Finding the Right Anesthesia Machine for Your ASC

Patient Safety Patient Experience Infection Prevention Anesthesia

By: Joe Paone

Published: 8/26/2021

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The unit should fit your procedural mix, provider preferences and requirements for portability and space.


At their core, anesthesia machines are basically all the same: They administer inhalational agents to induce sedation or general anesthesia while maintaining the patient’s respiratory state. Newer models, however, can vary significantly in terms of form, function and enticing add-ons. So how do you determine what your facility needs in a new unit? For surgery center administrators, the purchasing process boils down to a familiar value-based equation: acquiring necessary clinical and safety features within budget constraints.

“More isn’t always better, especially in the outpatient setting where an anesthesia machine needs to do what it’s supposed to do and be something you don’t have to worry about,” says Thomas Durick, MD, an assistant professor of anesthesiology at The Ohio State University Wexner Medical Center in Columbus.

When it comes to selecting the right anesthesia machine, Dr. Durick suggests going directly to your best source of information, your anesthesia team, and asking:

  • What features do they need, like or find useful? 
  • What ventilation modes do they use most often, or feel are necessary?
  • Would a basic machine serve their purposes, or do they need certain premium features?
  • Do they need medical-grade air in addition to oxygen and nitrous oxide for current or future cases?
  • Do they need jet ventilation capability for some airway cases?

Of course, answers to those questions will vary from facility to facility. You also need to factor in these key considerations before making a purchasing decision.

• Procedural mix. “In ambulatory centers, we do a lot of smaller, quicker cases with monitored anesthesia care,” says Steven Gayer, MD, MBA, FASA, chief of anesthesia at Bascom Palmer Eye Institute of Miami, Palm Beach and Naples, Fla., professor of anesthesiology at University of Miami Miller School of Medicine and emeritus chair of the American Society of Anesthesiologists’ (ASA) Committee on Ambulatory Surgical Care. In those shorter cases, he says, the provider isn’t using the ventilator portion of the machine, just simply providing auxiliary oxygen to the patient through a nasal canula.

On the other hand, if you’re performing intensive orthopedic procedures, Dr. Gayer says a full-featured machine similar to those found in hospital ORs is required. “You’d want to have everything you’re capable of doing in a hospital setting in terms of ventilating the patient and the ability to view the standard ASA monitors one needs to employ when administering an anesthetic,” he says. Then, there’s outpatient bariatric surgery and pediatric cases. These patients can be difficult to ventilate, so anesthesia providers in those specialties might require machines that are more advanced in managing airway pressures and volumes, says Dr. Durick.

PURCHASING POWER
BEST SUITED Anesthesia providers’ requirements for anesthesia machines can vary greatly across different surgical specialties.

Thomas Durick, MD, an assistant professor of anesthesiology at The Ohio State University Wexner Medical Center in Columbus, suggests touching on these topics with sales reps: 

• Are their technicians certified, insured and experienced?
• What happens if the model you purchased is suddenly 
discontinued or no longer supported? 
• Do they have a large enough inventory of regularly needed parts?
• Are loaners or rentals immediately available?
• Are they willing to provide references and guaranteed ‘uptimes’ for their machines?
• Do they work with the main EMR vendors?
• Will your current vaporizers work on the new machines or do you need new ones? 
• Will they take your current machines in trade and haul them away?
• What is the cost of the service contract and frequency of service? 

—Joe Paone

Eric K. Shepard, MD, FCCM, anesthesia director at Frederick (Md.) Surgical Center, and director of regional anesthesia-Maryland for North American Partners in Anesthesia group, suggests surgical center leaders focus on efficiency. “The ventilator should be very simplistic to use, where you pick your mode, your rate, your volume,” he says, adding that an adequate and appropriate number of modes is mission-critical.

“You want to have more than just your standard volume mode,” says Dr. Shepard. “At a surgery center, we’re more interested in spontaneous breathing modes, so you want a pressure support mode if you’re putting in an LMA, but still want the patient spontaneously breathing. A volume support mode in, in addition to volume control, is an added plus, but not a requirement, if you’re handling larger and more obese patients.”

Consider future growth when evaluating these machines, too. “Like any ASC on a budget, you do things somewhat incrementally,” says Dr. Shepard. “For example, we weren’t really doing many general anesthetics in our retina room, but when we started doing total joints, we purchased a new machine for our ortho room.” One favorable aspect of many anesthesia machines for budget-focused ambulatory centers is their modularity. “You can purchase exactly what you need for your patients and surgical procedures,” says Dr. Gayer, adding that this feature is a huge time-saving opportunity for high-volume centers.

• Versatile ventilators. Dr. Gayer says most new machines offer varying ventilation capacities, enabling providers to ventilate based on pressure, volume, pressure with volume or volume with pressure. For certain specialties, these features are critical for both clinical and safety reasons during cases with gentle sedation or monitored anesthesia care.

“When surgery is being conducted around the face, as in ENT or plastic surgery, we want to avoid creating a high oxygen environment where you can have a fire,” he says. “It’s important to be able to give auxiliary air or, even better, to be able to blend auxiliary oxygen and air to come up with the lowest possible fraction of oxygen you can get away with.”

He says this “blender option” to combine air and oxygen through an auxiliary port is a new component in many machines.

• Size and maneuverability. Square footage is limited — and valuable real estate — in many outpatient ORs. “When you have limited space, a more compact and movable machine is definitely a benefit,” says Dr. Gayer. “You want something that weighs less, and perhaps occupies a smaller footprint. You want to be able to easily unlock the wheels with a foot pedal or switch.”

• EMR integration. Anesthesia machines can generate and transmit a wealth of valuable data directly into patient records. However, EMR integration is not without its potential drawbacks. “It’s about how you implement it,” says Dr. Shepard.

During fast cases with the patient on a stretcher and tight turnaround times, EMRs can actually slow anesthesia providers down. “If there are a required number of computerized inputs you need to add to get started, that can create a problem,” says Dr. Shepard, noting that the process can be expedited with EMR templates. “If you’ve got to enter all the data for each case manually, that can really slow you down.”

• Low flows. Another issue is which inhalation agents your anesthesiology providers need. “You need to purchase an anesthesia machine with the vaporizers for the agents you’re going to use,” says Dr. Gayer. “Do you want the full range, or can you limit it to one or two or three? They all have different needs in order to vaporize them and administer them.”

The ability to deliver inhalation agents in low flows is an important waste-reducing feature of newer machines, he adds. “You can titrate down the flow of inhalation agent and the carrier that goes with it very, very low,” he says.

PROVIDER PREFERENCE Consult with your providers to find out not only what they need out of new anesthesia machines, but also what they don’t need.  |  Alexander Rodriguez, Bascom Palmer Eye Institute

• Interconnectivity and compatibility. Dr. Gayer also reminds surgical leaders to consider plug-and-play capabilities of anesthesia monitors and their connections. “If the monitors are different brands or have different connections, you have to put on one set in the preoperative area, then remove them and put on another set in the OR, then remove those and maybe put on the first set in the recovery room,” he says. “You want to find an anesthesia machine and monitors that are all in sync and use the same peripherals — blood pressure cuff attachments, oxygen saturation attachments, EKGs — so you apply them to the patient only once.” In this scenario, when the patient is transported to the OR, a provider simply plugs the same connections into the monitors there, and then again in the PACU.

Some manufacturers have refined interconnectivity to an even greater degree, he says, offering a box that is basically an anesthesia monitoring CPU. “Instead of disconnecting the different monitors, you just disconnect that box from the monitor in the preparation area, bring the patient into the OR and plug the box into the anesthesia machine.”

Compatibility with other equipment in the OR is vital as well, notes Dr. Durick. “An upgrade in one area can lead to surprising expenses to upgrade other areas — vaporizers, computer mounts, waste gas scavenging systems, oxygen cells, suction,” he says.

• Easy upkeep. “Properly maintained and serviced anesthesia machines can last years or even decades,” says Dr. Durick. “But when they fail, everything comes to a screeching halt.”

Because these machines are more electronics-based than they once were, maintenance goes beyond mechanical issues. “For the most part, anesthesia machines rarely ‘break,’ but they are not immune to the same issues that affect laptops and smartphones,” says Dr. Durick. “They occasionally need a reboot to get working again.”In centers doing short cases, quick startup times and reboots are crucial, says Dr. Shepard. “Our machines go through an interactive self-test in the morning, so you want to make sure that doesn’t take forever,” he advises.

Quick reboots can be crucial for safety reasons as well, says Dr. Shepard. “You need to make sure that when the machine is off, you still have oxygen flowing not from the circuit, but a little nipple flow meter like you’d have in any hospital room that works independently of the machine,” he says. “If you need to turn the machine back on very quickly, you want to be able to override the self-check and get basic functions up and running immediately.”

Ultimately, virtually all of the newer anesthesia machines have plenty to offer. As Dr. Shepard puts it, “I can’t think of a machine that’s come out in the last decade that I wouldn’t use today.”

It’s up to you to work closely with your anesthesia providers to identify the one that hews most  closely to their needs. OSM

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