Anaesthesia in Obstetrics and Gynaecology Jaideep Malhotra, Vinay Tewari, PL Gautam, Narendra Malhotra
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1INTRODUCTION2

Anaesthesia Work Station Check UpChapter 1

4Anaesthesia equipment is used to deliver oxygen, nitrous oxide and inhalation anaesthetics and to control ventilation. Several monitors are used to observe the function of the system, to detect equipment failures and to provide information about the patient. Before using the equipment, it should be checked to rule out any malfunction and to ensure adequate back up measures are available, if needed.
 
 
For the First Case of the Operation List
  1. Check that the anaesthetic machine is connected to the power supply (if necessary) and switched on. Pay attention to any information on the machine, particularly servicing details.
  2. Check oxygen analyser is present, turned on, checked and calibrated.
  3. Check gas supply connections.
    • Identify the gases being supplied by pipeline; confirm by a ‘tug test’ that the gas supply terminal is connected to the appropriate pipeline.
    • Check that the anaesthetic machine is connected to a supply of oxygen and that an adequate supply of oxygen is available from a reserve oxygen cylinder.
    • Check that adequate supplies of other gases (such as nitrous oxide and air) are available and connected.
    • Check that all pipeline pressure gauges in use indicate 400 kPa.5
  4. Check the operation of flow meters.
    • Ensure smooth operation of the flow control valve and check that the bobbin moves freely throughout its range.
    • Check oxygen failure device.
    • Check the operation of the emergency oxygen bypass control.
  5. Check the vapouriser(s).
    • Ensure that each vapouriser is adequately filled but not over-filled.
    • Ensure that each vapouriser is correctly seated on the back bar.
    • Check the vapouriser for leaks, both in “on” and “off” positions. Turn the vapouriser off.
    • A leak test should be performed immediately after changing any vapouriser.
  6. Check the breathing system.
    • The system should be visually inspected for correct configuration.
    • A pressure leak test should be performed on the breathing system by occluding the patient port and compressing the reservoir bag.
    • Bain's circuit should be checked for integrity of inner tube using Venturi's principle. Press oxygen flush; with this the reservoir bag should collapse indicating generation of negative pressure.
    • The correct operation of unidirectional valves should be checked if closed circuit or circle absorber is being used.6
    • All connections should be secured by ‘push and twist’ method.
  7. Check the ventilator and its connections.
    • Ensure the ventilator tubing is correctly configured and securely attached.
    • Set the controls for use and ensure an adequate pressure is generated during the inspiratory phase.
    • Check the pressure relief valve and the disconnection alarm function correctly.
  8. Ensure the availability of an alternative means (Resuscitation bag and mask/Breathing circuit) to ventilate the lungs.
  9. Check the anaesthetic gas-scavenging system
    • Whether it is switched on, if present and is functioning correctly.
    • Ensure that the tubing is attached to the appropriate (expiratory) ports of the breathing system or ventilator.
  10. Check all ancillary equipment such as laryngoscopes, intubation aids, intubation forceps, bougies, appropriately sized face masks, airways, tracheal tubes and connectors, etc. are available. Check that the suction apparatus is functioning and that all connections are secure.
  11. Ensure that the appropriate monitoring equipment is present, switched on and calibrated ready for use. Set all default alarms as appropriate.7
  12. Check that the operating table can be moved up and down, tilted laterally and into Trendelenburg/anti-Trendelenburg positions.
 
For the Subsequent Cases on the OT List
  1. Check that the adequate supply of oxygen is available from a reserve oxygen cylinder.
  2. Ensure that each vapouriser is adequately filled but not over-filled. A leak test should be performed immediately after changing any vapouriser.
  3. Check the breathing system. All connections should be secured by ‘push and twist’ method. The correct operation of unidirectional valves should be checked if soda lime of circle absorber has been changed.
  4. Check the ventilator and its connections. Ensure the availability of an alternative means (Resuscitation bag and mask/Breathing circuit) to ventilate the lungs.
  5. Check all ancillary equipment such as laryngoscopes, intubation aids, intubation forceps, bougies, appropriately sized face masks, airways, tracheal tubes and connectors, etc. are available. Check that the suction apparatus is functioning and that all connections are secure (Figs 1.1 to 1.3).8
    zoom view
    Figure 1.1: (1) Check gas supply connections, pressures and reserve oxygen cylinder, (2) Oxygen analyser, (3) Check the operation of flow meters and oxygen failure device, (4) Check the operation of the emergency oxygen flush and position of bypass control, (5) Check the vapourisers, (6) Check the breathing system, (7) Check the ventilator, (8) Resuscitation bag and mask, (9) Check all Ancillary equipment,(10) Ensure monitoring equipment, (11) Check the anaesthetic gas-scavenging system if present
    All connections should be secured by ‘push and twist’
    9
    zoom view
    Figure 1.2: (1) Check gas supply connections, pressures and reserve oxygen cylinder, (2) Oxygen analyser, (3) Check the operation of flow meters and oxygen failure devices, (4) Check the operation ofthe emergency oxygen flush and position of bypass control, (5) Check the vapourisers, (6) Check the breathing system, (7) Check the ventilator, (8) Resuscitation bag and mask, (9) Check all ancillary equipment,(10) Ensure monitoring equipment
    All connections should be secured by ‘push and twist’
    10
    zoom view
    Figure 1.3: Check the operation table for tilt facility prior to administration of spinal anaesthesia
  6. Ensure that the appropriate monitoring equipment is present, switched on and calibrated ready for use. Set all default alarms as appropriate.
(Modified from Association of Anaesthetists guidelines, 1997)