Chapter 13

### Introduction

Keywords

• design and ergonomics of anesthesia machines

• anesthesia machine safety features

• ventilators

• oxygen

• ASA monitoring standards

In the recent past, it was easier to perform a preanesthetic checkout on an anesthesia machine. The machines were not as complicated, and the checkout did not differ much from one type of machine to another. There was a list that you could either commit to memory or attach to the machine as a guide, and you had to complete each step, similar to an airline pilot’s preflight checkout. (But as we said earlier, we anesthesia providers would be much more careful about machine checkout if not only the patient’s, but our lives depended on it, in the same way a pilot’s life depends on his or her machine.)

Things are much different now. Not only are there many more models of anesthesia machines, with different features, but some machines do an automated checkout. This makes things potentially confusing because an automated checkout may or may not check for everything that needs to be checked. As an example, the user manual for some machines will indicate that the user is to perform a low-pressure leak test, but other machines do not. It can certainly be difficult to remember what machine requires what test to be performed by the user instead of being done automatically by the machine. The manufacturers say the clinician needs to read the user manual, and certainly that is true, but few of us do or even know where to find one. In fact, there is now not a standard preanesthesia checkout for every machine because machines vary so much. In 2008, the American Society of Anesthesiologists (ASA) devised an overview1 of what should be checked, but not in the “step one, step two” manner of previous checklists.

Keep in mind that a failure to perform a complete preanesthetic machine checkout would not be looked upon favorably in a medicolegal situation if any untoward event led to patient injury related to an equipment malfunction. But besides that, it is of prime importance that we as caregivers strive to perform at the highest standards possible; clinical excellence is not to be hoped for but is to be expected.

### Standard Machine Checkout

So, what is part of a standard anesthesia machine checkout? Sadly, the only morning checkout many clinicians will perform is to simply see if the anesthesia circle circuit will hold positive pressure. In an emergency situation, that may indeed be all that you have time to do. If a patient may suffer because of a delay, a machine check of the most basic things is appropriate; this would include if the power is on, if a source of oxygen is attached, and if the circuit hold can positive pressure.

Table 13-1 provides a generic machine checkout list from the Food and Drug Administration ...

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