A Promising Future For Anesthesia

Advancements in digital technology are driving a new generation of smart techniques in the anesthesia domain. Device manufacturers are focusing on exploring opportunities to improve the efficiency of anesthetic gas delivery to address the cumulative requirements of extra flexibility, increased patient safety, and improved patient care.

From the invention of a simple Boyle’s apparatus in 1917, anesthesia delivery has gone through significant technological advancements over a period of 100 years. The focus is always on making anesthesia delivery much more efficient by reducing use of anesthetic agents as much as possible and still maintaining optimal sedation for the patient. The innovations in the development of sub-systems of anesthesia delivery like ventilator, vaporizer, digital rotameter, circle absorber, and patient monitors are the emerging trends in the anesthesia space.

Now, the technology is advancing toward having all these modules seamlessly integrated into a single entity called anesthesia workstation. It helps clinicians to provide comprehensive care to patients. The evolution of mechanical ventilation technology to address complex lung conditions has contributed to better gas delivery in anesthesia ventilators. Starting from a simple flow-divider mechanism to deliver fixed tidal volumes, the latest ventilators can deliver gas in various flow shapes to ensure lowest mean airway pressure, thus reducing the possibilities of volutrauma and baratrauma.

The innovations in the field of anesthetic agents and vaporizers are highly commendable. Starting with ether as the first volatile agent in 1847, now there are numerous anesthetic agents including isoflurane, sevoflurane, and desflurane, which are widely used. Simultaneously, the technology of vaporizers has also grown to administer these anesthetic agents in the lowest possible concentration, thus helping patients to recover faster after surgery.

The future is promising for advanced technologies in the domain of patient monitoring during anesthesia. Various technologies like neuro-muscular transmission (NMT), BiSpectral Index (BiS), and anesthesia-gas module (AGM) are increasingly used today. The effort here is to define a spectrum that can be used universally to monitor and maintain adequate depth of anesthesia during surgery. By customizing anesthesia delivery with BiS monitoring, anesthetists are already recording a reduction in use of anesthetic agents up to 50 percent when compared to conventional systems. The benefit is evidenced with better turn-around-time of patients in intensive care units, post-surgery. It also helps to reduce foot-print on global warming, which is the need-of-the-day.

Indian market dynamics
The Indian anesthesia equipment market in 2018 is estimated at Rs 193.26 crore at 5000 units.

There are a handful of players in this segment who import the systems every quarter. These include Drager, Mindray, Spacelabs, BPL, Meditech, and Skanray, with GE dominating the segment at an approximate 40-percent market share. Mindray had a very good year and found major success in the tenders invited by the government, having ensured that it was present in every price point. It may be safely assumed that the indigenous sector contributes 14 percent to this market.

This is a price-driven market with the government continuing to buy premium products, and the smaller nursing homes and medical facilities in Tier-II and Tier-III cities procuring the super value and value range of products. The emphasis continues to be on quality at affordable cost, and reliable after-sales service.

Advancements in digital technology are driving a new generation of smart techniques in the anesthesia domain. Device manufacturers are focusing on exploring opportunities to improve the efficiency of anesthetic gas delivery to address the cumulative requirements of extra flexibility, increased patient safety, and improved patient care.

Global market dynamics
Global anesthesia equipment market is projected to witness a CAGR of 8.27 percent to reach the total market size of USD 13.3 billion by 2023, increasing from USD 8.9 billion in 2018, estimates Research And Markets. The vast increase in the number of surgical procedures undertaken across the globe every year has played a major role in the growth of the anesthesia equipment market. The most rapid increase was observed for laparoscopic hysterectomies. As every surgical procedure can be painful, anesthesia is administered to the patient during surgical procedures to keep patients pain free and unconscious during the procedure. Technological advancements, owing to increasing investments by major players in research and development, are enhancing the efficiency and reliability of these machines. Advanced anesthesia machines come with advanced ventilators, graphical displays, and other features integrated to ensure the safest-possible experience for the patients, which is increasing their adoption among the end-users, thereby augmenting the market growth. In addition, large patient pool and increased disposable income in emerging markets are expected to further boost the market in coming years.

Outlook
At some point in the future, if a fully autonomous anesthesia system could be created and validated, then it could certainly result in profound effects on the workflow patterns and needs of anesthesia providers. These innovations may allow anesthesiology the freedom to reinvent itself from an intraoperative specialty to one of true perioperative medicine. Such changes are already underway with emphasis on non-operating-room subspecialties like pain medicine and critical care. For the time being, though, both the hopeful and dystopian futures are possible, and there is no way to reliably predict which outcome is more likely. As a specialty, anesthesiologists have tended to be early adopters of technology, and tend to be comfortable incorporating technological solutions to improve patient care. They should continue this trend and not only stay abreast of advances in AI, but make concerted efforts to integrate them into practice now so that they can be the authors of their own future, improving provider productivity and each patient’s outcome by building and working in concert with narrow AI learning systems that create truly individualized, evidence-based clinical guidelines built in real time, based on analysis of the entirety of medical literature and pooled patient data from electronic medical records.