APPENDIX B: ANESTHESIA MACHINE CHECKOUT & SETTING UP THE OR

ANESTHESIA MACHINE CHECKOUT

Checkout only valid for an anesthesia system that conforms to current standards and includes an ascending bellows ventilator and the following monitors: Capnograph, pulse ox, oxygen analyzer, spirometer, and breathing pressure monitor w/high- & low-pressure alarms.

•  Verify backup ventilation equipment is available and functioning*

•  High-pressure system

• Check oxygen cylinder supply*

• Check central pipeline supplies*

•  Low-pressure system

• Check initial status of low-pressure system*

• Perform leak check of machine low-pressure system*

• Turn on machine master switch and all other necessary electrical equipment*

• Test flowmeters*

•  Adjust and check scavenging system*

•  Breathing system

• Calibrate O₂ monitor*

• Check initial status of breathing system

• Perform leak check of breathing system

•  Test manual and automatic ventilation systems and unidirectional valves

•  Check, calibrate, and/or set alarm limits of all monitors

•  Check final status of the machine

• Vaporizers off*

• APL valve open

• Selector switch to “Bag”

• All flowmeters to zero

• Patient suction level adequate

• Breathing system ready to use

SETTING UP THE OR FOR A CASE: “SOAP M”

S: Suction

Make sure suction is on, plugged in tightly to the canister, on at full blast

O: Oxygen

Check that pipeline supply is between 50–55 psi and connected to the wall

Check that the cylinder in the back of the machine has adequate oxygen (>1,000 psi)

Calibrate O₂ sensor

Make sure a self-inflating bag-valve-mask is available

A:  Airway

Check all laryngoscopes and handles

Choose appropriate ETT and check cuff for leaks. Have an ETT stylette available

Make sure an LMA is available

Oral airway, bite block, and tape

Stethoscope

P: Pharmacy

Draw up drugs needed for the case (including a sedative, induction agent, paralytics)

Make sure emergency drugs (epinephrine, atropine, extra succinylcholine) are available

Make sure vaporizers are adequately filled

Make sure appropriate antibiotics are available

Set up appropriate drips and have a functioning drug infusion pump

M: Machine/Monitors

Check the machine (see Anesthesia Machine Checkout above)

Check the monitors: BP cuff present and of appropriate size; pulse oximeter functioning; EKG cables & electrodes available; nerve stimulator present & functioning

Fluid & patient warmers available; A-line, CVP, PA and EEG monitors as indicated

*Note: If an anesthesia provider uses the same machine in successive cases, the steps denoted by an asterisk need not be repeated or may be abbreviated after the initial checkout.