Some items should be available and within arm’s reach but can remain unopened unless needed: oral and nasal airways, LMAs, lubricant, gastric tubes, extra IV supplies, or medications.

Think of these as your “contingency tools”: ready to go if the situation changes but not contributing to clutter or confusion if everything goes smoothly. Make sure that backup equipment is not only available but unobstructed (not in a locked drawer, for example).

The more senior you become, the higher the expectations for your room setup. A well-prepared setup is efficient, complete, and thoughtfully organized. Minimalism has its place, but it should never come at the expense of essential backup equipment. Trainees are expected to be more meticulous than minimalist. Resist the urge to cut corners!

Given that our field operates on razor-thin margins of error, having backup equipment is of the utmost importance. A setup that cuts corners may look slick until something doesn’t go as planned: the airway, the hemodynamics, or the IV access. The attending–trainee relationship relies on having the tools to bail each other out.

For junior trainees, my expectation is to work with them, guiding them closely through setup, planning, and execution. For senior trainees, the expectation shifts: I aim to supervise from a distance while they work independently and demonstrate ownership of the room.

Your anesthesia tech can be an invaluable lifeline, but your goal should be to become as self-sufficient as possible. There will be many times that you have to troubleshoot a machine error or equipment failure off-hours when there are no anesthesia technicians. Train yourself to be able to work solo, turn over your own room, and track down your own equipment. This is a valuable skill for independent practice. Resist the habit of calling the tech for every small task. The technician’s role is to ensure that equipment is operational and provide support in emergencies. They are not there to manage your routine setup.

Whether you’re in your home OR or a new environment, you should always know where critical supplies are stored. This includes, but isn’t limited to: LMAs and airway adjuncts, blood tubing and fluid warmers, cricothyrotomy kit, crash cart, malignant hyperthermia (MH) cart, and local anesthetic systemic toxicity (LAST) kit.

I treat propofol and rocuronium as emergency medications, and I keep them immediately available, just as I would code drugs. The vast majority of anesthetic emergencies are airway-related, so your meds and equipment for intubation should always be ready to go.

For a very sick patient, consider an additional backup medication: dilute 1 mg of epinephrine in 9 mL of saline. This allows you to bolus more precise doses of epinephrine in an emergency without having to work with just the small 1 mg unit-dose.

For pediatric patients, you should have succinylcholine and atropine ready to deploy, pre-drawn up into the appropriate weight-based doses for laryngospasm or bradycardia.