Continuous innovation in anesthesia machines

PCLC is an emerging technology that analyzes the specific data to regulate physiological variables by autonomous therapy, thus reducing cognitive overload, minimizing human error, and enhancing medical care during high workload.

The last decade has witnessed a steady rise in the demand for quality anesthesia workstations due to availability of advanced and cost-effective technology. If compared to the enormous medical specialty, anesthesia is young, somewhere around 150 years. However the innovations and advancement are being carried out since 1950s. It will not be wrong saying it is a boon providing relief from pain throughout the surgery. Anesthesia machines have helped in carrying out complicated surgeries successfully like organ transplantation, renal transplantation, liver transplantation. With these wide applications there has been much technological advancement in anesthesia machines. Many technologies are trending including the most advanced ultrasound devices for nerve localization. Initially they were used for diagnosis and monitoring but nowadays there has been increase in their usage in regional anesthesia for the monitoring of cardiac output.

The new safety features offered by anesthesia workstations are also a huge advantage and substantially minimize chances of any accidental incidents during anesthesia delivery. Modern day anesthesia workstations are equipped with a twin station manifold for mounting two selectatec type temperature compensated vaporizers with interlocking safety, an anti-hypoxic system, an in-built integrated ventilator with direct switching controls from the circle absorber system. The display screens are available in touch/non-touch variants to meet varied customer requirements. The ventilators offer a choice of ventilation modes comprising CMV, PCV, SIMV, and manual modes. The advanced versions also offer an addition of PSV, SIMV with pressure/flow triggers, and spontaneous mode of ventilation. The workstations are offered with a choice of monitoring options starting from hemodynamic monitoring to advanced anesthesia monitoring parameters.

Technological Advances
Vast technological advancements are taking place in the market and manufacturers are continuously introducing innovative, precise, and highly effective product varieties leading to the availability of better treatment options for patients.

Integrated systems. Recent models have added new ventilation modes and most manufacturers are trying to increase the similarities between their ventilator and anesthesia monitor interfaces. The new machine has ICU quality ventilation across all patient categories and has low flow and minimal flow anesthesia modes to improve anesthetic delivery and reduce financial impact. Anesthesia machines using the latest vent technology such as turbo vent ventilation with airway pressure release ventilation (APRV), and volume auto flow which provides protective ventilation therapy in the OR for all patient categories are worth the initial investment.

MRI-compatible. The MRI suite presents unique challenges to the anesthesiologist. For some scans which require breath holds, that is, for arterial mapping where even the slightest motion can interfere with image acquisition, general anesthesia may be necessary for those too young or unable to cooperate. Recent technological advances have improved safety and efficiency in providing patient care in this setting. Like other out-of-OR locations, adequate preparation and thoughtful consideration of environmental factors are of utmost importance. Newer MRI scanners combine a wider bore with high-field systems to facilitate obese or claustrophobic patients’ comfort in the scanner, as well as decrease the duration of the scan.

Anesthesia information management systems. (AIMS) is designed to record data from the anesthesia machine and to transmit the same to the electronics health record (EHR) in the hospital. AIMS allow the automatic collection, storage, and presentation of patient data. Modern day systems have clinical decision support systems (CDSS) integrated to AIMS to flag improper diagnoses or other issues in a clinical workflow. This has improved the quality and safety of patient care. CDSS is currently an active area of anesthesia research and development due to huge potential to improve patient care and outcome by reducing intraoperative complications. CDSS integrates aggregated data from AIMS, vitals monitors, and HIS to present quality and safety alerts to clinicians.

Direct infusion of anesthetic agents. In order to negate the influences of pressure and temperature on anesthetic agents and to guarantee controlled titration, the practice of direct infusion of volatile anesthetics is a modern advancement. In this technology, the device stores anesthetic liquid in a reservoir and travels to a dosing chamber for pressurization. Later, a specific dose of agent is released into a heated vaporizing chamber for vaporization and delivery into the breathing system. This method guarantees higher precision and stability of the set gas concentrations.

Physiological closed-loop controlled devices. PCLC is an emerging technology that analyzes the specific data to regulate physiological variables by autonomous therapy. They play an important role in reducing cognitive overload, minimizing human error, and enhancing medical care during high workload and high-stress environments like in operating rooms, intensive care, and emergency medicine settings and mass casualties’ incidents to ensure adequate and timely therapy delivered automatically. PCLC devices play an important role in OT for closed-loop anesthetic delivery, closed-loop vasoactive drug and fluid delivery, closed-loop mechanical ventilation, and monitoring vitals.

Carbon dioxide absorbers. A novel, lithium-based carbon dioxide absorber offers potential advantages over conventional absorbers. The lithium-based absorber by SpiraLith is reusable and can be recycled by the manufacturer. This technology offers certain advantages, including no desiccation and no generation of dust or workplace contaminants. However, this absorbent requires some practice adjustments, as it does not visibly change color as it nears the end of its life span. Anesthesiologists must remain attentive to continuous capnography when using SpiraLith to identify expired SpiraLith canisters when inspired carbon dioxide is greater than zero.

AI in anesthesia. Medical researchers, informatics specialists, and digital entrepreneurs have been exploring the use of artificial intelligence (AI) in the healthcare sphere for decades, but it is only within the past couple of years that the technology has really begun to take off. Indications are that in healthcare, AI, now commonly known as machine learning (ML) is set to explode. Imagine an environment in which machines capable of cognitive computing and processing vast amounts of data can support you with unprecedented accuracy, efficiency, and patient-specificity on everything from monitoring the depth of anesthesia, determining the amount of anesthetic gas to administer, somatosensory evoked potential monitoring, classifying patients, and mitral valve analysis to coding and billing. All clinicians, including anesthesiologists and nurse anesthetists, are likely to find themselves incorporating ML tools and capabilities into their practices in the not-too-distant future.

Outlook
Even though the advancements in anesthesia delivery are moving in the right direction, there is still room for improvement and engineers have a front row seat along with anesthesiologists to continue to drive the innovation. According to the World Health Organization (WHO) and World Bank, by the year 2026 the treatments demanding surgeries and hence anesthesia machines would eclipse that of tuberculosis and HIV as well as malaria. The current market scenario portrays the fact that about 30 percent of the population in the entire globe does not have access to surgeries. On the contrary, about 75 percent of major procedures are being performed in the developed countries whereas developing countries like India are witnessing only 3.5 percent of operations. Government bodies along with non-government institutions are continuously working on offering healthcare access to every region, which is expected to trigger the adoption of anesthesia machines in the years to follow.