Anesthesia cart: there’s no time to search in the operating room

How long does it take to find supplies in an anesthesia cart? A study published in 2023 in the Journal of Perioperative Practice measured this in a simulation. Eighteen anesthesia providers, in two different operating rooms, had to take 10 items out of the cart. All 10 may be needed quickly during surgery. Before the carts were reorganized, it took them 105 seconds on average. After the reorganization, with each item in the same place in both rooms, it took them 57 seconds: 45% less.

So time is lost when each room has its own layout: anyone working in an unfamiliar room has to search for things. According to the study’s authors, carts organized the same way in every room can lead to more timely patient care.

This article covers the rules for organizing an anesthesia cart, the zones it’s divided into, and a checklist of what must always be there.

The second requirement is about similar medications. In Italy, the main reference is SIAARTI, the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care. In April 2024, together with SIFO, the society of hospital pharmacists, it updated its good practice document on medication safety in the operating room. Among the most common medication errors, it lists “wrong placement of different medications in the same drawer” (our translation). It estimates that LASA medications, meaning those with similar names or packages (look-alike, sound-alike), are involved in up to 25% of medication errors. And it asks staff to prevent these errors starting with how medications are stored, in the pharmacy as well as in the operating room.

The third requirement is the label. The same document calls for labels with the color code of the ISO 26825:2020 standard, which sets the color, size, and wording of labels put on syringes in anesthesia. According to the document, the color code helps staff recognize the right medication and notice an error sooner.

The fourth requirement is the same layout in every room. This is the starting point of both the 2023 study mentioned at the beginning and the Calgary study. The 2023 guidelines from the Association of Anaesthetists, the society of anesthesiologists in the UK and Ireland, ask for this too: work areas, and the way medications are stored in them, should be standardized. In Portugal, for example, anesthesiologists and operating room nurses published a national model for the anesthesia cart in 2018. It says which drawers the cart must have and what goes in each one, so that staff can use medications and manage the airway more safely and reduce waste.

Five zones, one for each stage of the anesthesiologist’s work

A practical method is to divide the cart into zones that follow the anesthesiologist’s work.
The five zones listed below come from Francehopital’s experience in designing anesthesia carts. They’re a suggested layout, to adapt to the room and the surgery done there.

The five zones follow how often things are used: the items needed most often are at the top, in view and within reach. Inside the drawers, dividers and bins keep items separate, as we explained in Bins are a drawer’s best mate.

Frequently asked questions

Is an anesthesia cart different from a crash cart?
Yes. An anesthesia cart goes with every operation and holds the supplies the anesthesiologist uses routinely, plus a section for emergencies. A crash cart is for resuscitation. It’s closed with a seal and opens in a single movement. We covered this in Crash cart: what it contains, how it’s checked, and how often. The Portuguese model also asks for a dedicated difficult airway cart in every operating suite.

Does an anesthesia cart need to be locked?
Anesthesia uses opioids such as fentanyl, which in Italy are in Section A of the medications table and must be kept under lock and key. The Portuguese model recommends an access control system for the anesthesia cart. We described the possible closures and the rules in Medication cart security: a key is no longer enough.

When should the medication layout be reviewed?
For example, when a new package comes into use that looks like another one. The SIAARTI-SIFO document asks the pharmacist to inform staff before a medication with a name or package similar to another one reaches the ward. That’s the right time to decide where it goes, away from the medication it resembles.

What Francehopital offers

Preciso N°9 is the anesthesia cart in the Preciso line, and it’s organized according to the five zones described above. Its footprint is 900×650 mm, and it’s 1.050 mm high, or 1.760 mm with the overbridge. It has a large worktop with a pull-out surface on the right side. The overbridge holds 9 small bins for needles and syringes, in rows of 5 and 4, along with a glove box holder, a tray, and a double IV hook. Below it are five Exper-Mod drawers, Francehopital’s modular drawers, available in heights from 76 to 316 mm. There are two baskets on the left side and two accessory rails on the right side.

The central key lock locks all the drawers at once. Preciso carts with drawers can also be fitted with two electronic locks: Digicode, with a 4-digit code, and a keycard lock.

Presto carts, available in four widths from 570 to 1.115 mm, can also be configured as anesthesia carts.

If you’re preparing a tender or reviewing your operating room carts, write to us through our contact page. And if now isn’t the right time, you can sign up for our newsletter: we send only a few emails a year on these topics.