate-use items.
• Group by function: induction drugs together; analgesia together; muscle relaxants together; vasoactive drugs together.
• Keep a dedicated area for emergency drugs (e.g., metaraminol/phenylephrine, ephedrine, atropine/glycopyrrolate, adrenaline).
• Keep saline flushes separate from drug syringes to reduce accidental drug flush.
• Place a drug chart/quick reference (local) where you can see it without blocking workspace.

Common drug groups to stock/locate (know where they are)

• Induction agents: e.g., propofol; sometimes thiopentone/ketamine depending on site.
• Opioids: e.g., fentanyl, morphine; remifentanil may be infusion-based (check pumps/lines).
• Muscle relaxants: e.g., rocuronium/atracurium; reversal agents (e.g., neostigmine + glycopyrrolate; sugammadex where stocked).
• Vasoactive drugs: e.g., metaraminol/phenylephrine/ephedrine; adrenaline for emergencies.
• Antiemetics: e.g., ondansetron, dexamethasone; check local preferences.
• Local anaesthetics: e.g., lidocaine, bupivacaine/levobupivacaine/ropivacaine; intralipid location for LAST (local anaesthetic systemic toxicity).
• Antibiotics: often prepared per case; check timing and allergy status.
• Emergency adjuncts: e.g., naloxone, flumazenil (if stocked), calcium, magnesium, glucose, hydrocortisone/chlorphenamine (local).

Emergency readiness: what you should be able to do quickly

• Be able to immediately find and prepare: a vasopressor, an anticholinergic, and adrenaline.
• Know local ‘first-line’ choices for hypotension and bradycardia (varies by consultant/site).
• Keep a pre-prepared, clearly labelled vasopressor syringe only if that is local practice; otherwise have the kit ready to make it quickly.
• Check you have IV access equipment and flushes ready before induction.
• Know where the difficult airway trolley is (separate from drugs trolley but often needed urgently).

Infusions and pumps (if used)

• Confirm you have the correct giving set/extension, anti-siphon valve if required, and a free pump channel.
• Label infusion syringes/bags with drug name, concentration, date/time, and your initials (per local policy).
• Trace the line from syringe/bag to patient before starting (reduces wrong-line errors).
• Keep vasoactive infusions on dedicated lines where possible; avoid sharing with intermittent bolus drugs.

End of case: reset safely

• Dispose of sharps immediately; clear ampoules and packaging to reduce clutter and confusion.
• Discard any unlabelled or uncertain syringes; do not ‘save for later’.
• Return unopened stock to the correct drawer; follow local policy for part-used vials/ampoules.
• Account for controlled drugs according to local rules; complete documentation promptly.
• Restock key items so the next case starts safely (or hand over clearly if you are leaving).