Key Basic Plan for Anaesthetists

Ensure that help is on its way so you can focus on managing the patient effectively.

Stop surgery if possible.

Check fresh gas flow and FiO2. (You may need to change vaporiser settings if you alter the fresh gas flow).

Inspect entire breathing system with all the connections and valves.

Confirm reservoir bag/ventilator bellow movement.

Check position of airway device and listen for noise with a stethoscope (including larynx and stomach) to identify anything wrong i.e., leak/obstruction.

Check capnogram shape compatible with patent airway.

Confirm airway device is patent (you may pass suction through the ET tube).

Isolate equipment by ventilating lungs using self-inflating bag connected DIRECTLY to tracheal tube. DO NOT use HME filter, angle piece or catheter mount. If increased pressure manually confirmed, re-connect the machine. If increased pressure NOT manually confirmed, consider problem with machine/circuit/HME/filter/angle piece/catheter mount: check and replace as indicated.

Check chest symmetry, rate, breath sounds, SpO2, measured VTexp, EtCO2.

Feel the airway pressure using reservoir bag and APL valve <3 breaths. Airway 'feel' depends on the APL valve setting and fresh gas flow. You can only 'feel' a maximum of what APL valve is set to. Measured expired tidal volume gives additional information.

Check rate, rhythm, perfusion, re-check BP.

Be vigilant for signs of deterioration such as arrhythmias, hypotension, or bradycardia.

Ensure appropriate depth of anaesthesia, analgesia and neuromuscular blockade.

Identify and assess any surgical problems that could impact patient status.