Automation to loom large in the anesthesiology landscape

Despite all recent innovations, and new instruments added to the anesthesia machine, an under­standing of the anesthesia machine is still a core component of the practice of anesthesiology.

The practice of anesthesiology is inextricably dependent upon technology. Anesthetics were first made possible, then increasingly safe, and now more scalable and efficient in part, due to advances in monitoring and delivery technology. Anesthetic machines have evolved from simple inhalers to today’s work stations, resulting from the integration of the anesthesia device itself with monitoring, alarm, and protection systems.

Consumer technology and telemedicine have exploded onto the scene of outpatient medicine, and perioperative management is no exception. Preoperative evaluations have been done via teleconference, and copious consumer-generated health data is available. Regulators have acknowledged the vast potential found in the transfer of consumer technology to medical practice, but issues of privacy, data ownership/security, and validity remain.

Inside the operating suite, monitoring has become less invasive, and clinical-decision support systems are common. These technologies are susceptible to the garbage in, garbage out conundrum plaguing artificial intelligence, but they will improve as network latency decreases. Automation looms large in the future of anesthesiology as closed-loop anesthesia delivery systems are being tested in combination (moving toward a comprehensive system).

Moving forward, consumer health companies will search for applications of their technology, and loosely regulated health markets will see earlier adoption of next-generation technology. Innovations coming to anesthesia will need to account for human factors as the anesthesia provider is increasingly considered a component of the patientcare apparatus.

The global anesthesia machines market is expected to grow from USD 9.44 billion in 2020 to USD 12.77 billion in 2021 at a compound annual growth rate (CAGR) of 35.3 percent. The growth is mainly due to use of anesthesia machines being converted to ventilators to support the patients affected by COVID-19, which has spiked the demand for the equipment. The anesthesia machines market is expected to reach USD 18.62 billion in 2025 at a CAGR of 9.9 percent.

The increasing capabilities of anesthetic devices, such as the capability to deliver minimum low flow rate, variable flow, scavenging systems to capture waste gases, emergency systems, such as oxygen flush systems and others, are amongst the significant factors fueling the growth and demand of anesthesia machines. In addition, the rapid increase in minimal-invasive surgeries, increasing healthcare expenditure, and rising medical tourism are also contributing to the growth in the global market during 2021 to 2028. Also, the rising prevalence of chronic diseases, increasing aging population, and technological advancements are also lifting the growth of the market. Furthermore, the economic development and developing healthcare infrastructure are one of the significant factors flourishing the growth of the anesthesia machine market. Rapidly increasing healthcare awareness will also make sure high industry growth in coming years.

However, the dearth of skilled and trained anesthesiologists, as well as the high cost of installation and maintenance, will curb the growth of the anesthesia machine market, whereas the dearth of ventilators because of the huge demand and short supply has the potential to challenge the growth of the anesthesia machines market.

The use of computer-controlled anesthesia machines is an emerging trend in the anesthesia machines market. Computer-controlled anesthesia machines help in reducing the patient’s pain during surgical procedures, and also provide features, such as alarms, to notify in case of an emergency or backup required to switch the defected pipeline or cylinder. For example, the Dräger Primus anesthesia workstation provides advanced display and monitoring settings and automatic checkup option, thereby reducing human time and efforts. Similarly, GE Healthcare’s Aisys CS station manages the oxygen flow, records the consummation data, and avoids wastage of fresh gas.

The integration of various functionalities, such as oxygen saturation level, carbon dioxide level, heart rate, and blood pressure, coupled with decision-support systems and data analysis to aid clinicians to get better insights on their patients, is favoring the market growth. The introduction of new monitoring techniques, such as monitoring the depth of anesthesia, goal-directed fluid therapy, advanced neurological monitoring, improved alarm system, and technological advancements in objective pain assessment, is driving innovation in the industry. Decision-support system (DSS) is another specialty of anesthesia. It is a digitized information receiver and relay center, which, in conjunction with anesthesia information management system (AIMS), helps the clinician in the delivery of health services, simultaneously monitoring the well-being of the patient. Thus, increasing investments, which are supporting the technological advancements in anesthesia monitors, are having a major impact on the market’s growth, enabling faster deployment in the healthcare industry.

The Food and Drug Administration (FDA) regulated the anesthesia machines manufacturing market. The anesthesia gas machines fall under class II category of the FDA medical devices regulation. Most of the Class II devices or machines require approval as per Premarket Notification 510(k) – 21 CFR Part 807 Subpart E. According to this regulation, the manufacturer is not allowed to distribute the devices until it gets an approval letter from the FDA. Some other regulations and laws include the Medical Device Amendments 1976, and the Good Manufacturing Practices, 1978.The Medical Device Amendments outlines procedures for introduction of new products, labelling for products and manufacturer registration, and the Good Manufacturing Practices includes laws for quality assurance, distribution and manufacturing of devices. Hence, regulations such as these would keep a check on manufacturers of anesthesia machines.

Some of the major players of the market include B. Braun Melsungen AG, Medtronic PLC, Draegerwerk AG, Koninklijke Philips NV, and Fisher & Paykel Healthcare, among others.

Despite these advances, the machine is still prone to user error, and thus requires the attention and focus of all operating room personnel in anticipation of a dreaded scenario of failure to oxygenation/ventilate or anesthesia awareness. Although an understanding of the intricate workings of the anesthesia machine is not a requirement of all operating room staff, familiarity and awareness of components of the machine may help provide a safer anesthetic to the patient.

Healthcare team awareness of the location of a bag-valve-mask or self-inflating bag to hand off to the anesthesia provider can provide a temporary means of oxygenation and ventilation until anesthesia machine issues are resolved if the machine fails. Familiarity with the flaws of a low-pressure, circle-circuit anesthesia machine that is complex and prone to leaks may allow for greater confidence in nursing and allied health professionals to point out when a tube is disconnected so the anesthesia provider can quickly resolve issues to prevent unnecessary adverse outcomes. With the emphasis on faster turn-over times between cases, it can be easy for operating room staff to forget that the anesthesia machine is the most important piece of equipment in the operating room. Failure of its proper function can lead to hypoxia and death or anoxic brain injury in a matter of minutes. Although routine, anesthesia providers must have the time they need to check the machine and ensure its proper functioning before the arrival of a patient to the operating room, so concerns and issues can be addressed safely and effectively.