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Changing trends in anesthesia delivery system

A paradigm shift in anesthesia delivery system focus nowadays is maximum benefit with minimal side effects. The main avenues where technology is helping reshape medicine can be broadly divided into the artificial intelligence, robotics, nano-medicine, and the genetically targeted medicine. Significant advances during the last several decades have led to important improvements in clinical-monitoring technology and clinical-practice development, not only in patients undergoing surgery or in patients being cared for in intensive care units (ICUs) but also in ambulatory patients. These developments have contributed to great improvements in patient safety. New approaches to clinical airway management, such as airway algorithms, video laryngoscopy, extubation catheters, and advanced supraglottic airway devices like fibro-opticbronchoscopes, are also protecting patients from any harm. In the realm of perioperative cardiac monitoring, the use of conventional and 3D-echocardiography now allows for real-time monitoring of valvular function, ventricular filling, cardiac contractility, and other hemodynamic parameters. Additionally, hand-held ultrasound machines are changing how bedside examinations are conducted on injury.

Ultrasound machines for applications, such as echocardiography, regional anesthesia, or central line placement have now evolved to the point that they can be connected to a smartphone or tablet.

Modern anesthesia workstation
The modern integrated anesthesia work station is designed with complete anesthesia, advanced ventilation, gas delivery, and agent-vaporizing features with patient monitoring and information management to form an integrated anesthesia care station. While features may vary between individual machines, some of the salient features include: sophisticated pressure transducers and electronically controlled flow-control valves for accuracy of gas delivery; safer and more accurate; integrated software to control gas flow and vaporizer output so as to achieve best economy of gases; methods to accurately deliver low tidal volumes, including FGD or electronic compensation for fresh gas augmentation of tidal volume delivered; sophisticated electronic alarms; advanced ventilation modes; new monitoring capability, e.g., complex respiratory waveforms; self-test; compliance and leak testing of the breathing circuit, allowing precise and accurate delivery of very-low tidal volumes; low dead space; compact design with less external connections; and Automated record keeping.

Despite the sophistication of these machines, the anesthesiologist must be aware of their limitations and hazards. The modern integrated anesthesia workstation is designed to be a complete anesthesia and respiratory gas delivery and monitoring system. It combines advanced ventilation features, gas delivery, and agent-vaporizing with patient monitoring and information management to form an integrated anesthesia care station. Examples include the GE Healthcare Aisys Carestation and the Draeger Primus.

Future development
Xenon is supposed to be the next big thing in anesthesia. This noble gas has many properties of an ideal inhalational agent. It is already in use clinically in Russia and Germany. In this section, we will not discuss the pharmacology and physiologic concerns of xenon but will focus on issues involving its supply and delivery. Xenon has low blood-gas partition coefficient, permitting rapid onset and offset of action, good analgesic properties, and is cardiostable and environment friendly.

The big problem with xenon is its rarity and its expense. You may recall that xenon is found in our atmosphere but in a very small concentration (0.0000087 percent, or 1 part per 11.5 million). In fact, the amount of xenon being produced each year currently is only enough for less than half a million anesthetics. It takes a lot of energy to separate 1 L of xenon from the atmosphere. 1 L of xenon in the United States costs USD 10 to USD 12 or so. Even with a closed-circuit technique and rebreathing, a xenon anesthetic would be expensive. Technological advancements in anesthesia delivery system are continuing like use of Robot in anesthesia management.

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