Tracy Farrer-O’Bryant, MD UC Davis Medical Center

Department of Anesthesiology and Pain Medicine

}  M-MACHINES }  S-SUCTION }  M-MONITORS }  A-AIRWAY }  I-IV }  D-DRUGS }  S-SPECIAL STUFF

}  Low pressure test ◦  Before you turn on the anesthesia machine,

disconnect the fresh gas from the wall ◦  Depress the flush to expel all gas pressure within

the machine ◦  Open common gas outlet ◦  Close gas flows if open ◦  Attach suction bulb, deflate bulb and ensure the

bulb stays flat for 10 seconds ◦  Repeat with each vaporizer dial turned open

• Datex-Ohmeda Aestevia 5 featured. More recent • models have automated checks with onscreen prompts. • Follow the prompts.

Bulb is found in one of the anesthesia machine drawers

}  Turn everything on •  Anesthesia machine •  Vital signs monitor •  Airway gas monitor

•  While these are warming up, go around to back of machine to check out your fresh gas supply. •  Tanks •  Pipes

}  Check: O2, N2O, AIR tanks. Crack tanks then close. At least 1000psi in O2 and AIR tanks

• Check wall supply • Reconnect

• O2-Green • Air-Yellow • N2O-Blue • Suction

• Are all connected? • Ensure there is 50 psi on gauge on front of machine

}  Close APL valve to 30 cm H2O }  Occlude Y-piece }  Press flush until pressure increase to 20-30cm H2O }  Release flush }  Pressure shouldn’t fall for 10 seconds Ø Return APL valve to minimum

}  Set appropriate ventilator settings for your next patient

}  Test CO2 Sensor ◦  Unscrew CO2 line from Y-piece ◦  Blow into CO2 line and look for ETCO2 on monitor

}  Recommended Essential Steps in a Pre-Anesthesia Checkout Procedure }  TO BE COMPLETED DAILY, OR AFTER A MACHINE IS MOVED OR VAPORIZERS CHANGED

}  Item #1: Verify Auxiliary Oxygen Cylinder and Manual Ventilation Device (Ambu Bag) are Available &

Functioning. }  Item #2: Verify patient suction is adequate to clear the airway. }  Item #3: Turn on anesthesia delivery system and confirm that ac power is available. }  Item #4: Verify availability of required monitors, including alarms. }  Item #5: Verify that pressure is adequate on the spare oxygen cylinder mounted on the anesthesia

machine. }  Item #6: Verify that the piped gas pressures are ≥ 50 psig. }  Item #7: Verify that vaporizers are adequately filled and, if applicable, that the filler ports are tightly

closed. }  Item #8: Verify that there are no leaks in the gas supply lines between the flowmeters and the

common gas outlet }  Item #9: Test scavenging system function. }  Item #10: Calibrate, or verify calibration of, the oxygen monitor and check the low oxygen alarm.

}  Item #11: Verify carbon dioxide absorbent is fresh and not exhausted. }  Item #12: Perform breathing system pressure and leak testing. }  Item #13: Verify that gas flows properly through the breathing circuit during both inspiration and

exhalation. }  Item #14: Document completion of checkout procedures. }  Item #15: Confirm ventilator settings and evaluate readiness to deliver anesthesia care

Recommendations for Pre-Anesthesia Checkout Procedures (2008)

OFF ON

• Suction on MAX • Canister in place , tubing securely connected, and key turned up • Check suction strength • Tubing with yankauer tip connected and placed in easily accessible spot

• Ensure monitor is set to adult and alarms are on • Standard monitors

• Pulse oximeter • NIBP cuff (appropriate size) • ECG leads • Temp probe • Optional:

• Arterial line/flowtrack • CVP • BIS

• Prior to case: • Adult setting • BP Q2.5 minutes for induction • ETCO2 monitor on and working • Alarm limits that are patient specific • Alarms on

}  Laryngoscope handles with MAC and Miller blades (check lights on each)

}  Endotracheal Tubes ◦  Styleted, shaped (hockey stick), ◦  Cuff checked and syringe attached ◦  8.0 & 7.5 for ◦  7.0 and 6.5 for

}  Oral airway w/ tongue blade }  Humidifier, temp probe, tie/tape

}  Ensure the following airway management tools are available in the room ◦  LMAs (sizes3,4,5) ◦  Gum elastic bougie ◦  Cricothyroidotomy kit ◦  Ambu bag

2nd drawer down in Blue Bell cart

On top of some of the anesthesia machines

• Ambu bag: On the back of the Blue Bell cart • Cricothyroidotomy kit: Bottom drawer of the anesthesia machine

• IV Catheters • Alcohol swabs • Tourniquet • J-loop/flush • Opsite • Tape • Gauze

}  Take blood tubing and extension out of bag and attach to each other

}  Close both rollers at proximal end }  Close clip at distal end }  Hang bag of fluids, take blue tab off }  Spike fluids, open that roller, squeeze

chamber with filter to create reservoir, fill second chamber

}  Open distal clip, finish priming, re-clip }  Check tubing for air }  If you spike it, prime it!

PROPERLY LABELED: Drug, Concentration, Date, Time, Initials

*There are many induction drugs. This is an example and a specific plan should be made with your attending

• Make sure OR bed is plugged in and is on • Make sure bed is locked and controls are working

• STERILE GLOVES • ROLL FOR WRIST EXTENSION • CHLOROPREP • A-LINE CATHETERS X2 • LARGE TEGADERM • CLEAR TAPE • 4X4s • HAND EXTENDER PIECE • BUCKET

• Transducer

QUESTIONS?