The delivery of a safe anesthetic in modern-day practice begins with a checkout of the anesthesia machine. Improper or lack of inspection of anesthetic equipment prior to use has been associated with several significant incidents. Failure to check equipment clearly results in an increased risk of operative morbidity and mortality. With the large variety of anesthetic delivery systems available today, it is critical to understand the basic components of the system so that malfunctions can be detected prior to use or when failure occurs during use. Moreover, regular testing may lead to improved preventive maintenance and enhanced familiarity with the equipment. This chapter focuses on the fundamental components of the anesthesia machine checkout. Specific issues related to unique anesthesia delivery systems should be resolved by referring to the appropriate manufacturers’ operator manuals.

In 1993, a joint effort between the American Society of Anesthesiologists (ASA) and the U.S. Food and Drug Administration (FDA) resulted in the 1993 FDA Anesthesia Apparatus Checkout Recommendations. This simplified the initial 1986 preuse checkout and made it more userfriendly. At the time, the 1993 checklist focused on components that were immediately dangerous for patients and mechanisms that failed more regularly. This checklist was applicable to most commonly available anesthesia machines. Nevertheless, despite the recognized importance of an anesthesia machine checkout, available evidence suggests that the 1993 recommendations were neither well understood nor reliably used by anesthesia providers.

Moreover, because of recent and ongoing fundamental changes to the various anesthesia machine designs, the 1993 FDA preuse checklist may no longer be universally applicable to all anesthesia delivery systems. As more machines incorporate electronic checkouts, the user must determine which portions are automatically checked and which portions require manual checks. In such cases, the anesthesia care provider must be aware that the electronic machine check may not be a comprehensive preanesthesia checkout, and the user should follow the original equipment manufacturers’ recommended preuse checklist.

As a result, in 2005, the ASA‘s Committee on Equipment and Facilities, in conjunction with the American Association of Nurse Anesthetists (AANA) and the American Society of Anesthesia Technologists and Technicians (ASATT), began to develop a revised preuse checklist that was designed to be more workstation specific. These recommendations were published in 2008 and were intended to eventually replace the 1993 FDA Anesthesia Apparatus Checkout Recommendations. Rather than a checklist with specific instructions on how to perform each test, these new guidelines elaborate on specific systems and subsystems that must be evaluated. It is ultimately up to the user, along with the anesthesia machine manufacturer, to determine the actual mechanisms and/or specific checks that should be used to accomplish these subsystem evaluations. Appropriate personalized checkout procedures may need to be developed for individual machines and practices.

The 1993 Anesthesia Apparatus Checkout Recommendations placed all of the responsibility for the preuse checkout on the anesthesia provider. The new 2008 recommendations identify certain aspects of the preanesthesia checkout that may be performed by a qualified anesthesia
technician or a biomedical technician (http://www.apsf.org/newsletters/html/2008/spring/05_new_guidelines.htm).

Redundancy in the critical aspects of the checkout process makes it more likely that problems will be identified prior to use for a patient. Nevertheless, regardless of the additional support of technicians, the anesthesia care provider is ultimately responsible for the proper function of all equipment used to deliver anesthesia care.

As stated earlier, the goal of the preanesthesia checkout is to allow for the safe delivery of anesthesia care. Requirements for safe delivery of anesthetic care include the following:

The new guidelines for the preanesthesia checkout procedures consist of 15 items. These items must be performed as part of a complete preanesthesia checkout on a daily basis. (Items that must be completed prior to each procedure are in bold). The 15 items are as follows: