Laryngoscopes are used to perform direct laryngoscopy and
support in tracheal intubation Al-Shaikh&Stacey (2013).  A laryngoscope comes with a small cuff at the
far end for inflation into the trachea E.Martin (2015). The blades can be
curved or straight depending on the patient. The Macintosh blade is mostly used
over the curved blade, miller being the common 
straight style blade being used. Both blades are available in sizes 0 to
4 the Al-Shaikh (2013).  Laryngoscopes
are located into the right side of the mouth making sure the tongue is swept to
the left. The laryngeal inlet can be viewed by the tip of the blade being
inserted into the vallecula lifting the epiglottis J.Shorthouse (2017).


Nasopharyngeal is a device to uphold a patients airway to
relieve upper airway obstruction. It is flexible and curved with a wide end to
stop loss within the nostril J.Shorthouse (2017). The sizes vary, in order to
gain the correct size measuring the patients nostril to the angle of their jaw
needs to be done J.Shorthouse (2017).  Before inserting, lubrication is applied and
the airway is inserted through the nose into the nasopharynx to avoid the
tongue from obstructing the posterior oropharynx J.Shorthouse (2017).

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A guedel is an oropharyngeal airway piece which is used to
uphold a patients airway by avoiding the tongue covering the epiglottis
R.Ireland (2010). A guedel comes in different sizes from new-born to adults, a
size 4 which is for a large adult, a size 3 for medium adults, size 2 for small
adult and a size 1 and under for a child R.Ireland (2010). A guedel is introduced
into the mouth upside down and is then rotated 180° in adults with the
wide part resting firmly against the oral introductory. For infants, it is introduced
the right way up with the tongue held forward using a tongue depressor
R.Ireland (2010).


Laryngeal masks support by keeping a patients airway opened
during anaesthesia or unconsciousness. The average size for adult females is 3
and adult males are mainly 4 or 5  E.Martin (2015). A laryngeal mask has an
airway tube with an oval inflatable cuff at one end for insertion into the
mouth E.Martin (2015).  The laryngeal
mask sits in the hypopharynx at the crossing point amongst the gastrointestinal
and respiratory tracts which is where it produces a low compression closure
around the glottis J.Brimacombe (2008).


Endotracheal tubes are used to protect a patients airway
and can be used for both oral or nasal, they differ in sizes for adult males it’s
8.5-9mm and for adult females is 7.5-8mm. For paediatric patients the sizes
differ depending on the age and weight Al-Shaikh (2013). Endotracheal tubes are
cuffed and uncuffed, air tight seal is present when the cuff is inflated between
the tube and tracheal wall. A pilot balloon exists which specifies if the cuff
has been inflated or not Al-Shaikh (2013). The tube is put into the trachea it’s
shown whether it has been placed in the correct position or not by ensuring the
vocal cords are at the black mark in tubes with one mark or should be amongst
marks if there are two such marks Al-Shaikh (2013).


Ensuring airway equipment is available with a full range working
with spares. These include endotracheal tubes, laryngeal masks, guedel,
nasopharyngeal airways, laryngoscope, catheter mounts, intubation forceps and bougies
Hartle (2012). Equipment may be needed for the management of any unforeseen
difficult airway which should be available and checked. A record needs to be
made of who checked the anaesthetic machine by signing and dating the logbook
to confirm it has been checked Hartle (2012).


to a test lung or bag , ensuring the reservoir bags has no
leaks. Blocking off the patient end and squeezing the reservoir bag should be
done by performing a pressure leak amongst 20-60 cmH2O on the breathing system
Hartle (2012). Vaporisers need to be filled and each need to be accurately
seated on the back bar making sure it’s not slanting and checking for any leaks
by temporarily blocking the common gas outlet Hartle (2012). All vaporises need
to be turned off repeating the test instantly after altering any vaporiser. Ventilators
also need to be checked ensuring the tubing is firmly attached and the controls
should be set for use, confirming an acceptable pressure is being produced during
the inspiratory phase. Disconnection of alarms need to function. Alternatives
to ventilate the patients lungs need to be available so a self-inflating bag
and an oxygen cylinder ensuring both are functioning and the cylinder consists
of a suitable supply of oxygen Hartle (2012). The scavenging system also needs to
function which is done by attaching the tubing to the appropriate exhaust port
of the breathing system Hartle (2012). 

The two bag test is done by attaching the patient end of
the breathing system


primary check on the anaesthetic machine involves
ensuring a workstation and applicable ancillary equipment are connected to the
main electrical supply and all are turned on. Extension leads which are
multi-socket shouldn’t be plugged or used to connect the anaesthetic machine to
the mains supply and backup batteries should be available and charged Hartle
(2012). The next check is a ‘tug test’ where the pipeline hoses are plugged in
individually and cylinders are filled and turned off, ensuring the machine is
connected to a source of oxygen and a suitable supply of oxygen is available
from the oxygen cylinder the accurate pipeline gauge should indicate about 400
kPa Hartle (2012). Each valve on the flowmeters should activate smoothly and
each bobbin should be moving easily without sticking to the gauge. Checking the
anti-hypoxia device is working accurately is another check where the nitrous
oxide rotameter is turned anticlockwise in a precise way until the bobbin
reaches the top of the flow tube, if the link 25 safety system is working
precisely the oxygen flow should have also triggered making sure that there is
at least 25% mixture of the gases Hartle (2012) . Checking the oxygen flush is
working is done by pressing the flush button on the machine. Checking suction
is also a vital part and is done by making sure all the connections are secure and
testing for fast progress of an adequate negative pressure Hartle (2012).


The policies on examination of the anaesthetic equipment
have been issued by the Association of Anaesthetists of Great Britain and
Ireland (AAGBI). According to these guidelines checking the anaesthetic equipment
is the most vital part to safe patient care A.Hartle, E.Anderson, V.Bythell,
L.Gemmell, H.Jones, D.Mclvor, A.Pattinson, P.Sim and I.Walker (2012).

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