4.1 Routine anesthesia set up preparation 

Equipment should be checked thoroughly each day and an abbreviated check of all equipment shall be completed before each anesthetic. The incorporation of a system check into the daily routine of setting up for surgery can help early detection of equipment problems and potentially avoid emergencies during anesthesia. Failure to check anesthesia equipment prior to use can lead to patient injury. Checking equipment has also been associated with a decreased risk of severe postoperative morbidity and mortality. The anesthetist should perform the following on daily base 

• Check the function of the components of anesthesia machine and the breathing circuits 
• Set up airway equipment 
Suction (manual and/or electrical) with suction tip [Yankeur (rigid) or flexible] 
Always Have 3 different size ETT for every case 
Diferent size Oral airways and tongue depressor 
Have 2 laryngoscope handles: with different types & size blades, check light & bulbs 
Make preparation for difficult air way and other emergency events 

• Get all monitoring equipment ready including temperature 
• Tape and or lubricating agent for eye 
• Means of warming the patient/ maintain room temperature comfortable for the patient: 

Check room temperature and humidity: Humidity and temperature levels are adjusted in accordance with relevant standards and clinical procedure. The temperature and the humidity play a very important role in maintaining staff and patient comfort. In low humidity there is a danger of the production of electrostatic sparks. The temperature in the operating theatre and anesthetic room should be sufficiently high to minimize the risk of inducing hypothermia in the patient, but must be comfortable for theatre staff. The patient may develop hypothermia at an ambient temperature of less than 21°C. Temperatures of 24°C are usually acceptable in the operating room, with a relative humidity of 50-60%; a higher environmental temperature is required during surgery in the neonate or infant. 

• Safe electric power out let and light intensity: 

The overhead operating room lights should design to provide a range of intensity. They should be freely movable, shadow less and less heat emitting and easy to adjust. A high level of illumination is required over the operating table, and ceiling-mounted lamps are standard; it is preferable if they can be positioned directly by the surgeon. The intensity and color temperature of general lighting are very important to the anesthetist, as appreciation of skin color is affected by the spectrum of the source of illumination. The spectrum provided by lighting tubes should be similar to that of day light. A spot light should be available if increased illumination is required for specific procedures. 

• Get your drugs & equipments ready (medication drawn and labeled by your own allways) 
Induction (Ketamine, thiopentone, etomidate, propofol…) 
The vaporizer filled with halothane, … 
Narcotics (Pethedine, morphine, fentanyl,...)
Muscle relaxants (depolarizing and non depolarizing muscle relaxants) 
Presser drugs (ephedrine, epinephrine, phenylephrine…) 
Obstetric drugs(oxytocin, ergometrin...) 
Anticholinergics and reversal (Atropine, glycopyrrolate, neostigmine,…) 
Adjuvant e.g., lidocaine, Hydrocortisone, 40% Glucose, Diazepam) 
Intravenous fluids including cross matched blood if necessary 
Sufficient oxygen source 
Different sizes of syringes with needle, intravenous and transfusion set 
Fluid pumper 
Fluid warmer 
Suction machine and suction tubes 
NGT 
Spinal sets 
Antiseptic solutions 
Airway adjuvants 

• Check with the OR staff (techs and nurses) prior to bringing the patient in the room. Getting along well with the staff is crucial and is part of the core clinical competency of Professionalism. 
• If the patient is to have a regional anesthesia or other procedure prior to surgery, make arrangements for general anesthesia and resuscitation. 
• Immediately prior to aneastesia, identify the patient, check allergy, availablty/necessity of crossmatched blood and NPO status, proposed operation, and any change in the patient’s health.