FACILITIES AND EQUIPMENT

Many features of non-operating room anesthetizing locations may render delivery of quality anesthetic care difficult. Such features include the impact of the physical layout of the facility on delivery of care, unfamiliar anesthetic equipment, the anesthetic implications of the procedure performed, the remoteness of available assistance, and personnel less familiar than the usual personnel in the operating suite with the anesthetic aspects of patient care.

Anesthetizing locations outside the operating suite are frequently designed for their primary role, with provision for the requirements of anesthesia being a seeming after-thought. Access to the patient for anesthetic care is hampered by diagnostic and therapeutic equipment such as C-arms, other angiographic equipment, ultrasound machines, and other devices. Space for anesthesia equipment and drugs may be limited and not conveniently located. Advance planning and communication with involved personnel are key to providing safe anesthetic care to the patient in such locations.

Piped-in gases, suction, and isolated power are not always available in non-operating room anesthetizing locations. Anesthesia personnel must be familiar with the gas cylinder supply for anesthesia machines. The machines themselves may be older models relegated from the operating suite to areas where their use is less frequent. The ASA has developed Guidelines for Determining Anesthesia Machine Obsolescence.^[5] These guidelines have not been reviewed or approved as a practice parameter, but they are practical, instructive, and worthy of review. Briefly, the anesthesia machine should have essential safety features such as a minimum gas ratio device and oxygen failure alarm, not have unacceptable features such as measured flow vaporizers, and be able to be maintained and serviced. Anesthesia machines that do not meet these standards should not be used in any anesthetizing location. Anesthesia personnel must perform standard machine checks before delivering anesthesia and should be familiar with the operation of the machine, which may be quite different from the familiar operating room anesthesia machines. Ideally, the familiarization and machine checks should be performed before the procedure. Grounded power outlets are a minimum electrical requirement.