Anesthesia Workstation, by Drs.
Kelly and Stephen Heape.
Healthcare workers in all healthcare settings should always adhere to the latest World Health
Organization guidelines on hand hygiene and barrier precautions before and after contact
with a patient, bodily fluids, or patient surroundings.
For more information, please watch our video entitled Hand Hygiene.
Hi.
I'm Dr. Stephen Heape.
And I'm Dr. Kelly Price.
Today, this video will describe the recommended setup for your anesthesia workstation prior
to intubation or induction of general anesthesia of a child.
Introduction.
Today, we will be using the mnemonic SOAPM.
S-O-A-P-M.
S standing for suction, O for oxygen, A for airway, P for pharmacy, and M for machine.
These are all essential components to your anesthesia workstation setup, and should be
checked and verified immediately prior to intubation induction of general anesthesia.
Suction.
Suction is an essential piece of equipment that must be immediately available.
Aspiration is always a major concern and the ability to manage secretions is key in successful
airway management.
Vacuum source must be located and verified to be functional.
Tubing connected to the source should be inspected for obvious defects, leaks, obstructions,
or kinks.
Tubing must be of sufficient length to reach the patient with enough slack to manipulate
freely.
Appropriate suction device, such as Yankauer suction tip or soft suction catheter is connected
to the end of the tubing and must be kept in immediate reach of the provider.
Manual verification of functioning suction should always be performed.
Oxygen.
Immediate availability of oxygen is critical in preparing for intubation and induction
of general anesthesia.
Oxygen is supplied to the anesthesia machine by a central source.
Functioning of the central source can be assessed by reading the pipeline oxygen pressure display
on the anesthesia machine.
A backup source of oxygen in this setting is located on the back of the anesthesia machine
in an E cylinder.
This should be opened briefly to verify sufficient oxygen pressure in the backup tank.
Oxygen E cylinder pressures should be at least 1,000 psi, indicating the cylinder is at least
half full.
No matter what setting you're practicing in, oxygen supply must be identified and checked
for sufficient amount.
Ideally, a backup source of oxygen should be immediately available and verified, particularly
if an oxygen concentrator is the primary source of oxygen.
It is essential to have sufficient length of oxygen tubing to reach the patient from
a secondary source of oxygen.
Airway.
Airway equipment, including noninvasive ventilation equipment, laryngoscopes, endotracheal tubes,
laryngeal mask airways, and other backup airway devices must be checked immediately prior
to intubation and induction of general anesthesia.
Ambu-bag or Mapleson Circuit must be available and inspected for proper function.
Oral and/or nasal airways appropriately sized for your patient should be available.
Oral and nasal airway size can be approximated by comparing the device to the length between
the patient's mouth or nose and the angle of the jaw.
Laryngoscopes must be checked to ensure proper functioning of light source.
A blade one size smaller and one size larger should also be available.
An endotracheal tube of the appropriate size must be available and inspected for defects
and functioning of the cuff.
Endotracheal tube size can be estimated by age divided by 4 plus 4.
Cuffed endotracheal tubes should be sized one half size smaller.
Endotracheal tubes one size smaller and one size larger should also be available at the
time of induction and intubation.
Laryngeal mask airways or other supraglottic airway devices may be considered in some cases
and should be available for emergency airway management.
An appropriately sized laryngeal mask airway should be selected based on age, weight, and
clinical judgment.
If difficult airway is anticipated, consider availability of additional equipment, including
an endotracheal tube introducer, fiber optic scope, or other equipment available at your
institution.
Point of clarification-- it is important to be aware of the location of the difficult
airway cart in your operating room suite.
Pharmacy.
Drugs should be available for induction of anesthesia, vasopressors or inotropes, and
atropine to support hemodynamics, as well as neuromuscular blocking agents to facilitate
endotracheal intubation or to treat laryngospasm.
Appropriately selected antibiotics should be available in the operating room prior to
incision.
In addition, syringes and needles should be prepared for drawing up and administering
in medication.
Machine.
Assuming a complete anesthesia machine check out has been performed within the previous
24 hours, it is prudent to briefly verify the functioning of the anesthesia machine,
confirming oxygen delivery and the ability to deliver and release positive pressure ventilation.
Availability and inspection of standard ASA monitors must also be performed.
Temperature, blood pressure monitoring with a noninvasive blood pressure cuff appropriately
sized for your patient, EKG monitoring, pulse oximetry, and end-tidal co2.
So materials to secure intravenous access must also be immediately available.
These include tape, alcohol prep pads, tourniquet, an appropriately sized IV catheter, materials
for ensuring normothermia, including blankets, a forced air warming device, or a plastic
wrap.
Point of clarification.
It is important to be aware of the location of the resuscitation card, including the defibrillator,
in your operating room suite.
We have reviewed the basic set up for your anesthesia workstation prior to induction
of general anesthesia in a child.
These include suction, oxygen, airway, pharmacy, and machine, easily remembered by the mnemonic
SOAPM.
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