Tracy Farrer-O’Bryant, MD from UC Davis Medical Center provides a detailed checklist for completing a pre-anesthesia checkout procedure. The checklist includes over 15 essential items to verify including: ensuring auxiliary oxygen and manual ventilation devices are available and functional, verifying patient suction is adequate, turning on anesthesia machines and monitors, checking gas pressures, testing vaporizers and scavenging systems, and documenting completion. The full procedure verifies equipment, monitors, airway tools and supplies are present and functioning properly to deliver safe anesthesia care.

1. Tracy Farrer-O’Bryant, MD
UC Davis Medical Center
Department of Anesthesiology and Pain Medicine

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

3. } 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.

4. Bulb is found in one of the anesthesia machine drawers

5. } 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

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

7. • 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

8. } 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

9. } Set appropriate ventilator settings for your
next patient

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

11. } 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)

12. 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

13. • 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

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

16. } 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

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

21. 2nd drawer down in Blue Bell cart
On top of some of the anesthesia machines

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

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

24. } 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!

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

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

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

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

35. QUESTIONS?