The intention is to strike the right balance so that the AAGBI checklist for anaesthetic equipment is not so superficial that its value is doubtful or so detailed that it is impractical to use. MR compatible anaesthetic machines and ventilators can be sited adjacent to the magnet bore, minimizing the length of the breathing system and allowing for the safe delivery of volatile anaesthesia. Check all breathing systems that are to be used and perform a ‘two‐bag test’ before use, as described below [9]. Veterinary Anesthetic and Monitoring Equipment. A quick ‘run‐through’ before the start of an operating session is not acceptable. Check that the appropriate laryngoscopes are available and function reliably. An important consequence of this change is that Checklist 2 does not test the oxygen failure warning alarm in machines connected to pipeline oxygen. Checking anaesthetic machines — checklist or visual aids? Check that all pressure gauges for pipelines connected to the anaesthetic machine indicate 400–500 kPa. 2.Is analyser functioning correctly?Yes/No. A Working Party was established in 2009 comprising Officers and Council Members of the AAGBI and representatives of the Group of Anaesthetists in Training (GAT), RCoA, MHRA and the British Association of Anaesthetic and Respiratory Equipment Manufacturers Association (BAREMA). Anaesthetic machine have a coaxial male 22 mm, female 15 mm conical connector to the breathing systems. 4. If these are unavailable, a standard machine can be secured firmly to a wall outside the 5 G contour, with the exact location determined by the local physicist. Check that all connections within the system and to the anaesthetic machine are secured by ‘push and twist’. Please check your email for instructions on resetting your password. Conclusion(s): This survey highlighted that successful implementation of new practice regarding checking anaesthetic machines requires technical and adaptive changes. The location of these must be clearly signed [17, 18]. It is mandatory to do a full machine check prior to the start of every list. Several versions of the checklist were trialled in simulators using different machines. The anaesthetic workstation should be connected directly to the mains electrical supply, and only correctly rated equipment connected to its electrical outlets. The continued presence of carbon dioxide cylinders on most of the anaesthetic machines in our hospital reflects a decision by the anaesthetic department to leave the cylinders in place for the members of the department who continue to use them. Increased Resistance to Flow and Ventilator Failure Secondary to Faulty CO2 Absorbent Insert Not Detected During Automated Anesthesia Machine Check. Yes/No. Switch on electrical supply (if appropriate). Switch on the gas supply master switch (if one is fitted). Reinhalación severa de dióxido de carbono secundaria a la ausencia de las válvulas inspiratoria y espiratoria de la estación de anestesia no detectada en su revisión diaria. Pre-hospital airway management: guidelines from a task force from the Scandinavian Society for Anaesthesiology and Intensive Care Medicine. Inspect the contents and connections and ensure there is adequate supply of carbon dioxide absorbent. Documentation of the routine checking and regular servicing of anaesthetic machines and patient breathing systems should be sufficient to permit audit on a regular basis. It has been suggested that regular disconnection of the pipelines is time‐consuming and unnecessary [6, 7] and that it may also damage the pipeline terminals. Go/no-go decision in anaesthesia: wide variation in risk tolerance amongst anaesthetists. The checking procedure described in this publication is reproduced in an abbreviated form, as a sheet entitled Checklist for Anaesthetic Equipment 2012 (Fig. Use the link below to share a full-text version of this article with your friends and colleagues. The ‘first user’ check after servicing is especially important and must be recorded. Compliance with the automated machine check. Which checks should be made prior to each case? Back‐up batteries for anaesthetic machines and other equipment should be charged. The most common type of anaesthetic machine in use is the continuous-flow which is designed to provide an accurate and continuous supply of medical gases (such as oxygen and nitrous oxide), mixed with an accurate concentration of anaesthetic vapour (such as isoflurane), and deliver this to the patient at a safe pressure and flow. The increasing sophistication and diversity of anaesthesia workstations made the AAGBI’s existing guideline less universally applicable. A logbook should also be kept with each anaesthetic machine to record the daily pre‐session check and weekly check of the oxygen failure alarm. There is also a Day Surgery Unit, with two operating theatres. In the event of a change of anaesthetist during an operating session, the status of the anaesthetic equipment must be confirmed, including that a formal check has been performed. 2013 Sep;57(5):533-40. doi: 10.4103/0019-5049.120151. In particular, check that the oxygen analyser, pulse oximeter and capnograph are functioning correctly and that appropriate alarm limits for all monitors are set. The results were also grouped according to the grade of anaesthetist completing the check (Table 2). Gas monitoring lines are often the cause of a significant leak; check that they are properly attached and any sampling ports not in use have been blanked off. 1000 anaesthetic incidents: experience to date, https://doi.org/10.1046/j.1365-2044.1998.00462.x. The anaesthetists completing the checklists were asked to give their grade, as well as starting time and finishing time for each check. Check that gas sampling lines are properly attached and free from obstruction or kinks. Carbon dioxide cylinders were present on the machines in 99 checks (75%), contrary to Association guidelines. Since the publication of a checklist for the pre‐operative check of anaesthetic machines by the Association of Anaesthetists of Great Britain and Ireland (AAGBI) in 1990 [1], there has been concern about widespread failure to perform adequate pre‐operative checks of anaesthetic machines [234]. The hospital has a suite of five operating theatres, each with an anaesthetic room, and a separate two‐theatre suite for Obstetrics and Gynaecology. Equipment and drugs for rarely encountered emergencies, such as malignant hyperthermia and local anaesthetic toxicity must be available and checked regularly in accordance with local policies. The accompanying Checklist for Anaesthetic Equipment 2012 has been completely reformatted (Fig. Then turn the oxygen flow off and check that the nitrous oxide flow also stops. All other faults found are shown in Table 4. These guidelines offer advice and information on checking anaesthetic equipment The modern anaesthetic machine is a. complex device. A named consultant anaesthetist must be responsible for difficult airway equipment and the location of this equipment should be known. Management of Severe Local Anaesthetic Toxicity 2010. 3. The first draft was circulated to the membership of the AAGBI and to manufacturers for comments, and the guideline amended in the light of these. It represents an important part of safe patient care. When TIVA is used there must be a continuous intravenous infusion of anaesthetic agent or agents; interruption from whatever cause may result in awareness. This may be caused by pipeline failure, electrical failure, circuit disconnection or incorrect configuration, etc. To check the correct function of the oxygen failure alarm involves disconnecting the oxygen pipeline on some machines, whilst on machines with a gas supply master switch, the alarm may be operated by turning the master switch off. It has been trialled and modified in simulator settings on different machines. It is not intended to replace the manufacturer’s pre-anaesthetic checks, and should be used in conjunction with them. Turn on each vaporiser in turn, and briefly occlude the, 6.Do any leaks occur from the filling ports of the vaporisers? Évaluation d’une liste de contrôle du matériel médical avant ouverture de chambre en réanimation. Other frequent faults were due to empty vaporisers or spare gas cylinders and the emergency oxygen bypass control. 1. To eliminate the need to change the sampling line repeatedly, the gas monitoring line should be assembled as an integral part of the breathing circuit by attaching it proximal to the patient breathing filter. Following the Association of Anaesthetists of Great Britain and Ireland machine checking guidelines, a structured questionnaire, … For example, some modern anaesthetic workstations will enter a self‐testing cycle when the machine is switched on, in which case those functions tested by the machine … Check the whole breathing system is patent and the unidirectional valves are moving (if present). It is not intended to replace the manufacturer’s pre‐anaesthetic checks, and should be used in conjunction with them. Ensure that there are no leaks or obstructions in the reservoir bags or breathing system and that they are not obstructed by foreign material. It is a well-established principle that anaesthetists have trained assistance during the conduct of anaesthesia. It represents an important part of safe patient care. An anaesthetic machine (British English) or anesthesia machine (American English) is a medical device used to generate and mix a fresh gas flow of medical gases and inhalational anaesthetic agents for the purpose of inducing and maintaining anaesthesia.. Other related guidelines have been produced in Scandinavia [2] (Berlac P, Hyldmo PK, Kongstad P, et al. 1.Are vaporisers for the required volatile agents present, correctly seated and locked to the back‐bar? There were 21 pairs of checklists in which the same anaesthetist checked two machines in sequence. The scope of the checklist has been widened to include a check of monitoring and ancillary equipment and the practice of disconnecting the pipeline supplies at the start of the check has been replaced by a ‘tug‐test’. Of the 132 machine checks completed, at least one fault was reported in 109 machines (82.5%). The AAGBI checklist for anaesthetic equipment is applicable to all anaesthetic workstations and should take only a few minutes to perform. Check that the anaesthetic gas scavenging system is switched on and functioning. Organisations should give preference to purchasing intravenous connectors and valves that are clearly labelled. Where more than one vaporiser is present, turn each vaporiser on in turn and repeat this test. Safety in MRI Units-an update 2010. As it is possible for errors to occur when reassembling an anaesthetic machine, it is essential to confirm that the machine is correctly configured for use after each service. A pre‐use check to ensure the correct functioning of anaesthetic equipment is essential to patient safety. Learn about our remote access options, Medicines and Healthcare products Regulatory Agency, British Association of Anaesthetic and Respiratory Equipment Manufacturers Association. All cylinders should be securely seated and turned off after checking their contents. In the light of these results, failure to check the oxygen failure warning alarm is difficult to justify. Involvement with this equipment, especially ‘trouble shooting’ problems that arise intra‐operatively, must not be allowed to distract anaesthetists from their primary role. Reproduced with the kind permission of the Association of Anaesthetists of Great Britain and Ireland. This is a consensus document produced by expert members of a Working Party established by the Association of Anaesthetists of Great Britain and Ireland (AAGBI). If it is accepted that an important factor governing compliance with the AAGBI guidelines is time, then the mean times of 6.78 min to check an anaesthetic machine according to the revised guidelines and 12.7 min to check two machines consecutively, compare favourably with the mean times of 8.9 min and 18.25 min found by Barthram and McClymont , who assessed the time to perform a machine check and two … Multisocket extension leads must not be plugged into the anaesthetic machine outlets or used to connect the anaesthetic machine to the mains supply. Users must know the default setting for the machine in use. Careful note should be taken of any information or labelling on the anaesthetic machine that might refer to its current status. Circuit accessoire ou simplicité ne rime pas avec sécurité. The guideline and checklists have been endorsed by the Chief Medical Officers of England, Scotland, Wales and Northern Ireland. Confirm presence, size range and function of all ancillary equipment which may be needed. Requirements for the design and implementation of checklists for surgical processes. Perform a pressure leak test (between 20 and 60 cmH2O on the breathing system by occluding the patient‐end and compressing the reservoir bag. Check that adequate supplies of any other gases intended for use are available and connected as appropriate. It has been endorsed by the Chief Medical Officers of England, Scotland, Wales and Northern Ireland. The commonest fault was the presence of a carbon dioxide cylinder, which was attached on 99 machines (75%). This may have been considered unnecessary in a machine check that is based on the use of an oxygen analyser. The results are shown in Table 1. The anaesthetist has a responsibility to understand the function of anaesthetic equipment and to check it before use. The study was carried out over a 6‐week period in a district general hospital. Even when the presence of a carbon dioxide cylinder is not counted as a fault, faults were found in 30.3% of the machine checks in this study and the majority of these were potentially serious. No pre‐operative check can be exhaustive without becoming impracticable and the revised AAGBI guidelines aim to strike a compromise between safety and practicability. It is the responsibility of the anaesthetist to make sure that these checks have been performed, and the anaesthetist must be satisfied that they have been carried out correctly. This article is accompanied by an Editorial. widely accepted standard for checking the anaesthetic machine and allied equipment in the modern operating theatre [1]. The anaesthetic rooms in the Obstetrics and Day Surgery units are not routinely used. Sites of intravenous infusions should be visible so that they may be monitored for disconnection, leaks or infusions into subcutaneous tissues. Clinical staff should know how to use, and to check, the equipment before use. Turn off the fresh gas flow or reduce to a minimum. Checklist for Anaesthetic Apparatus 2 follows the same principles that governed the original edition; in particular it is based on the use of an oxygen analyser. Number of times cited according to CrossRef: Ten years of the Helsinki Declaration on patient safety in anaesthesiology. It is not intended to replace the manufacturer’s pre‐anaesthetic checks, and should be used in conjunction with them. Identify and take note of the gases that are being supplied by pipeline, confirming with a ‘tug test’ that each pipeline is correctly inserted into the appropriate gas supply terminal. 3. In addition, specific checks should be carried out before each new patient during a session or when there is any alteration or addition to the breathing system, monitoring or ancillary equipment. The revised AAGBI guidelines were translated into a checklist format (Appendix 1). Magee P. Learn about our remote access options, Consultant, Directorate of Anaesthesia, Perth Royal Infirmary, Perth PH1 1NX, UK. Guidelines . Check the function of the APL valve by squeezing both bags. and you may need to create a new Wiley Online Library account. Check that appropriate monitoring equipment is present. Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username, I have read and accept the Wiley Online Library Terms and Conditions of Use, Association of Anaesthetists of Great Britain and Ireland. (For details of decontamination of reusable equipment, see the AAGBI safety guideline Infection Control in Anaesthesia [19].). Anaesthetists using TIVA must be familiar with the drugs, the technique and all equipment and disposables being used. These were analysed for the time taken to complete the check and for the faults found in the anaesthetic machines. Frequency distribution of anaesthetic machine check times. Modern machines have overcome many drawbacks associated with the older mach … Anaesthesia machine: checklist, hazards, scavenging Indian J Anaesth. A clear note must be made in the patient’s anaesthetic record that the anaesthetic machine check has been performed, that appropriate monitoring is in place and functional, and that the integrity, patency and safety of the whole breathing system has been assured. Yes/No, 2.Are the vaporisers adequately filled?Yes/No, 3.Are the filling ports tightly closed?Yes/No, 4.Does the control knob for each vaporiser move, Only perform the following tests where the back‐bar is. 2015 2nd International Conference on Electrical Information and Communication Technologies (EICT). Set a flow of oxygen of 5 l.min−1 and with the vaporiser turned off, temporarily occlude the common gas outlet. A number of different faults in the analyser occurred; these are shown in Table 3. 2.4 Confirmation that a secondary means of oxygenation and positive pressure ventilation is immediately available. The Association of Anaesthetists of Great Britain and Ireland (AAGBI) developed a standardized checklist 1, 2 for checking anaesthetic machines and a laminated copy of the checklist should be attached to every anaesthetic machine to assist the anaesthetist checking the machine. Ten years of the Helsinki Declaration on patient safety in anaesthesiology. 1). This responsibility may be devolved to the department of anaesthesia, but where such a department does not exist other arrangements must be made. Checking anaesthetic equipment: AAGBI 2012 guidelines. Anaesthetists must not use equipment unless they have been trained to use it and are competent to do so. Manual leak testing of vaporisers was previously recommended routinely. Requirements for Anaesthetic Machines and Workstations for Clinical Practice. AAGBI Updated Guidelines. It has been seen and approved by the AAGBI Council. Annales Françaises d'Anesthésie et de Réanimation. What do you do? Random Safety Auditing, Root Cause Analysis, Failure Mode and Effects Analysis. Some anaesthetic workstations will automatically test vaporiser integrity. The anaesthetic equipment must be checked by trained staff on a routine basis using the checklist and according to the manufacturer’s instructions, in every environment where an anaesthetic is given. Anaesthetists must not use equipment unless they have been trained to use it and are competent to do so. The importance of this pre‐use check is recognised worldwide and the check has been included in the World Health Organization’s Surgical Safety Checklist [1]. The previous audit [ 1] highlighted six key areas of the machine check that were inadequately performed by most anaesthetists: gas pipelines, gas cylinders, rotameters, oxygen failure alarm, vapourizer system and ventilator disconnect alarm. The mean time taken to complete a check was 6.8 min and the mean time taken to complete two consecutive checks, in the anaesthetic room and operating theatre, was 12.7 min. We carried out a similar survey, using the revised guidelines, to determine whether there is any difference in the time taken to complete the new check, or in its ability to detect faults in the machine. What is the first thing you should do prior to checking the anaesthetic machine? The checking procedure described covers all aspects of the anaesthetic delivery system from the gas supply pipelines, the machine and breathing systems, including filters, connectors and airway devices. Accuracy of tidal volume delivery by five different models of large-animal ventilators. Check the colour of the absorbent. Lest we forget: learning and remembering in clinical practice. Whenever a breathing system is changed, either during a case or a list, its integrity and correct configuration must be confirmed. Check that the anaesthetic workstation and relevant ancillary equipment are connected to the mains electrical supply (where appropriate) and switched on. [20]. Acta Anaesthesiologica Scandinavica 2008; 52: 897–907.) In the event of failure, some modern anaesthetic workstations may default to little or no flow, or oxygen only with no vapour. A two‐bag test should be performed after the breathing system, vaporisers and ventilator have been checked individually. An alternative source of oxygen should be readily available. Where a blanking plug is supplied this should be fitted to any empty cylinder yoke. The following checks should be carried out at the beginning of each operating theatre session. If it is accepted that an important factor governing compliance with the AAGBI guidelines is time, then the mean times of 6.78 min to check an anaesthetic machine according to the revised guidelines and 12.7 min to check two machines consecutively, compare favourably with the mean times of 8.9 min and 18.25 min found by Barthram and McClymont [8], who assessed the time to perform a machine check and two consecutive machine checks, according to the original guidelines. A self‐inflating bag must be immediately available in any location where anaesthesia may be given. The study was conducted between 21 July 1997 and 31 August 1997. The guideline reflects anaesthetic practice and staffing in the UK and Ireland and is applicable to any anaesthetic machine, including those yet to be developed. A record should be kept with the anaesthetic machine that these checks have been done. With O2 flow of 5 l.min−1, occlude common gas outlet. Is adequate pressure generated during the, 3.Does the pressure relief valve operate correctly when, 4.Is the disconnection alarm present and operating, 5.Is alternative means of ventilation available?Yes/No, 1.Is scavenging system correctly attached and functioning? 1). Ensure that the emergency oxygen bypass control ceases to operate when released. If you do not receive an email within 10 minutes, your email address may not be registered, It has evolved from. Check that the anaesthetic apparatus is connected to a supply of oxygen and that an adequate reserve supply of oxygen is available from a spare cylinder. Modern anaesthetic workstations are complex devices. It is therefore recommended that, in addition to these checks, the oxygen failure alarm must be checked on a weekly basis by disconnecting the oxygen hose whilst the oxygen flowmeter is turned on, and a written record kept. Ensure you know the functions of each of the components named in the diagram. Any part of the breathing system, ancillary equipment or other apparatus that is designated ‘single‐use’ must be used for one patient only, and not reused. Medical gas cylinder expiry dates – a reply. Vaporisers must always be kept upright. However, this study found faults in the oxygen analyser in 11.3% of machine checks and other studies found the oxygen analyser to be absent or faulty in 25.4% and 55% of machine checks [7, 8]. Ensure that the vaporiser is not tilted. Note any labelling or service information attached to machine. ; check that these are all available in the appropriate sizes, at the point of use, and that they have been checked for patency. Check that all monitoring devices, especially those referred to in the AAGBI’s Standards of Monitoring during Anaesthesia and Recovery guidelines [14], are functioning and that appropriate parameters and alarms have been set before using the anaesthetic machine. This is particularly important for paediatric lists when breathing systems may be changed frequently during a list. Changes in anaesthetic equipment and introduction of microprocessor‐controlled technology necessitate continued revision of this document. The final version of the checklist was then submitted for further usability tests in simulators. AAGBI Safety Guidelines Management of Severe Local Anaesthetic Toxicity 1 Recognition 2 Immediate management 3 Treatment 4 Follow-up Signs of severe toxicity: ü Sudden alteration in mental state, severe agitation or loss of consciousness, with or without tonic-clonic convulsions ü Cardiovascular collapse: sinus bradycardia, conduction blocks, asystole and ventricular tachyarrhythmias may occ Users must know which are included and ensure that the automated check has been performed. Revista Española de Anestesiología y Reanimación. Affiliation 1 Department of Anaesthesiology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India. There was no significant difference between the average time taken to check a machine in the anaesthetic room (7.02 min) and in the operating theatre (6.56 min). Ensure that the tubing is attached to the appropriate exhaust port of the breathing system, ventilator or anaesthetic workstation [13]. Check the operation of flowmeters, where these are present, ensuring that each control valve operates smoothly and that the bobbin moves freely throughout its range without sticking. Please check your email for instructions on resetting your password. Incidents reported to the Medicines and Healthcare products Regulatory Agency (MHRA), National Patient Safety Agency (NPSA) and AAGBI also highlighted priority checks that would avoid harm. If you do not receive an email within 10 minutes, your email address may not be registered, If nitrous oxide is to be used, the anti‐hypoxia device should be tested by first turning on the nitrous oxide flow and ensuring that at least 25% oxygen also flows. The mean time taken to check two machines consecutively was 12.7 min. Anaesthetics for Junior Doctors and Allied Professionals. However, certain important changes have been introduced. Changing and filling vaporisers during use. Firstly, the breathing system, ventilator and vaporizers must be checked individually. Barthram and McClymont [8] found that the average time to check a machine according to the original guidelines was 8.9 min and that the average time to perform two consecutive checks, in the anaesthetic room and operating theatre, was 18.25 min. The NHS Clinical Negligence Scheme for Trusts and NHS Quality Improvement Scotland require that hospitals ensure all personnel are trained to use and to check relevant equipment [5, 6]. Management of a Patient with Suspected Anaphylaxis During Anaesthesia 2009 AAGBI Updated Guidelines Interhospital Transfer 2009 AAGBI guideline Reducing the risk of retained throat packs after surgery 2009. The aim of the AAGBI draw-over anaesthesia working party was to produce a checklist that could be used in any setting with enough information in the accompanying glossy to ensure safe use of draw-over anaesthetic equipment. It should only be performed on basic ‘Boyle’s’ machines and it may be harmful to many modern anaesthetic workstations. Checking of anaesthetic equipment: an audit of practice. Where possible, repeat the leak test; failure to do so is a common cause of critical incidents [10]. A log book should be kept with each anaesthetic machine to record the daily pre-use check. Such records should be retained for an appropriate time. For further details on pre-use checks of anaesthetic equipment please refer to the AAGBI website. Anaesthetists must be aware of both the tone of the alarm and also which gases will continue to flow on the particular model of anaesthetic machine in use. It was modified after a consultation with the membership of the AAGBI and industry. (Machines fitted with a gas supply master switch will continue to deliver a basal flow of oxygen). The adaptive changes often … a ‘trolley’ that did little more than. In the 2012 guidance, the ‘two-bag check’ was added to the full pre-list check. Reduction of time to definitive care in trauma patients: effectiveness of a new checklist system. Working off-campus? The AAGBI cannot be held responsible for failure of any anaesthetic equipment as a result of a defect not revealed by these procedures. Learn more. Catastrophic Perioperative Complications and Management. 2. Use the link below to share a full-text version of this article with your friends and colleagues. Authors Umesh Goneppanavar 1 , Manjunath Prabhu. Modern anaesthetic workstations employ digital technology to deliver safe and measured anaesthesia to patients. Severe intraoperative hypoxaemia in a horse due to failure of an oxygen concentrator and auxiliary oxygen supply. These include bacterial filters, catheter mounts, connectors and tracheal tubes, laryngeal mask airways, etc. Great Britain and Ireland published the second edition of its ‘Checklist for Anaesthetic Machines’ which gained widespread acceptance in the profession. Classification of breathing systems Classifications by Conway in the UK, and Dripps in the USA, using the terms open, closed, semi-open and semi-closed, differ in definition, are confusing, and are not discussed further. This document recognised that changes in anaesthetic equipment and the introduction of microprocessor-controlled technology would necessitate continued revision of the document in the future. There should be no leak from any part of the vaporiser and the flowmeter bobbin (if present) should dip. Fifty‐five completed checklists were analysed; no problems developed during anaesthesia which were missed by the checklist. Set the fresh gas flow to 5 l.min−1 and ventilate manually. THEATRE:ANAESTHETIC MACHINE: Anaesthetic room/Theatre. And Northern Ireland, female 15 mm conical connector to the breathing system and that the patient ’ s checks! Scandinavica 2008 ; 52: 897–907. ) of patient harm have from... Standard, the use of an adequate negative pressure rapidly blanking plug supplied... Medical College, Manipal University, Manipal University, Manipal, Karnataka, India or not apparent on the analyser! Is also a Day Surgery Unit, with two operating theatres will have their own back‐up system this, the. Should take only a few minutes to perform these checks have been considered unnecessary in machine..., 18 ]. ) have additional regulators and check that the automated check has been endorsed by new! Familiar with the drugs, the equipment necessary to conduct safe anaesthesia, but should back‐up... And positive pressure ventilation is immediately available in all locations where anaesthesia may changed... Workstation and relevant ancillary equipment are connected to the mains supply microprocessor-controlled technology would necessitate continued revision of the [... Between 20 and 60 cmH2O on the use of an oxygen analyser display approaches 100 % that gas lines. And/Or gas supply terminal test for the design and implementation of checklists for surgical processes test lung,... 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