Emerging trends in anesthetic equipment: A glimpse

Anesthesia has come a long way from when W.T.G Morton used ether to alleviate Gilbert Abbott’s pain completely in a public demonstration for the removal of a neck tumor and when John Snow’s chloroform allayed Queen Victoria’s labor pains at the birth of both Prince Leopold and Princess Beatrice. Halothane is slowly bidding goodbye to us as newer more superior options have emerged in the market. Desflurane belonging to the Tec-6 range is electronically driven and surpasses the entire range of vapourizers in patient awakening. Its sister product, the Aladin vaporizer uses a cassette containing the volatile liquid anesthetic (Desflurane), which is inserted into a port with a central electronic control mechanism and dispenses the agent into the stream of fresh gas flow like other bypass vaporizers.

Papaver somniferum from the poppy plant has been used by mankind as an analgesic (opium) for centuries. Fredrich Wilheim Serturner isolated morphine, the first pure opioid from the original compound and thus paved way for an entire new set of pharmaceutical drugs. Thus, began the use of bolus opioids which have now been effectively replaced by patient-controlled computer driven infusion pumps. Pain relief has now witnessed a sea of change from the customary doctor controlled pain to patient controlled analgesia (PCA) even nurse controlled NCA pumps in the case of young children.

Joseph O’Dwyer developed a metal tube system in 1800s to pass blindly in children suffering from diphtheria related pseudomembrane formation causing airway obstruction. George Fell modified Dwyer’s tube by connecting an apparatus to the metal tube to provide positive pressure ventilation. Direct laryngoscopy was performed for the first time ever by Manual Garcia in 1855, a professor in singing in London using a dental mirror. The Macintosh and Miller laryngoscopes emerged back in 1940s. Series of innovations in these laryngoscopes resulted in the Bullard laryngoscope and the McCoy articulating laryngoscope.

Airway devices, presently, are not limited to the Guedel’s airway, anatomical antistatic rubber mask, and endotracheal tube alone. Fibreoptic intubation has been largely replaced by video laryngoscopy using either a handheld LCD screen or even more refined the Airtraq, with an inbuilt tracheal tube placement channel. In the midst of all these hi-tech equipment, let’s not forget the meek looking, yet most user friendly gum elastic bougie that has turned innumerable difficult intubations into a piece of cake.

The whole new set of airway equipment using Nodesat techniques permits unrestricted para-oxygenation, a technique whereby we can provide apneic oxygenation even while attempting intubation has revolutionized difficult airway management. This grants us adequate time to protect the airway, a full 60 minutes without dipping in saturation.

Talking about our ever so humble Boyle’s machine, developed in the early 20th century, it has given us a thorough understanding of a complete anesthesia delivery system with its multiple connections. Henry Boyle invented his machine from the American Gwathmey apparatus of 1912. It became the best known continuous flow anesthetic machine. The quest for greater patient safety and technological innovations led to the present physiological monitoring systems which now monitors advanced parameters such as depth of anesthesia even core and surface temperature.

Introduction of ventilators have unloaded the task of anesthetists as it allows them to be hands free apart from providing uniform, synchronized, ventilation in diseased lungs. Over the years, after much refinement, have emerged the current anesthesia workstation models: Draeger Primus and GE HealthCare Aisys workstations, which are complete anesthesia and respiratory gas monitoring and delivery systems with superior safety systems in place.

ln the midst of a swiftly changing technology era, this March, we were struck by the COVID-19 pandemic, that put us in a state of a perpetual comma or a full stop for some, from which we are recovering slowly bit by bit .We learnt the art of Donning and Doffing our PPE (personal protective equipment) kits when we kept thinking these suits were most suited for celestial space visits. Our lives have been shaken so drastically that N95 masks has now become part and parcel of our essentials. From being anesthesiologists, where we were designing intubation incubators to protect ourselves from the vicious virus while securing the airway to proudly stitching DIY masks for our kids, we have come a long way.

I salute the hundreds and thousands of corona warriors who have laid down their own lives treating infected, hopelessly dying, and sometimes abandoned patients.

Cardiopulmonary resuscitation (CPR) has moved from chest compression alone to AED (automated external defibrillators) assisted CPR. AEDs have become compact, affordable, and absolutely essential to save valuable lives. Be it an airport, a gym, a small clinic, or a resort the AED has been installed for public use and safety. Designed initially in 1947 by Claude Beck, the portable version transpired in the mid-1960s by Frank Pantridge. Not only has the AED made CPR easier, it has helped increase the number of cardiac arrest survivors who would have otherwise been lost to undiagnosed ventricular fibrillation. The ease of operating an AED even for a layperson makes it a truly remarkable landmark in CPR.

Ultrasound which has ruled the realms of radiology for decades has set foot into regional anesthesia and is here to stay. Its superb performance, non- invasiveness, ease of control, and excellent visual assistance has metamorphosed the once dull, unsuccessful patchy peripheral nerve blocks into stand-alone anesthetic techniques.

The latest point of care ultrasound machines, be it Sonosite, Philips, or GE Logiq have transformed its safe usage in bedside cardiac and lung assessments in the ICU. What began with the purpose of expediting central line insertions has smoothened the conduct of entire surgeries under combined peripheral nerve blocks – an invaluable boon for patients who would otherwise be refused surgery being ASA IV or V grade (having multiple systemic comorbidities/moribund patient).

As we continue to experience more and more wonders of modern anesthesia and technology, let us take a moment to thank our forefathers and our teachers – W.T.G Morton, James Leonard Corning, Friedrich Serturner, Horace Wells, James Young Simpson, Carl Koller, Sigmund Freud, and August Bier for taking the first baby steps for us!