Federal rules leave an ASC's emergency list to its own medical staff, but some stocking decisions come in pairs: stock sevoflurane or succinylcholine and MHAUS says dantrolene must be on site. Here's how to buy anesthesia drugs by group, format, and storage.
· 6 min read
Written and clinically reviewed by Jacob Fuchs, PharmD
Reviewed on
There is no federal drug list for an ambulatory surgery center. Medicare's rule leaves it to each center's medical staff and governing body to decide what emergency equipment the operating room needs, as long as it's immediately available, fits the patient population, and is maintained. What the rule doesn't do is stop one stocking decision from creating another. If you keep sevoflurane or succinylcholine, the Malignant Hyperthermia Association of the United States (MHAUS) says dantrolene has to be on site too.
This guide walks through how to buy anesthesia drugs by group, by format, and by storage, so the formulary your clinicians set doesn't turn into expired inventory. It's a purchasing guide, not a clinical protocol: your anesthesia providers and medical staff decide what's used and how.
Your own medical staff. Under 42 CFR 416.44(d), the ASC's medical staff and governing body set policies specifying the emergency equipment the operating room requires. That equipment must be immediately available in an emergency, appropriate for the facility's patient population, and maintained by appropriate personnel (eCFR, current as of October 16, 2026).
Office-based practices answer to state rules and to their accreditor rather than to the ASC rule, and those requirements vary. Either way, purchasing starts from a written list your clinicians own, not from a vendor's catalog.
Most anesthesia formularies are built from the same handful of groups. The examples below are common members of each group, not a recommended list — yours should come from your clinicians. What Premier has in stock right now is listed at the end of this guide.
| Group | Examples | What drives the purchase |
|---|---|---|
| Induction and sedation | Propofol (20, 50, and 100 mL vials), dexmedetomidine | Vial size versus case length; single-patient use |
| Inhaled anesthetic | Sevoflurane | Vaporizer compatibility; triggers the dantrolene requirement |
| Neuromuscular blockade and reversal | Rocuronium, succinylcholine, glycopyrrolate | Refrigerator space; succinylcholine also triggers the dantrolene requirement |
| Blood pressure support | Ephedrine, phenylephrine | Look-alike storage with epinephrine |
| Antiemetics and adjuncts | Ondansetron, dexamethasone, famotidine, scopolamine patches | Package size versus case volume |
| Local anesthetic | Lidocaine 1% in 5, 20, 30, and 50 mL vials | Single-dose versus multiple-dose vials |
| Analgesic | Ketorolac 30 mg/mL and 60 mg/2 mL | Vial strength matches your order sets |
| IV fluids | Lactated Ringer's, 0.9% sodium chloride | Storage space; case count |
Two groups deserve extra attention because their storage and labeling rules shape what you should buy.
Propofol is single-patient, and the clock starts when the vial opens. One manufacturer's label states that vials are never to be accessed more than once or used on more than one person, and that the drug must be discarded at the end of the procedure or 12 hours after the vial is opened, whichever comes first (Pfizer propofol label). Check the label for the product you actually buy. The purchasing consequence is the same either way: a 100 mL vial opened for a short case is mostly waste. Buy the vial size that matches your typical case, not the lowest cost per milliliter.
Rocuronium lives in the refrigerator until it doesn't. The Pfizer labeling says to store rocuronium at 2°C to 8°C (36°F to 46°F) and not to freeze it. Once a vial moves to room temperature, it must be used within 60 days, and opened vials within 30 days (Pfizer rocuronium storage). Plan refrigerator space before you plan quantities, and date every box the day it leaves the refrigerator.
Yes, according to MHAUS. Its consensus statement says dantrolene must be available at every anesthetizing location where malignant hyperthermia trigger agents are used. Most MH cases follow a volatile anesthetic, with or without succinylcholine, and a small share follow succinylcholine alone, so the recommendation covers succinylcholine even where no volatile agents are used (MHAUS dantrolene statement).
The stocking amounts MHAUS recommends:
MHAUS also says the dantrolene must be available to give within 10 minutes of the first sign of MH. If you stock the 20 mg vials, it says to keep sterile water for injection, without a bacteriostatic agent, nearby for reconstitution: 60 mL per vial (MHAUS MH cart FAQ). That's 36 vials of sterile water sitting beside 36 vials of dantrolene, which is a storage decision as much as a clinical one.
Ephedrine and epinephrine. Pennsylvania's patient-safety reporting system documented the two being swapped. The names look alike, both can come in 1 mL vials or ampules, and both are vasopressors, which makes storing them near each other likely. The advisory's recommendation: don't store them side by side (PA PSRS advisory).
If your practice also keeps an anaphylaxis kit, the same advisory's epinephrine concentration problem applies there. Our clinic anaphylaxis kit guide covers it.
Premier Pharma supplies licensed surgery centers, physician offices, and pharmacies. The full Anesthesia & Surgery category lists everything we carry right now, including propofol, dexmedetomidine, sevoflurane, and ketorolac. Open a free account — credential review typically takes 1–2 business days.
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