Introduction The anesthesia gas machine must be equipped with an ascending bellows

ventilator and certain monitors (capnograph, pulse oximeter, oxygen analyzer, spirometer,
breathing system pressure monitor with high and low pressure alarms). If not so
equipped, the checklist must be modified.
Verify backup ventilation equipment is available & functioning.
Contaminated oxygen supply, loss of oxygen supply pressure, and obstruction
of the breathing system, though rare, cause the machine to be totally inoperable. So check
for that Ambu!
Check oxygen cylinder supply
One cylinder must be at least half full (1000 psi), according to the FDA
Checklist (older versions called for 600 psi as the lower limit). This will allow gas machine
function for 10-60 minutes, or longer.
It is not necessary to:
Check any other cylinders beside oxygen
"Bleed" the pressure off the cylinder pressure gauge after checking
Leave cylinder closed after checking.
While you're behind the machine, check suction, Ambu bag and extra circuit
present. Also: gas analysis scavenged, scavenger caps all present, location of circuit
breakers, any loose pipeline, electrical, or etc. connections, head strap, tank wrench, and
color/date of CO2 absorbent.
Check central pipeline supplies.
Check for proper connection at wall
Check the pipeline pressure gauge- should read approximately 50 psi.
It is not necessary to unhook pipeline connections at wall.
Check initial status of low pressure system.
Remove oxygen analyzer sensor.
Check liquid level and fill vaporizers if necessary.
Check vaporizer interlock.
Perform leak check of low pressure system.
Leaks as low as 100 mL/min may lead to critical decrease in the concentration
of volatile anesthetic (creating a risk for intraoperative awareness), or permit hypoxic
mixtures under certain circumstances.
Negative pressure leak test (10 sec.) is recommended.
Repeat for each vaporizer.
Turn master switch on.
Test flowmeters.
Check for damage, full range, hypoxic guard.
Calibrate oxygen monitor (FDA Step 9)
Its not the alphas and betas which kill them, its the little green Os. - John
Garde
Final line of defense against hypoxic mixtures.
Trust it until you can prove it wrong.
Mandatory for all general anesthetics, or when using the breathing circuit (for
example during a propofol or other sedation)
Calibrate/daily check: expose to room air and allow to equilibrate (2 min).
Then expose to oxygen source and ensure it reads near 100%
Check initial status of breathing system (FDA Step 10)
Assemble circuit with all accessories.
Test ventilation systems and unidirectional valves (FDA Step 12)
Test ventilator and observe action of unidirectional valves.
Perform leak check of breathing system (FDA Step 11)
The "usual" high pressure check.
Let the gas out of the circuit through the popoff [APL] valve, not the elbow.
Adjust and check scavenging system. (FDA Step 8)
If active (suction) is applied to a closed scavenger interface, check the positive
and negative pressure relief valves of the interface.
If open interface, ensure that adequate suction is applied (the indicator float
between the scribed lines).
Check, calibrate, set alarm limits of all monitors
Check final status of machine.
Vaporizers off
Bag/Vent switch to "bag" mode
APL open
Zero flows on flowmeters
Suction adequate
Breathing system ready