Your equipment is handled by you alone and no one can help you

Make sure that your equipment is full and complete and you are capable of conducting any case even in a village. You must be fully equipped with all your drugs for induction, maintenance, reversal, and also for resuscitation. Do not depend upon the nursing home to provide you with anything.
One of my colleagues never carried distilled water vials with him. One day he was faced with no saline, no water to dissolve Thiopentone. He probably used boiling water from the sterilizer and no wonder all patients developed hyperpyrexia.
When you paralyze a patient with long acting muscle relaxant you must possess the necessary prostigmine with you. Similarly if you intend to give spinal a vasopressor must be in your possession. While anaesthetizing an asthmatic patient check the immediate availability of aminophylline, cortisone, adrenalin etc. and the spray he may be using (salbutamide).
Laryngoscope
Laryngoscope is the most important piece of equipment. It must be in perfect condition. All spares must be readily available all the time. A spare bulb and pair of batteries (unused) must be at hand. Those who use rechargeable batteries, a note of caution, when the batteries are nearly discharged the bulb can fade away within seconds. A pair of batteries must always be in stock. The repairs and checking of all parts must be mastered for use in emergency. If the bulb is not working, check the following:
Change the batteries.
Check all contacts points and clean all the metal contacts with rough hard object or sandpaper if available.
Check the bulb by unscrewing from its place and checking it on the spring of the metal contact on laryngoscope handle and touching the body of the bulb to the body of the handle. If the bulb lights it means that laryngoscope handle, batteries, and bulb are O.K.
Clean the seating of the bulb in the blade and re-check the contact point on the blade and polish the same with sandpaper or even a metal file. The seating of the bulb can be cleaned by a needle and a drop of ether. Allow it to dry and replace the bulb.
Check the bulb. If it shows blackish discoloration change the bulb.
The insulation between the bulb body and contact points is only a small piece of paper, which gets wet while cleaning with water. Disengage the bulb and let it dry. Try to use it again. If it does not, pull the metal contact by a fraction of a millimetre. After constant use the insulation (paper) becomes useless and the contact and the bulb body touch directly and the bulb is short-circuited.
Checking the handle is easy. Unscrew the cap of the handle. Check the tension of the spring. Dry the handle from inside. Polish the contact of the spring with the metal body of the battery. Thus all metal contact points must be checked and cleaned of deposition of copper oxides. After use detach the blade, screw the bulb (if it is loose) and wash it with soap and water. The handle does not need cleaning unless smeared with blood during use in a difficult intubation. Minor points in repair of the laryngoscope must be known. Nobody teaches nor is it given in books. Check the light after cleaning.
If possible keep a spare Laryngoscope, cells and a bulb.
Extra long blade and special laryngoscopes can be useful.
Lastly do not loose your head. Insert the un-lighted blade in the patient’s mouth, give the correct position for intubation and pass a tube blindly. If the intubation for the same reason is difficult you may fail, otherwise in 90% cases you will succeed and carry the day.
Endotracheal tubes
The length of the endotracheal tube (ET) must not be longer than 2” of the size required. Longer ET may cause endobronchial intubation. The ET must have a nose worthy connection fitted permanently. So that it can be easily connected to the unidirectional valve for IPPR. Longer ET comes in the way for operations on the head and face and intra-oral surgery.
All tubes must be boiled for 2–3 minutes before use and re-checked as some debris only becomes apparent after boiling. The hard plastic tubes should be kept in warm water to make them soft and non traumatic (for nasal intubation).
Always check the temperature of the ET after it is taken out from the boiling water. Allow it to cool. Apply lubricant jelly after the tubes have cooled. In extreme emergency cool the tubes under tap water before intubating.
Keep all sizes of ET handy all times including OO size for new born resuscitation. Always have 3 sizes of ET ready. Apart from the proper size that you have selected have a smaller size and bigger size ready. Do not fumble at the last moment.
Special nasal tubes of sizes 6 mm to 10 mm must always be available for emergency use in failed oral intubation.
All endotracheal tubes must be secured with a good strip of sticking plaster. In cases of patient with beard or patient in prone position, it must be secured with additional bandage going round the neck. Chances of slipping of tube (which are quite high) are thus prevented. In case of infants it can be a disaster. In cases of children never pass a cuffed endotracheal tube. Avoid using cuffed tubes in cold cases. If at all used, inflate the cuff balloon yourself.
Other equipment

• A set of airways: Apart from serving as airway it can be good bite block and can also be used for fixing the endotracheal tube. The modern anaesthesiologist is neither trained nor he believes in open drop anaesthesia. Airway becomes mandatory equipment in both open drop anaesthesia and total intravenous technique.
  
• Magill's forceps: One size (big one) is mandatory. In difficult intubation it can be useful. If not used carefully it can cause trauma e.g. mucous membrane can be picked up by mistake.
  
• Flexo Metallic Stillette: Is mandatory. In difficult intubation it can be useful. Remember it can be traumatic if not used carefully.
  
• Ethyl chloride spray and ether drop bottle with Schimelbusch’s masks of all sizes. If spray is not available use Halothane in 5cc syringe with needle size 20G, 22G and 25G for induction depending on the age of patient.
  
• 3 sizes of Scalp vein needle.
  
• A cannula of the size needed for the patient.
  
• Endotracheal Tube connections
  All tubes should be fitted with Noseworthy connections of proper size so as to avoid searching for a connection and fitting of wrong connection (small) in a bigger endotracheal tube (by the assistant or ward boy) the Nose worthy connection takes up the unidirectional valve directly and does not need any other connection or catheter mount. In some cases of facio maxillary surgery (cleft lip and palate) use the Magill’s connection going to the endotracheal tube (especially the Oxford tube) with extra length of arm going out. This makes the job of the plastic surgeon of fitting the Boyle Davis gag easy and leaving some length of connection for fitting Ayre’s T piece.
  
• Ayre’s T piece: Keep it ready with both arms fitted with pieces of rubber tubing to take up the connection on the machine or the bellows. Have a half-meter long plastic tube fitting on the inlet of Ayre’s connection. The other side of this tube should have a permanent adapter to go directly on the Boyle’s machine or the exit of the Bellow unit.
  Bellows Unit: Always open the bellows from the lock instead of fumbling. Never keep cotton swabs and gauze pieces on the table as they are likely to get sucked in and block the inlet of the bellows and after a time may not allow any air in the bellows. These foreign bodies are not easily spotted unless you expect them. If the rubber shows signs of perishing get it changed immediately.
  
• Oxygen: In case you need to use oxygen, administer it with RR attachment and not through tap provided. Tap should only be used for IPPR and not for anaesthesia as it dilutes the vapour and lower concentration is delivered to the patient.
  It is always preferable to use the bellow unit with unidirectional valve situated under the bellows than separate disc valve set. Like in Oxford inflating bellows. It makes the equipment lighter.
  
• Hoses: Hoses connecting the vaporizer and the patient should be lightweight and not the heavy rubber as they can drag the endotracheal tube out in case one is not careful. The male and female connections at the end of hoses must be well fitting.
  
• Unidirectional valve: Any valve, which functions well and has not got the leak, is acceptable. Minor difference does not matter much. The Reuben valve material is damaged with continuous use of ether and should be replaced (replacement should be kept ready) as soon as one sees opaque patches or cracks. If it falls it crumbles to pieces easily. In the absence of unidirectional valves one can carry IPPR with a thumb technique.
  
• Tourniquet: Always carry a 1 foot long latex tubing with you. Help may not be available. One should palpate the vein in case one is suspicious of it being an artery. I have demonstrated abnormal superficial arteries in many cases.
  
• Draw over Bottle or Modified Flagg's can: A very convenient apparatus to use after induction with open drop ether and intubation in children. The size of the container (Glass bottle or can) should be small. The level of ether should be well below the lid and the inlet ports provided should have total cross sectional area equal to adult Trachea. It is better if is glass. Cooling of ether is very fast and in cold weather does not deliver adequate concentration. Even then one should resist the temptation of dipping in hot water. Remember boiling point of ether is only 35º C. Tap water jacket is all that one needs.
  Disconnect the delivery tube whenever one leaves the bottle or the patient. Always keep the palm loosely over the lid which keeps you informed about the respiratory rate and volume and it steadies the vaporizer. So many accidents have been recorded due to aspiration of pure liquid ether in the respiratory passage which results in pulmonary oedema and death. At one time this technique was supposed to be the safest. However if taken lightly it can cause deaths.