Anesthesia

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.

There are dozens of units in today’s market for anesthesia machines, and with the ocean of features, accessories and technical jargon surrounding the field, narrowing such a broad market of equipment to the unit that’s right for your practice can prove a challenging feat. The first step in shopping for a new or refurbished anesthesia machine is research – knowing which words to use and what questions to ask. So in this post, we’re going to analyze the traits of the modern anesthesia machine and the vocabulary used to describe them.

To make this analysis as helpful and applicable to your shopping experience as possible, we’re going to compare two of the industry’s leading units: the DRE Integra SP I and the DRE Integra SP II, both available at DRE’s Home Page. We’ve chosen these two units for comparison because they each have a versatile array of features that make them both appropriate for small and large facilities alike, while remaining economical enough for practices of any size to afford. So, now that we’ve selected our specimen, let the analysis commence.

Size and Mobility Possibly the most decisive factor when choosing an anesthesia machine, the size of the machine should be determined by the workspace in which it is used and how often it must be moved. Upright anesthesia machines are inherently large so that controls and gauges are at appropriate viewing heights, but the scale upon which they are built varies from unit to unit. For instance, the Integra SP II is a full 8 inches wider than it’s SP I counterpart. The cause of this discrepancy is rooted in the features each unit offers, but we’ll get to that later; for the time being, size is all that matters. Thus, it is easy to see why some practitioners may prefer the SP I to the SP II: it’s slimmer and lighter – 50 pounds lighter to be exact. Though the SP II is among the lightest and most agile units in its class (200 lbs) due to its lightweight cast aluminum construction, the smaller SP I weighs in at just 150 pounds. While most anyone can roll 200 pounds with relative ease, if speed and frequency of movement are imperative in your practice you may want to consider the lighter, smaller unit.

Conversely, if available space is your priority, a larger unit like the SP II would certainly be optimal. With just under 400 square inches of shelf space, nearly 350 square inches of work space and 3 spacious built-in drawers, the SP II offers more than enough room for access and storage. Even if you plan to rarely move the unit, it is important to ensure the unit you purchase is equipped to accommodate mobility. Both the Integra SP I and SP II are outfitted with side handles and four 5″ anti-static castors equipped with front wheel brakes.