Chapter 45. Preoperative Anesthesia Checklist

Machine Checkout

The following monitors should be available for every anesthetic procedure:

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

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

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

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.

The following monitors should always be available:

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

Checkup procedure:

• 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

Additionally:

• 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

Anesthesia Setup

Can be remembered with the mnemonic MSMAID.

M—“Machine”

• Perform machine check as indicated above

S—“Suction”

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

M—“Monitors”

• 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

A—“Airway”