Medical Equipment News

As in our first and second posts on full-size upright anesthesia machines, we’re using the Integra SP I and Integra SP II to compare features available on the leading units in the anesthesia machine market. (If you’re shopping for such a unit, feel free to visit our sponsor.) In this post, we’ll analyze the importance of warranty and maintenance costs, CO2 absorbers and mounting/compatibility options.

Warranty and Maintenance

A new anesthesia machine should last about 15 years, but that lifespan varies between manufacturers. Of course, there is no crystal ball to tell when your anesthesia machine will fail or break down, but the warranty offered by the manufacturer is often indicative of the quality of the product. Most anesthesia machines offer a two year defective parts warranty and a manufacturer’s warranty of about the same length. Be cautious of new units that are accompanied by a warranty of less than two years; buying a cheaper unit in the short run frequently leads to greater maintenance and repair costs in the long run.

While not as costly as a repair, regular maintenance is certainly an expense that concerns many facilities that own anesthesia machines. Most units require four preventative maintenances a year; new technology, however, enables some units to operate with only half that many. The SP I and SP II are both equipped with such technology, thus cutting their maintenance expenses in half.

Aside from the quality of the machine itself and the corresponding warranty offered, the next greatest determinate of repair expenses is the way the unit is designed. Foremost among these design measures to look for is the non-integration of monitors, ventilators and vaporizers. For instance, if the unit you purchase features an integrated oxygen monitor that fails or breaks down, the expense of repairing or replacing it will be inflated by the hassle of removing it from the machine as a whole. Furthermore, in the case of such a failure, you would have to wait until the monitor is repaired to use any part of the machine.

CO2 Absorbers Newer anesthesia machines often feature a double canister CO2 filter. Why two filters? For the same reason you might install a secondary filtration device on your facility’s water supply or ventilation system: while having one filter keeps things clean, having two filters increases the effectiveness of the filtration system as a whole. Increasing the percentage CO2 filtered per cycle is important to maintaining proper concentrations of oxygen and NO2 in a patient, and that precision is vital to the safety of your patient and the success of your procedure. Contrarily, twice the filtration should not have to mean twice the clutter. The insightful ergonomic design of the Integra series accounts for the limited space in many facilities by building in a storage space for the canisters under the work shelf – within reach for accessibility, but out of the way for productivity.

Mounting and Compatibility Because every facility has a unique setup in which it uses its anesthesia machine, it’s important to choose a unit that allows you to mount both the equipment you already have and any equipment you may plan to purchase in the future. For instance, the Integra SP series features a versatile T-slot side mounting design that allows for pole-mounting, v-brackets and ventilator brackets. Of course, the importance of each of these is determined by the setup of your facility, but v-brackets are in many cases a must. V-brackets can mount gas scavenging units, suction units and other access. Pole mounts, also provide a versatile mounting system, accommodating entire upright ventilators as well as bellows alone. Ensure that your choice of anesthesia machine does not limit your choice of vaporizers: every system is not compatible with every vaporizer. Contrarily, both of our comparison specimens feature a Selectatec®-compatible vaporizer mounting system that is diverse enough to accommodate an entire array of makes and models.

In today’s market of ever-expanding technology, the issue of compatibility stretches far beyond the realm of simple connections; today’s machines must interact and cooperate with any number of systems. One of the most overlooked OR harmonies that may not seem immediately apparent is that of MRI compatibility. If your facility requires the storage and usage of an anesthesia machine in the same room as an MRI machine – as many facilities do – the ability to operate the two within close proximity is invaluable. Even more important, and tangible, is that of compatible ventilators. The Integra SP I and II are both compatible with the DRE AV800, Ohmeda 7000 and 7800. Most units make ventilator options apparent in their sales literature, but if they do not, ask your sales associate for a complete list.

Conclusion Now that we’ve covered the field of features available in today’s anesthesia machine market – or at least as many as would fit in these three blog posts – we hope you are able to make a more informed purchasing decision with greater confidence, less frustration and higher satisfaction. Our sponsor also hopes you’re a bit more informed about the advantages of their product line, and we of course encourage you to experience them for yourselves.

Yesterday, we posted the first of our three part series on full-size upright anesthesia machines in which we discussed the importance of considering size and mobility when shopping for anesthesia machines.  Today, in the second part of this series, we take a look at the merit of various technologies in gas management.

Gas Management Of course, finding a unit that is the right size for your facility is important, but we also recognize that you’re not buying a unit just to fill space. As anyone in the market for an anesthesia machine knows, anesthesia is an exact science that relies upon the utmost precision. If administered properly, anesthesia can save lives; if mismanaged, it can be fatal. Consequently, when shopping for an anesthesia machine, it is important to choose a unit with the latest technology in gas management and administration. First and foremost among these features are those pertinent to protecting a patient from an influx in chemical concentration. For instance, the Integra SP I and Integra SP II are both equipped with a Mechanical Anti-Hypoxic Device (MAHD). Designed to prevent the delivery of a hypoxic mixture to a patient, the MAHD regulates the concentration of gases administered to ensure sufficient oxygen flow. This technology greatly deters the likelihood of harm via human error by eliminating the possibility of the administration of an oversaturated concentration. So if the oxygen level is increased or decreased, the chemical level is altered accordingly.

Just as important as a MAHD is an Air/N2O interlock. This technology ensures that if the oxygen supply pressure drops, the amount of chemicals being administered is corrected to maintain the proper chemical concentration level. Much like a MAHD, this technology is designed to protect the patient from dangerous level of chemical delivery, but while the MAHD safeguards against personnel administering inaccurate dosages, the Air/N2O interlock prevents an internal failure. The integrated Air/N2O interlock built into the Integra SP I and SP II works in cooperation with a diaphragm pressure regulator to reduce the pressure of the compressed gas supply and a pressure relief valve. The system is factory set to prevent any pressure build up under the diaphragm in case of leakage. Regardless of whatever technology is built into the system, it is always important for a unit to display pressure gauges for oxygen, N2O and air in an accurate, easy to read format. For more detailed information of oxygen levels both in the system and the patient, one may consider purchasing an optional oxygen monitor.

Patient safety is certainly the top priority to be considered in gas management features, but a close second is operating costs. The greatest costs affiliated with gas management are the use of medical grade gases; it is for that reason that units like the Integra SP I and SP II are designed with low flow oxygen systems. Available on only a handful of units, the low flow oxygen system allows a machine to operate for a longer duration on a smaller supply of oxygen. Much like today’s hybrid cars which achieve higher mile per gallon ratios, low flow oxygen management mitigates what can, for small and large facilities alike, be a substantial expense.

"Chances of survival from sudden cardiac arrest decreases 10 percent each minute after collapse," said Mary Newman, executive director for the National Center for Early Defibrillation. "The key to survival is quick action on the part of those near the victim, so it is critical that people be prepared." In recent years AED technology has received rave reviews and support from national organizations like the American Heart Association and the Red Cross. It has become the device of choice within airports, schools, sporting events, industry, and many other venues where time is critical and ease of use is important.

In the state of Florida, the Florida Board of Dentistry recently implemented a new office safety requirement where every dental office location shall be required to have an automatic external defibrillator by 02/28/2006. This and other similar legislation is becoming much more common.

As would be expected, most dental and oral surgery offices either have an AED on hand or are currently considering one. Many offices have had the technology in place for several years. What is sometimes overlooked is the importance of a proper maintenance and readiness process in the case of an eventual emergency situation.

The American Heart Association and the Red Cross both promote an essential four part process to integrate effective early defibrillation through AEDs into a life saving technique.

1. Quickly call the EMS 911system.
2. Promptly giving CPR when needed
3. Early Defibrillation -- having proper equipment and being trained to use it when indicated.
4. Ongoing and advanced cardiovascular care.

For those who need basic training, the American Heart Association offers a Heartsaver AED Course which teaches the fundamental techniques for effective use. It is a 3 hour course and recommended for people that may be in a situation to use an AED. For more information call the AHA at 1-800-242-8721 or visit their website at http://www.americanheart.org/

Is Your Equipment Ready? Along with proper CPR and AED use training it is extremely important for staff to periodically check the AED equipment to insure good working order.

Below is a short checklist of things to consider:

• Placement of AED is in visible location and near phone.
• Verify proper battery installation.
• Check the status/ service indicator light.
• Note absence of visual audible service alarm.
• Inspect exterior components and sockets for cracks.
• Check for two sets of AED pads in sealed package.
• Keep at least one set of pediatric pads available when applicable.

In some cases it may be time to update your AED technology. In such cases here are some tips on what to look for:

• Does the unit self check on a daily basis and warn upon device failures?
• Does the unit test the pads?
• Is the unit Adult and Pediatric capable? (It is not recommended to use adult devices on pediatric patients.)
• Guidance and instructional prompts should be included for untrained users. Most new devices have audible verbal instruction and pictorials for ease of use.
• Battery life should be 3 plus years. Most new units have extended life batteries.