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Machine Checkout

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The following monitors should be available for every anesthetic procedure:

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  • EKG leads (three- or five-lead)
  • Pulse oximeter
  • Noninvasive blood pressure monitor
  • Temperature monitoring

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Additional monitors depending on surgery type and patient history may include:

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  • Invasive arterial blood pressure monitoring
  • Central venous pressure monitoring
  • Pulmonary artery catheter monitoring
  • Precordial Doppler
  • EEG/BIS monitoring

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The anesthesia machine should be checked every day and rechecked in between cases if different anesthesia equipment is used or if the anesthesia operator changes.

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The following monitors should always be available:

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  • Oxygen analyzer
  • Capnography
  • Low- and high-pressure alarms
  • Spirometer

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Checkup procedure:

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  • Backup gas cylinders and Ambu-type bag valve mask device should be available in the room
  • Turn on the machine master switch and all monitors
  • A high-pressure system check should be performed with the oxygen cylinder supply and the central supply
  • A value of 1,000 psi in an O2 E cylinder indicates 340 L of O2 (half-full) at atmospheric pressure, that is, it would last for 34 minutes at 10 L/min
  • A low-pressure system leak test should be performed (tests for leaks from flow control valves to common gas outlet)
  • Check flow meter function
  • Calibrate the O2 sensor
  • Check leak test of breathing system
  • Check manual ventilation and ventilator bellows
  • Check integrity of unidirectional valves
  • Check capnography function
  • Check scavenging system and CO2 absorber; change absorbent if necessary
  • Ensure APL valve is in the open position and ventilator is set to “manual” prior to patient’s arrival in OR

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Additionally:

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  • Ensure that the MH box or cart is available and stocked
  • Ensure defibrillator is in functioning condition and readily available
  • If using local anesthetics, ensure lipid rescue is available and ready for use
  • Ensure rapid transfuser is available and stocked for use if needed

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Anesthesia Setup

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Can be remembered with the mnemonic MSMAID.

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M—“Machine”

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  • Perform machine check as indicated above

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S—“Suction”

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  • Ensure suction is available and attached to appropriate length of tubing to reach patient’s head
  • Attach Yankauer tip to end of tubing

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M—“Monitors”

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  • Ensure that monitors as indicated above are available, calibrated, and ready to be used
  • All monitors should be of the appropriate size for the patient including blood pressure cuff size, arterial and central catheter sizes
  • Ensure that disposable monitors are attached and ready to be used for the next patient such as EKG leads, pulse oximeter, and, in some cases, BP cuff
  • A nerve stimulator should be readily available and functioning
  • Fluid warmers and patient warming blankets and devices should also be readily available and functioning
  • Have eye protection and lubricant ready

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A—“Airway”

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  • Check handle with ...

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