Thinking of Buying: Anesthesia Machines

Five or 10 years ago, a basic anesthesia machine was perfectly suitable in many outpatient ORs. Times have changed, however, as the differences between hospitals and surgery centers continue to narrow. Surgery centers are now caring for larger, older and sicker patients, and performing more complex surgeries such as total joints. This wider pool of patients can present significant anesthetic challenges compared with the younger, healthier individuals who once were the prototypical outpatient surgery patient. Patients who present for surgery with more comorbidities require more finesse in their anesthetic care. As a result, anesthesia providers working at many outpatient centers now require anesthesia machines that offer more precise, versatile controls and richer functionality.

For anesthesia providers the most basic anesthesia machines at ASCs usually worked just fine. If the machine had a manual ventilation mode, basic oxygen and at least one vaporizer, they were good to go. That’s no longer the case. Sleek new platforms designed for fast-paced surgery centers boast small footprints and the control providers need to manage more complex surgeries and sicker patients. 

Assessing the following features when shopping the latest options in anesthesia machines will help you find a model ideally suited for your ASC. 

• Ventilation modes. Units with multiple ventilation modes allow anesthesia providers to administer safer anesthetic care. These additional modes — which providers didn’t use as much, or ever, before at outpatient centers — not only enable them to deliver safer care, but also make surgery far easier on the patient while increasing efficiency for the center. For example, I prefer to work with machines that can manage two vaporizers so I can administer either desflurane or sevoflurane. Because efficiency is an issue both clinically and financially at centers, I prefer to administer desflurane because it results in faster emergence and less need for oral airways in the PACU. I also want to be able to administer sevoflurane to certain patients such as children, because the pungent smell of desflurane makes it a less than ideal choice during inhalation inductions.

Anesthesia providers work on a continuum at ASCs, flowing with a patient from pre-op to the OR and to the PACU. We might need to be more conservative about how we drop patients off in the PACU than we would be in a hospital setting where there is typically a float provider available for issues such as airway obstruction. Having a desflurane vaporizer available is optimal because patients will wake up much faster, which prevents providers from taking a groggy patient with an oral airway into the PACU. 

There are several modes of ventilation available on current anesthesia machines that offer varying degrees of functionality: volume-controlled ventilation (VCV); pressure support ventilation (PSV); synchronized intermittent mandatory ventilation (SIMV); pressure-controlled ventilation (PCV); and pressure control with volume guarantee (PCV-VG). When evaluating anesthesia machines for your surgery center, you want to find the middle ground. To some degree, your choice should be tailored to your specific surgery center. If your facility specializes in GI, your care team will barely use a ventilator, let alone advanced modes. In this setting, VCV and PCV, the most basic modes, would be appropriate. But the patient populations at most of today’s surgery centers will require more than these basic, one-size-fits-all modes. If you’re a multispecialty surgery center performing complex surgeries with inhalational anesthesia, the enhanced modes are especially useful.

• Monitoring. Every anesthesia provider needs the basic and accurate monitoring of oxygen concentration, gas concentration and end-tidal CO2. Many anesthesia machines have these modalities built-in, while others require the use of standalone monitors. For example, some machines have a separate gas analyzer attached to the oxygen monitor. Machines with integrated monitoring modalities are more expensive, but are the more user-friendly and clinically efficient option.

• EMR integration. As more ASCs transition away from paper charts, newer anesthesia machines are compatible with EMR platforms. EMR integration is an important consideration when upgrading anesthesia machines, monitors or when outfitting a new ASC. When the monitor brand is different from the make of the anesthesia machine, EMR integration can be difficult. Some machines require an adapter (one example is called a capsule) that acts as a data networking intermediary between the machine, the anesthesia monitor and the EMR. If your machine is EMR-capable but you can’t get it to automatically feed data to the EMR, your providers might still need to enter the information manually. This isn’t optimal when there are many solutions that allow for automatic data capture. 

• Compact designs. Floor space at surgery centers is valuable real estate, so anesthesia machine manufacturers are offering versatile units with advanced capabilities in smaller footprint. Still, you might need to pull back on some options if there isn’t a lot of room to move around the sterile field. Every anesthesia provider would love a machine with a wraparound workstation and all kinds of drawers and storage options, but you might need to forgo these bells and whistles if space is a major concern in your ORs.

• Intuitive controls. I’ve used machines with touchscreen controls that were difficult to navigate and at times unresponsive. I’d repeatedly push on the screen to switch the ventilation mode, but it wouldn’t work. That’s not just a time-wasting annoyance, it can also present a patient safety issue. The good news is that many newer machines have user-friendly touchscreens with great functionality that make operating them a breeze.

The key to purchasing the best anesthesia machine for your surgery center is to involve your anesthesia providers in the purchasing process from the start. Let them trial machines before you buy them, so they can tell you which features would allow them to provide safe and efficient care. OSM