TECH SAVVY Newer anesthesia machines should be able to communicate with EMRs, quality assurance programs and billing systems.

If you're in the market for a new anesthesia machine, it's important to maintain perspective — to remember that anesthesia providers who spend the bulk of their time in outpatient settings aren't likely to be dealing with arterial lines or central venous pressures. They're not anesthetizing neonates or patients with severe pulmonary issues. They don't need the same level of sophistication you'd need in an intensive care unit. The best way to invest in a machine that's ideally suited for same-day surgery is to understand the differences between essential features and unnecessary bells and whistles. Start by considering these 5 factors to ensure you get the right-sized bang for your anesthesia-machine buck.

1. Ease of use
What might seem like the most basic consideration can make a big difference in maximizing the efficiency of room turnovers. For example, how easy is it to manage the cords and cables on a given machine? Some models integrate them into the back of the unit, keeping them off the floor, reducing the tangle and eliminating the need to clean them between cases. Other details also matter. Consider how easy a machine is to set up and turn on, and how long it takes to run through its automated checks that ensure it's primed and ready for the next case. If a machine connects to electronic medical records, how intuitive is it to enter patients' names and clinical information before cases and record clinical data during surgery? Finally, look for models with smooth surfaces that are easy to wipe clean between cases.

2. Easy upkeep
Along with the initial cost of the machine, the big money is going to be in maintenance and downtime. A hospital might be able to afford a machine that's out of service for 2 days every time maintenance is required, but that's not going to work at most surgery centers. In addition to what reps tell you about maintenance and failure rates, be sure to talk to people who've used the machine. And if possible, talk to biomedical engineering experts to find out what they think about the serviceability of a given piece of equipment.

COMPACT MODEL Many of today's anesthesia machines take up less floor space in the OR, but still include the features your providers need to deliver advanced anesthesia care.

3. Interoperability
This is a tricky area. Ten or 15 years ago, I'd have had no problem advising most outpatient facilities to buy used or refurbished anesthesia machines as cheaply as possible — as long as they could be used to treat patients safely and effectively. But if you buy an older machine today, it might not be able to interface with EMRs, quality assurance programs and billing systems. That's an important consideration in today's digital world.

Outpatient facilities have so far been spared the edict to convert to EMRs. If you work in a surgery center that hasn't yet gone paperless, it might be a cost-savvy decision to settle for an older machine now and put off investing in an upgraded model until your facility is required to make the conversion to electronic recordkeeping. There's no doubt that day is coming, however, so if you're planning to buy a new machine, you'll want one that lets you enter and record all electronic data as efficiently as possible. Be sure any new machine you're interested in can interface with your facility's electronic records. Do your research to know what you need and what you're buying, and don't settle for anything less than full interoperability.

4. Low-flow capabilities
Volatile anesthetic agents like sevoflurane and desflurane are expensive, so anything that reduces the volume you use is going to save money. If you're in the market for a new machine, you'll likely hear a lot about low flow — the anesthesia equivalent to using the autopilot system in a plane at cruising altitude.

The idea behind low flow is fairly simple. Once the patient is asleep (at cruising altitude, you might say), the goal is to maintain that steady state with just the right mix of fresh gas (air, oxygen and/or nitrous oxide) and vaporized anesthesia agents. The less fresh gas you use, the less anesthetic agent you need to maintain the same mix and the same steady state.

Some manufacturers say their machines make it easier to deliver low flow. That may be true, but the reality is that most anesthesia providers have known for a long time how to facilitate low flow. It's not that difficult, so I'd be skeptical about spending extra on a machine that claims to make it easier. I'd want to hear the business case as to why I need that (or any other) feature, and I'd want to see real numbers.

The concept of low-flow anesthesia may also be less important in the outpatient setting, because cases tend to be shorter. As with a short airline flight, you may spend a lot of time taking off (induction) and landing (emergence), but very little time cruising through the steady state, which is when low flow is most valuable. If you're doing a 10-hour neurological procedure, low flow will save a significant amount of money. It won't shave much of the case cost of a 30-minute knee scope, however.

5. Small footprint
Square footage is at a premium in the outpatient setting. Fortunately, you don't need a big machine to match the capabilities of more complex units. Several newer compact machines were designed with space-conscious surgery centers and smaller hospitals in mind. They take up less floor space in the OR, but still include the features your providers need to deliver advanced anesthesia care.

Ask the experts
With all the accessories available on today's anesthesia machines, many of which add little or no value to patient care in the outpatient environment, you can overspend by tens, or even hundreds, of thousands of dollars if you're not thorough and diligent in researching and understanding your options. There's a huge difference in price between top-of-the-line monitor and ventilator machines and alternative stripped-down versions.

If you're considering spending a significant chunk of money on new machines, be sure to get input from the providers who are going to be using the equipment on a daily basis. Ask for feedback from members of your anesthesia team who have as much business sense as clinical expertise to ensure you're investing in cost-effective machines that meet your facility's needs. OSM