Buying a new anesthesia machine requires an unusual assembly of people to approve the product, most of whom have never administered an anesthetic and have no idea how such a machine works. Such is the world of surgery today, where administrators and accountants wield as much purchasing influence as anesthesia providers and surgeons. But, hey, it never hurts to get a little perspective on capital equipment decisions. Depending on the options end users are allowed to tack on, a new anesthesia machine can cost anywhere from $30,000 to more than $150,000. (New machines will come with customer service at no additional cost, but an assortment of necessary add-ons and attachments can quickly inflate the take-home cost.)

There are many reasons to like today's new offerings (see the product roundup beginning on page 82). Some offer features such as heated circuits, pressure-supported ventilation and enhanced low-flow anesthesia. Others have airway-compliance-regulated, pressure-controlled ventilation; adaptors for neonatal and pediatric patients; and even piston-controlled (rather than gas-generated) ventilation.

It's really amazing what's out there, therefore it's important that, in the decision regarding which anesthesia machine and which options you purchase, you give the most weight to input from the end user anesthesiologists and CRNAs, as well as nurses who might have to work with the machine in the OR. Administrators, accountants and anyone else in the chain of command for capital acquisitions can keep an eye out for price breaks through buying groups and same-manufacturer discounts, but it's important to let clinicians assess the inherent quality or specifications of the product itself - rather than relying on brand familiarity.

This doesn't necessarily mean that your anesthesia providers will want all manner of bells and whistles: Sometimes, the older, less-complex anesthesia machines are easier to maintain (and clean) by staff and facility-based biomedical personnel, and this will prove appealing, especially if the basic machine will fit clinical needs. As such, many anesthesia providers will offer the opinion that purchasing an older-model, refurbished machine allows a significant savings and makes possible the purchase of much-needed newer patient monitors instead. These "used" models are less likely to be comprised of sophisticated computer components which, when they crash, can render the entire machine unusable. Newer models look nice and sporty, but sometimes that old, reliable Chevy is all you really need. Here's a look at what's on the lot, as it were, these days.

Cardinal Medical Specialties
OBA1
(800) 443-5997
www.obamed.com
Price: $9,000 to $13,000
FYI: This 35-lb. portable anesthesia machine recently received approval for 3 Tesla rating, which means you can safely set it up right beside the magnet in an MRI machine. You can take this machine to the MRI and start your anesthesia in the same room you're doing the MRI. The OBA1, which stands for "office-based anesthesia," fits into a compact carrying case and also sits on a five-legged stand, making it very stable, says the company. You can put this machine in the back of a car and take it to another facility if need be.

Monitors can go right on the shelf with this small machine. There are built-in safety alarms and monitors to alert to problems such as low oxygen and others you would expect to find in a larger, standard anesthesia machine, says Cardinal.

Cardinal also recently launched the ThermH2Osorb CO2, a disposable, low-priced absorber unit that can be attached to any anesthesia machine in less than 15 seconds, says the company. The absorber unit also accepts any adult or pediatric single or dual limb breathing circuit and is MRI-compatible.

Datascope Corporation
Anestar
(800) 288-2121
www.datascope.com
Price: not provided
FYI: MD Buyline recently ranked Datascope's Anestar as the leader for value and user satisfaction. The breathing system has an absorber, ventilator bellows and a warmed aluminum manifold. The machine also features automatic compliance compensation, as well as volume, pressure-controlled and pressure-support ventilation.

The warmed breathing system targets 35'C to eliminate many issues with condensation and rainout, says the company. This also helps reduce maintenance costs and enhances durability. The manifold reduces the number of multiple pneumatic hoses and connections, which can reduce both potential leaks and the necessity to assemble connections, which reduces the potential for human error.

Draeger Medical
Apollo
(800) 437-2437
www.draegermed.com
Price: $75,000
FYI: Introduced last year, the Apollo is the newest machine from Draeger Medical. Its ventilation system works with a servo-controlled high-speed piston. This mechanism moves the patient gas directly instead of relying on the gas itself to be the driving force. The problem with relying on gas is that it's compressible and therefore won't always replicate the same driving force, says the company. Using a mechanical piston generates high inspiratory flow rates, which pushes the gas into the lungs faster and provides better oxygenation.

The Apollo also captures all the patient data from every case and interfaces with your existing software systems to export the information to the patients' electronic medical records. You can use this data not just for more complete records, but also for cost-trending purposes: By monitoring the set fresh gas flow, you can monitor the cost of the inhalational anesthetic drug, which is usually the largest pharmacy item for the anesthesia department, notes Draeger.

The Apollo also continues to perform in the event of a total power or system failure. Its low-flow wizard provides real-time information on the adequacy of the fresh gas flow to the patient. Finally, the Apollo sports an electronic version of the esophageal stethoscope, which gives audible feedback on the patient's respiration and eliminates the need for costly disposables, according to the company.

GE Healthcare
Aespire 7900 (pictured) and Aisys Carestation
(800) 345-2700
www.gehealthcare.com
Price: $28,000 to $65,000
FYI: GE's latest product improvement is known as Pressure Controlled Ventilation - Volume Guaranteed, which can be found on the company's newest anesthesia machines, the Aespire 7900 and Aisys Carestation. The purpose of this feature, known in shorthand as PCV-VG, is to maintain a consistent tidal volume. Pressure control assists in maximizing time for gas exchange and helps prevent baratrauma, says the company.

Compliance changes in patients with each breath, especially in laparoscopic surgery, gas insufflation or in Trendelenberg position. Further, packs, retractors, position, surgical exposure and degree of relaxation are all factors that alter compliance. GE's SmartVent ventilation feature measures the patient's compliance breath-to-breath and delivers the selected tidal volume in a pressure control waveform so that you can better dial in the target pressure, even as volume changes with compliance, says GE.

Both machines also utilize the company's patented Advanced Breathing System, which introduces fresh gas near the inspiratory check valve and optimizes low-flow anesthesia delivery. This ensures that there are only 2.7 liters of volume and a quick reaction time to adjustments in fresh gas concentration, optimizing low-flow anesthesia delivery, according to GE.

The Aisys Carestation has a feature it calls Inview Patient Displays, which lets you position the patient monitoring, ventilation data and controls exactly where you want them. The gas and agent consumption numbers are displayed to help surgical centers track usage and thereby measure costs.

Keomed
Prima SP3
(800) 328-6216
www.keomed.com
Price: Not disclosed
FYI: The Prima SP3 is Keomed's newest anesthesia machine. The new AV-S ventilator incorporates six ventilation modes: volume, pressure, spontaneous monitoring, pressure support, SIMV and SMMV. The monitor is a large color touchscreen. The Prima SP3 also has the capability to capture the electronic data to be integrated with the anesthesia data management systems, according to Keomed.

The Prima SP3 also accepts the A200SP Absorber, an ergonomic, low-flow heated desflurane absorber that is said to enhance patient comfort through moisture reduction. The bag/vent control interface on the absorber provides automatic AV-S ventilation mode switching; its airway flow sensors and an oxygen monitor can be easily integrated into the system. A quick-release canister allows for standard pre-pack or loose fill options.

Oceanic Medical
Magellan Model 2
(913) 874-2000
www.oceanicmedical.com
Price: $37,000 with accessories
FYI: Oceanic Medical is introducing its Magellan Model 2 this fall. There are three main improvements to this model over the Magellan Model 1, says the company. First: There are several power sources built in so the anesthesia provider can use this 45-pound anesthesia machine anywhere. There are rechargeable NATO batteries and transformers that let the machine work with global voltage and current specifications. The second main feature is the new ventilator that's pneumatically powered and is time-cycled to work on all ages of patients, from neonatal to adult. Using a high-pressure drive with an internal resistance, the pressure is controlled and the flow pattern remains constant. The third feature is the built-in air compressor; its oxygen concentrator draws ambient air in and separates the oxygen out. There are no cylinders in this machine.

The machine is made to be mobile and used in rigorous environments. The only maintenance tools required are a screwdriver and a wrench, says Oceanic. The quick-connect feature lets the anesthesiologist adjust to all types of operating situations, whether controlled ventilation or continuous-flow intermittent mandatory ventilation is required.

Paragon Service
Platinum SC430
(800) 448-0814
www.paragonservice.com
Price: $32,900
FYI: Paragon Service's year-old Platinum SC430 anesthesia system is designed for flexibility and ease of use, according to the company. A large, color touchscreen provides a one-touch user interface for today's fast-paced surgical environment, says the company. The system also features open architecture for monitors and accessories to accommodate flexible specifications. A heated absorber reduces humidification within the breathing system. By keeping the absorber warm, moisture doesn't get a chance to condense.

Paragon is quick to tout the benefits of the Platinum SC430's standard pressure-supported ventilation. The way it works, says a representative, is that the patient initiates the breath; the ventilator then continues the breath to assist the patient in breathing, following the individual's breathing pattern. This is said to ease emergence and recovery because it saves the patient from having to do all the breathing on his own, wasting precious energy while the body is in what is still essentially a critical state.

Spacelabs Healthcare
Sirius 3000
(800) 522-7025
www.spacelabs.com
Price: not provided
FYI: Last year, Spacelabs Healthcare acquired manufacturer Blease and as a result added the British-based company's Sirius anesthesia machines to its product lines. The fully configured Sirius 3000 features the Precision Pressure Control Ventilation system, which uses a variable inspiratory flow and an active proportional exhalation valve during the entire inspiratory time, says Spacelabs. Both valves work in conjunction to maintain target pressure. This machine won't overshoot the pressure, which can hurt the patient with insufficient gas volumes. Also, the fixed flow rate is usually higher during the inspiratory phase.

The company also introduced a new perioperative monitoring suite, which includes three main features, to go along with the Sirius machine:

• a multigas analyzer that measures O2, CO2 and N2O, as well as five anesthetic agents and identifies mixed agents;
• software that includes a start- and end-case function that changes modes with the touch of a button to speed transition time between patients; and
• the BISx module, which delivers up-to-date information on monitoring the patient's depth of consciousness and level of sedation.

Ulco
Integrus PSV
61 (0)2-9-519-5881
www.ulcomedical.com
Price: not provided
FYI: This Australian anesthesia machine manufacturer recently released a Tee-Piece Circuit Adapter to allow Ayre's Tee-Piece (or Jackson-Reece) style circuits to be used with the inbuilt ventilator on its latest anesthesia machine, the Integrus PSV. The internal ventilator acts as "Tee-Piece Occluder," which in combination with the add-on circuits, can be used to ventilate neonatal or pediatric patients without the provider's having to manually bag the patient for the entire operation, says the company.

Another improvement to the Integrus PSV is the Medical Minimal Flow Shutter Valve, which replaces the yellow silicone shutter valves on the carbon dioxide absorbers. This new valve assists in ultra-low flow anesthesia techniques to reduce the amount of anesthetic agent used in a surgery, thereby decreasing costs. In addition to saving money, this adaptor is also environmentally friendly because it reduces the N2O gas and anesthetic agent released to the atmosphere, according to Ulco.