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      Anaesthesia Machine: Checklist, Hazards, Scavenging

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          Abstract

          From a simple pneumatic device of the early 20 th century, the anaesthesia machine has evolved to incorporate various mechanical, electrical and electronic components to be more appropriately called anaesthesia workstation. Modern machines have overcome many drawbacks associated with the older machines. However, addition of several mechanical, electronic and electric components has contributed to recurrence of some of the older problems such as leak or obstruction attributable to newer gadgets and development of newer problems. No single checklist can satisfactorily test the integrity and safety of all existing anaesthesia machines due to their complex nature as well as variations in design among manufacturers. Human factors have contributed to greater complications than machine faults. Therefore, better understanding of the basics of anaesthesia machine and checking each component of the machine for proper functioning prior to use is essential to minimise these hazards. Clear documentation of regular and appropriate servicing of the anaesthesia machine, its components and their satisfactory functioning following servicing and repair is also equally important. Trace anaesthetic gases polluting the theatre atmosphere can have several adverse effects on the health of theatre personnel. Therefore, safe disposal of these gases away from the workplace with efficiently functioning scavenging system is necessary. Other ways of minimising atmospheric pollution such as gas delivery equipment with negligible leaks, low flow anaesthesia, minimal leak around the airway equipment (facemask, tracheal tube, laryngeal mask airway, etc.) more than 15 air changes/hour and total intravenous anaesthesia should also be considered.

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          Most cited references68

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          Checking anaesthetic equipment 2012: association of anaesthetists of Great Britain and Ireland.

          A pre-use check to ensure the correct functioning of anaesthetic equipment is essential to patient safety. The anaesthetist has a primary responsibility to understand the function of the anaesthetic equipment and to check it before use. Anaesthetists must not use equipment unless they have been trained to use it and are competent to do so. A self-inflating bag must be immediately available in any location where anaesthesia may be given. A two-bag test should be performed after the breathing system, vaporisers and ventilator have been checked individually. A record should be kept with the anaesthetic machine that these checks have been done. The 'first user' check after servicing is especially important and must be recorded. Anaesthesia © 2012 The Association of Anaesthetists of Great Britain and Ireland.
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            Adverse anesthetic outcomes arising from gas delivery equipment: a closed claims analysis.

            Anesthesia gas delivery equipment is a potentially important source of patient injury. To better define the contribution of gas delivery equipment to professional liability in anesthesia, the authors conducted an in-depth analysis of cases from the database of the American Society of Anesthesiologists Closed Claims Project. The database of the Closed Claims Project is composed of closed US malpractice claims that have been collected in a standardized manner. All claims resulting from the use of gas delivery equipment were reviewed for recurrent patterns of injury. Gas delivery equipment was associated with 72 (2%) of 3,791 claims in the database. Death and permanent brain damage accounted for almost all adverse outcomes (n = 55, 76%). Equipment misuse was defined as fault or human error associated with the preparation, maintenance, or deployment of a medical device. Equipment failure was defined as unexpected malfunction of a medical device, despite routine maintenance and previous uneventful use. Misuse of equipment (n = 54, 75%) was three times more common than equipment failure (n = 17, 24%). Misconnects and disconnects of the breathing circuit made the largest contribution to injury (n = 25, 35%). Reviewers judged that 38 of 72 claims (53%) could have been prevented by pulse oximetry, capnography, or a combination of these two monitors. Overall, 56 of 72 gas delivery claims (78%) were deemed preventable with the use or better use of monitors. The year of occurrence for claims involving gas delivery equipment ranged from 1962 to 1991 and did not differ significantly from claims involving other adverse respiratory events. Claims associated with gas delivery equipment are infrequent but severe and continue to occur in the 1990s. Educational and preventive strategies that focus on equipment misuse and breathing circuit configuration may have the greatest potential for enhancing the safety of anesthesia gas delivery equipment.
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              Guidelines to the practice of anesthesia revised edition 2013.

              The Guidelines to the Practice of Anesthesia Revised Edition 2013 (the guidelines) were prepared by the Canadian Anesthesiologists' Society (CAS), which reserves the right to determine their publication and distribution. Because the guidelines are subject to revision, updated versions are published annually. The Guidelines to the Practice of Anesthesia Revised Edition 2013 supersedes all previously published versions of this document. Although the CAS encourages Canadian anesthesiologists to adhere to its practice guidelines to ensure high-quality patient care, the society cannot guarantee any specific patient outcome. Each anesthesiologist should exercise his or her own professional judgement in determining the proper course of action for any patient's circumstances. The CAS assumes no responsibility or liability for any error or omission arising from the use of any information contained in its Guidelines to the Practice of Anesthesia.
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                Author and article information

                Journal
                Indian J Anaesth
                Indian J Anaesth
                IJA
                Indian Journal of Anaesthesia
                Medknow Publications & Media Pvt Ltd (India )
                0019-5049
                0976-2817
                Sep-Oct 2013
                : 57
                : 5
                : 533-540
                Affiliations
                [1]Department of Anaesthesiology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
                Author notes
                Address for correspondence: Dr. Umesh Goneppanavar, Department of Anaesthesiology, Kasturba Medical College, Manipal University, Manipal - 576 104, Karnataka, India. E-mail: drumeshg@ 123456yahoo.co.in
                Article
                IJA-57-533
                10.4103/0019-5049.120151
                3821271
                24249887
                b31d4cc3-7a2e-4596-8b15-e0f7a5817495
                Copyright: © Indian Journal of Anaesthesia

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Review Article

                Anesthesiology & Pain management
                anaesthesia machine,anaesthesia workstation,checklist,hazards,scavenging

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