02/21/2025
COCKPIT DRILL: A SAFE ANAESTHESIA PRACTICES
COCKPIT DRILL: An Advanced Safe Anaesthesia Practice
Introduction
The Cockpit Drill in anaesthesia is a structured pre-induction checklist designed to enhance patient safety, optimize workflow, and minimize human error. This approach mirrors aviation pre-flight procedures, ensuring readiness for both routine and high-risk cases. Advanced anaesthesia safety practices involve thorough equipment checks, comprehensive patient assessment, and proactive emergency preparedness.
1. PATIENT ASSESSMENT & OPTIMIZATION
- Patient Identification & Procedure Confirmation – Verify patient identity, surgical site, and consent in line with WHO Surgical Safety Checklist.
- Preoperative Risk Stratification:
Airway: Mallampati score, thyromental distance, neck mobility.
Cardiovascular: Hypertension, arrhythmias, ischemic heart disease.
Respiratory: Obstructive sleep apnoea, COPD, asthma.
Coagulation Status: Bleeding risk, anticoagulant therapy.
- Optimisation of Medical Conditions:
Diabetes, renal failure, liver disease, anemia.
Pre-medications as per ASA guidelines.
2. AIRWAY & BREATHING: ENSURING AIRWAY SECURITY
- Detailed Airway Assessment – Identify potential difficult airway predictors and plan for alternatives.
- Airway Equipment Readiness:
Standard: Laryngoscope, endotracheal tubes, supraglottic airway (LMA).
Advanced: Video laryngoscope, fiberoptic bronchoscope, bougie, cricothyrotomy kit.
- Suction System Check – Ensure readiness in case of regurgitation or difficult intubation.
- Ventilation System:
Verify functional oxygen supply & backup cylinders.
Test circuit integrity & confirm ventilator settings.
3. ANAESTHESIA MACHINE CHECK: FUNCTIONAL SAFETY VERIFICATION
- Pre-use Machine Self-Test – Perform a full system check, including:
Oxygen, nitrous oxide, air flowmeter functionality.
Vaporiser levels (sevoflurane, isoflurane, desflurane).
Leak test of circuit & tubing.
- Scavenging System Check – Confirm proper waste gas removal to prevent OR pollution.
- Manual & Mechanical Ventilation Check – Ensure both modes function correctly.
4. ADVANCED MONITORING SETUP
- Standard ASA/AAGBI Monitoring:
ECG – Detect arrhythmias, ischemia.
Pulse Oximetry – Ensure continuous SpO₂ monitoring.
Non-Invasive Blood Pressure (NIBP) – Baseline BP measurement.
Capnography (EtCO₂) – Confirm airway patency and ventilation adequacy.
- Invasive Monitoring (For High-Risk Patients):
Arterial Line – Real-time BP monitoring.
Central Venous Pressure (CVP) Monitoring – Fluid management & vasopressor guidance.
- Neuromuscular Monitoring (For Paralysis Management).
5. INTRAVENOUS ACCESS & DRUG PREPARATION
- Secure IV Access:
Minimum one large-bore cannula (16G or 18G).
Additional lines for major surgeries or unstable patients.
- Ensure All Anaesthetic Drugs Are Prepared:
Induction Agents: Propofol, etomidate, ketamine.
Neuromuscular Blockers: Succinylcholine, rocuronium, atracurium.
Opioids & Analgesia: Fentanyl, remifentanil, paracetamol.
Emergency Drugs: Atropine, ephedrine, phenylephrine, adrenaline, naloxone, sugammadex.
- Confirm Dose Calculation & Syringe Labeling to Prevent Drug Errors.
6. CRISIS PREPARATION & EMERGENCY EQUIPMENT CHECK
- Difficult Airway Cart Available:
Video laryngoscope, fiberoptic bronchoscope, LMA, cricothyrotomy kit.
- Defibrillator & Emergency Drugs Ready:
Resuscitation trolley accessible in case of cardiac arrest or anaphylaxis.
- Massive Transfusion Protocol (MTP) Ready for High-Risk Cases.
- Ensure Anaphylaxis, Malignant Hyperthermia (MH) Management Plan.
7. FINAL TEAM BRIEFING & SAFETY CHECKS
- Confirm Surgical Plan, Anticipated Difficulties, and Backup Strategies.
- Assign Roles & Responsibilities for Anaesthesia Team.
- Review WHO Surgical Safety Checklist (Sign-in, Time-out, Sign-out).
- Ensure Clear Communication Between Anaesthesia, Surgical, and Nursing Teams.
CONCLUSION
An advanced anaesthesia cockpit drill ensures systematic preparation, reduces human errors, and enhances patient safety. By adopting a structured, evidence-based approach, anaesthetists can improve procedural efficiency, anticipate complications, and deliver optimal perioperative care.
