ESMOE - Pre-Anaesthetic Checklist

Question 1

Main general checks:

Answer 1

1. STARTING UP
2. WALL
3. MACHINE
4. ANTI HYPOXIC DEVICE
5. O2 FAIL DEVICE
6. VAPORISERS
7. CO2 ABSORBER
8. CIRCUIT
9. VENTILATOR
10. AUXILLARY EQUIPMENT

Question 2

1. STARTING UP

Answer 2

1. Check last & next service date
2. Turn on machine and monitors:
   NIBP, SpO2, ECG
3. Calibrate O2 analyser:
   FiO2 0.21 in room air, FiO2 0.90 with O2 flush
4. Capnograph should pick up expired breath

Question 3

2. WALL

Answer 3

1. Check pipelines – colours/shapes, tug test

Question 4

3. MACHINE

Answer 4

1. O2 cylinder should be > 5000 kPa
2. Pipeline pressures should be 400-500 kPa
3. The rotameters should open easily +
   bobbins shouldn’t stick
4. When FGF is occluded, the bobbins should
   bounce. (Repeat with each vaporiser open)

Question 5

4. ANTI HYPOXIC DEVICE

Answer 5

1. Prevents patient getting hypoxic gas mix
2. The O2 bobbin should rise - when N2O is
   opened
3. The N2O bobbin should fall - when O2 is
   closed

Question 6

5. O2 FAIL DEVICE

Answer 6

1. Disconnect wall O2
2. The O2 fail alarm should sound
3. Open the O2 cylinder
4. Alarm should go off
5. O2 bobbin should rise
6. Reattach O2 pipeline and repeat tug test
7. Close O2 cylinder

Question 7

6. VAPORISERS

Answer 7

1. Ensure O rings (on the back bar) intact
2. Ensure fitted securely and locked
3. Vaporiser should be at least half full,
   with the correct agent
4. The dials must open easily
5. ONLY ONE dial should be able to open at a time

Question 8

7. CO2 ABSORBER

Answer 8

1. Must be securely in place

2. There should be <50% colour change - otherwise indicates absorber saturation

Question 9

8. CIRCUIT

Answer 9

1. No holes or cracks or water
2. Switch to BAG (or manual) mode
3. Check APL valve:
4. 1 Close valve completely
5. 2 Press O2 flush up to 40cm H2O
6. 3 Compress reservoir bag
7. 4 APL valve should open at 65cm H2O
8. Attach test lung and ‘bag’:
9. 1 Check that the tubing has no obstruction
10. 2 Valves are working

Question 10

9. VENTILATOR

Answer 10

1. Switch onto VENTILATOR mode
2. FGF should be at minimum
3. Set ventilator and watch that TV
   and RR that you have set is
   delivered.
4. Bellows should rise to the top of the casing
   (if not, increase FGF till bellows reach the top: this FGF is the quantity of the leak in the machine).
5. Acceptable leak is <200ml
6. Commonest sites of leak: circuit, CO2 absorber, vaporisers and bellows

Question 11

10. AUXILLARY EQUIPMENT

Answer 11

1. M: Masks, Magill’s forceps
2. A: Airways, Assistant
3. L: LMA, Laryngoscope blades and handle
4. E: ETT, Emergency drugs
5. S: Stylet Strapping
6. S: Suction: Should reach -30 to -50 cm H2O
7. S: Scavenging
8. AmbuBag: valve working, bag and tubing attached
9. Defibrillator checked and available