Guidelines
Guidelines to the Practice of Anesthesia
Appendix III: Pre-anesthetic Checklist
A. Gas pipelines
1. [ ] Secure connections between terminal units (outlets) and anesthetic machine
B. Anesthetic machine
1. [ ] Turn on machine master switch and all other necessary electrical equipment
2. [ ] Line oxygen (40-60 psi or 275-415 KPa)
3. [ ] Line nitrous oxide (40-60 psi or 275-415 KPa)
4. [ ] Adequate reserve cylinder oxygen pressure
5. [ ] Adequate reserve cylinder nitrous oxide content
6. [ ] Check for leaks and turn off cylinders
7. [ ] Flow meter function of oxygen and nitrous oxide over the working range
8. [ ] Vaporizer filled
9. [ ] Filling ports pin-indexed and closed
10. [ ] Ensure Òon/offÓ function and turn off
11. [ ] Functioning oxygen bypass (flush)
12. [ ] Functioning oxygen fail-safe device
13. [ ] Oxygen analyzer calibrated and turned on functioning mixer (where available)
14. [ ] Attempt to create a hypoxic O2/N2O mixture and verify correct changes in flow and/or alarm
15. [ ] Functioning common fresh gas outlet
16. [ ] Ventilator function verified
17. [ ] Backup ventilation equipment available and functioning
If an anesthesiologist uses the same machine in successive cases, departmental policy may permit performing an abbreviated checklist between cases.
C. Breathing circuit
1. [ ] Correct assembly of circuit to be used
2. [ ] Patient circuit connected to common fresh gas outlet
3. [ ] Oxygen flow meter turned on
4. [ ] Check for exit of fresh gas at face mask
5. [ ] Pressurize. Check for leaks, and integrity of circuit (eg, Pethick test for co-axial)
6. [ ] Functioning high-pressure relief valve
7. [ ] Unidirectional valves and soda lime
8. [ ] Functioning adjustable pressure relief valve
D. Vacuum system
1. [ ] Suction adequate
E. Scavenging system
1. [ ] Correctly connected to patient circuit and functioning
F. Routine equipment
1. [ ] Airway Management:
2. [ ] Functioning laryngoscope (back-up available)
3. [ ] Appropriate tracheal tubes: patency of lumen and integrity of cuff
4. [ ] Appropriate oropharyngeal airways
5. [ ] Stylet
6. [ ] Intravenous supplies
7. [ ] Blood pressure cuff of appropriate size
8. [ ] Stethoscope
9. [ ] ECG monitor
10. [ ] Pulse oximeter
11. [ ] Capnograph
12. [ ] Temperature monitor
13. [ ] Functioning low- and high-pressure alarm
G. Drugs
1. [ ] Adequate supply of frequently used drugs and intravenous solutions
2. [ ] Appropriate doses of drugs in labeled syringes
H. Location of special equipment in each anesthetising location
1. [ ] Defibrillators
2. [ ] Emergency drugs
3. [ ] Difficult intubation kit
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By Nilsen RHEVI at http://nilsen.home.ro
