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How to choose the right Anesthesia machine for your hospital?

A hospital may purchase an integrated advanced Anesthesia workstation with all the components or a modular system assembled from standard components. The choice of Anesthesia system may depend on varied factors like procedure types, patient profile, budget, compatibility with existing systems, staff’s ability and training to handle the equipment and even space constraints. What are the various components of anesthesia system? What are the features and considerations in buying one? To know more read Basic components of anesthesia machine and advanced features in anesthesia workstation

Anesthesia systems have improved vastly over the years and decades from basic gas delivery devices to integrated and highly automated systems including advanced ventilation, extensive monitoring and display,electronics based controls and operations, audio and visual alarms, with high degree of patient safety features built-in. Higher the degree of sophistication, higher the price.

Some of the safety and operational features present in newer machines may be absent in older machines. However, they were designed to be operated without much electricity, using compressed gas power for the ventilator and suction apparatus. Modern machines which are highly electronic, need battery backup in every component, which can be only for a limited period of time, say 30 minutes. Staff comfort with older machines vs the newer sophisticated systems could also be a significant factor in choice of an anesthesia machine. When faced with budgetary constraints and potentially limited utilization, one may not be in a position to go for an advanced full-fledged anesthesia workstation. In which case, a thorough approach to features comparison would be necessary to make the right purchase.

Before you purchase your Anesthesia Machine, you may want to consider the following checklist (by no means exhaustive) in order to compare and evaluate various options:

GENERAL FEATURES

Features Parameters
1 Brand /Manufacturer name Drager/GE/ Others
2 Model of machine
3 Is it FDA certified? Yes/ No
4 Is it CE certified? Yes/ No
5 Dimensions
Length …cms
Width …cms
Height ….cms
Weight …..kgs/lbs

 

TECHNICAL FEATURES

Technical features  Parameters
6 Gas Delivery System
Gas system 3 Gases/ 2 Gases

Air/ O2/ N2O

Is compressed gas input included? Yes/No
Non-interchangeable Schrader valve connectors for pipeline gas hoses? Yes/No
Non-Interchangeable Screw Thread or Diameter Index Safety System included? Yes/No
Pin Index Safety System included? Yes/No
Colour coding included? Yes/No
Pressure regulator included? Yes/No
Pressure –relief device/valve included? Yes/No
Only one flow control knob for a single gas delivered to the Common Gas Outlet Yes/ No
Anti-disconnection device at the fresh gas outlet? Yes/ No
Airway pressure alarm? Yes/ No
Power loss alarm / Low battery alarm Yes/No
7 Flow meters, Fail Safe & Hypoxic guard
Dual flowmeter for O2 & N2O Yes/No
Electronic flowmeter 3 gas system Yes/No
Is an O2 failsafe device included? Yes/No
Is a hypoxic mixture / ratio controller included? Yes/No
Is an O2 concentration monitor included? Yes/No
Oxygen supply pressure failure alarm? Yes/ No
Power loss alarm / Low battery alarm Yes/No
8 Vapourizers
No of Vapourizers (At least 2 recommended) 1/2/3 vapourizer
Vapourizer technology Tec 6 plus/Tech 5 /others
Is vapourizer interlock included? Yes/No
Is transport setting included? Yes/No
Colour-coded, keyed/ funnel filling system? Yes/No
Is a high-pressure alarm included? Yes/No
Is an expiratory volume/flow monitor included? Yes/No
Power loss alarm / Low battery alarm Yes/ No
9 Breathing Circuit
Circle System Yes/No
Circle absorber Integrated/ Stand alone
Is an expired CO2 concentration monitor included? Yes/No
Is a disconnection/leak/obstruction alarm included? Yes/No
Battery back-up Yes/No
10 Ventilation System
Ventilator  system Integrated/ Stand alone
Ventilator use / Patient profile Adult/Peadiatric   /    Neonatal
If Bellows type Standing or Hanging
If Electronic driven type Piston/ Turbine
Is a suction system included? Yes/No
If not, Is area provided for attaching a suction regulator? Yes/No
Electronic PEEP Yes/No
Is an airway pressure monitor included? Yes/No
Battery Back Up Yes/No
Power loss alarm / Low battery alarm Yes/ No
Bag to ventilator switch Yes/No
Built in Fio2 monitoring Yes/No
Fio2 monitoring- Fuel cell/ Paramagnetic
11 Ventilator Modes
A Volume mode Yes/No
B Pressure control mode Yes/No
C SIMV mode Yes/No
D Other modes
12 Ventilator monitoring parameters
Fio2 % Monitoring Yes/No
Respiratory Rate monitoring Yes/No
Tidal volume Monitoring Yes/No
Minute volume Monitoring Yes/No
I : E ratio Monitoring Yes/No
Airway pressure monitoring Yes/No
PEEP monitoring Yes/No
13  Anesthesia Monitor
Monitor type Preconfigured/Semi Modular/ Modular
 Screen size 10.4″/12″/15″/others
 Display of set values Yes/No
 Display of patient values Yes/No
Monitoring of ECG 5/12 lead
 Fio2 Monitoring Yes/No
Spo2 Monitoring Yes/No
Etco2 monitoring Yes/No
Heart Rate monitoring Yes/No
Temperature Monitoring x2 Yes/No
Agent identification Yes/No
Agent monitoring Yes/No
  MAC value Yes/No
  NIBP monitoring Yes/No
  IBP Monitoring x 2 Yes/No
   Respiratory rate Monitoring Yes/No
   Storage of memory  (trend & data) 72hrs/others
  Battery back up Yes/No
Special features
Audio visual alarms for high/low set values of
  a. Heart rate Yes/No
  b. Spo2 % Yes/No
  c.  Etco2 % Yes/No
  d. NIBP Yes/No
  e. Advanced arrhythmia alarms Yes/No
Wave forms Yes/No
Spo2 wavelength Yes/No
CapNograph Yes/No
ECG traces 3/5/12/others
 a. BIS Yes/No
 b. Entropy Yes/No
Networkable system Yes/No
ECG printing facility Yes/No
Bain circuit Adult /peadiatric
Closed circuit pressure gauge Analogue/Digital/        both
Upgradable features , if any
Power loss alarm / Low battery alarm
14 Scavenging System
Is a scavenging system included? Yes/No
Negative and positive pressure relief valves included? Yes/ No
Connection (s) in scavenging system of the same (i.e., 15-mm or 22-mm) diameter as a breathing system connection? Yes / No

 

OTHER CONSIDERATIONS

15 Other considerations Parameters
Is a back-up battery included?

Is it a trolley mount unit?

Is it a wall mount unit?

Is it a rail mount unit?

Is it a ceiling suspended pendant mount unit?

Yes/No

Yes/No

Yes/No

Yes/No

Yes/No

 

16 If used/refurbished,
Year of Manufacture
What is the date of the last periodic maintenance?
Software installed? (Name + Version)
Spares & Accessories available
Track-record of the refurbisher

 

General tips for buying Anesthesia Machine

  1. Hospitals can buy integrated anesthesia workstations or customized modular systems assembled from standard components or they can put together their own modular systems.
  2. Integrated workstation would mean low dead space, compact design with less external connections and most importantly seamless data sharing between components.
  3. Hospitals should choose systems that are compatible with the ones already in use. This helps reduce parts inventory, standardize training, servicing and processes.
  4. If the anesthesia unit is going to be shared between OT rooms, consider factors for ease of movement like trolleys or large lockable caster wheels and a push handle to make it easy to move.
  5. Refurbished or used anesthesia machines which are 5-7 year old but come at 1/3rd to ½ the price could be good buys. Do a thorough evaluation of the working condition of the machine, past service records and/or reputation of the refurbisher, if you are considering one.
  6. Anesthesia carts could be useful to keep items such as intravenous medications, syringes, needles and other items of equipment that caregivers providing anesthesia might need.
Disclaimer : All views and information in this site and the blogs is based on secondary information available in public domain and is provided "as is", with no guarantee of completeness, accuracy, timeliness or of the results obtained from the use of this information. PrimedeQ is not responsible for any errors or omissions, or for the results obtained from the use of this information. Readers are encouraged to independently verify all required information.

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