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. How to choose the right anesthesia machine for your hospital? 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 anesthesia machine 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 – for selecting the right anesthesia machine
There are other ergonomic or utility consideration to select the right anesthesia machine.
| 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 the Right Anesthesia Machine
Consider the following general tips for buying the right anesthesia machine for your hospital over an above the technical features.
- Hospitals can buy integrated anesthesia workstations or customized modular systems assembled from standard components or they can put together their own modular systems.
- Integrated workstation would mean low dead space, compact design with less external connections and most importantly seamless data sharing between components.
- Hospitals should choose systems that are compatible with the ones already in use. This helps reduce parts inventory, standardize training, servicing and processes.
- 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.
- 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.
- 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.
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