Deployable Anesthesia
Battlefield surgery has improved significantly since the Civil War when surgeons anesthetized patients with chloroform. One of the major improvements was the development of the portable anesthesia machine—a rugged device that could be used by forward surgical teams.
by Al Staropoli, MMT Correspondent
Battlefield surgery has improved significantly since the Civil War when surgeons anesthetized patients with chloroform and amputated shattered limbs with scalpels and bone saws.
One of the major improvements was the development of the portable anesthesia machine—a rugged device that could be deployed and used by forward surgical teams.
The U.S. Army Medical Materiel Development Activity at Fort Detrick began toying with the concept of a mobile anesthetic unit nearly 20 years ago, but portable devices with ventilators were only ordered by the U.S. Army for battlefield use in the early 2000s.
The Kansas-based Oceanic Medical Products Inc. obtained FDA clearance for such a device in 2001. The Magellan, a pneumatically-driven portable anesthesia device, was first tested in five hospitals of the U.S. armed forces before finally being deployed to the battlefield in 2004.
“Equipment was sent to Afghanistan for battlefield evaluation. Based on the after-action reports, we made some adjustments,” said Rodney Peake, president of Oceanic. “We had a lot of help from the Army and Navy. They had a lot of input into the design of the machine. So in large part it was designed by the military for the military.”
In 2006 Oceanic was awarded a $25 million, five-year contract to develop more units. The company’s latest model, Magellan-2200 Model II, was developed, in part, by taking into account feedback from users in the field.
Magellan-2200 Model II is lighter and more compact than its predecessors, allowing for only one operator, instead of two, to set up the machine. It also allows for a variety of power options including electricity, compressed air and even direct current (through a jumper cable to a battery). The unit has a battery backup that allows it to operate for a few hours when power goes out.
Model II also has visual as well as audible alarms as well as the ability to adjust how often and how deeply the patient breathes. Lacking any ferrous components, the Model II is practical when there’s a need for its use in conjunction with an MRI.
Besides portability, the Magellan differs from other anesthesia devices in its ruggedness. “It passed the military standards 810, the testing protocol that takes into account extreme heat, cold, moisture, dirt, sand storms, vibration testing and dropping,” said Peake.
The Magellan-2200 Model II weighs about 100 pounds when fully enclosed in its hard-side suitcase, which doubles-up as a stand for the device. It’s fully self-contained with everything needed for use, except for the anesthesia itself.
Magellans have applications beyond the military. They have been used after natural disasters, such as hurricanes, where lack of electricity and accessibility to the disaster area make a compact model ideal.
It was used during relief operations by civilians following the 2003 earthquake near Bam, Iran, which caused major destruction and took thousands of lives. Magellans have also been used in Argentina, Canada, Chile, Columbia, India, Malaysia, Singapore and Thailand.
Another portable anesthesia is the Fabius, developed by Draeger Medical Inc., a German-based company with a subsidiary in Pennsylvania. Draeger has a long-standing reputation and has been developing anesthesia devices since the early 1900s. The company’s Fabius Tiro portable anesthesia device obtained FDA approval in 2003. Since then, the device has been successfully adopted by hospitals worldwide.
But it wasn’t until late 2007 when a new version was launched, the Fabius Tiro M, which was developed exclusively with the military in mind. The Fabius Tiro M model was developed along with military experts and is more durable than its previous versions.
It meets military standards of shock and vibrations, allowing it to be carried along rugged terrains or even delivered by parachute if properly packed. The ventilator’s piston technology eliminates the need for a compressed gas source to drive the ventilator, which is an important consideration in field environments.
Fabius Tiro M can be set up by one person in 15 minutes without using tools. It fits in a container roughly the size of a cube with 30-inch sides and weighs 198 pounds when loaded in its container.
In the 1980s, before the recent development of portable anesthesia machines, the Army used a model called the drawover anesthesia device. It was developed by Datex-Ohmeda (now GE Healthcare).
“It’s essentially a vaporizer and a breathing circuit to the patient,” said Mark Arnold, product manager, U.S. Army Medical Materiel Agency. “The drawover vaporizer has no means of automatic ventilation of the patient. It’s as basic an anesthesia device as you can possibly have.”
It’s a simple machine consisting of very few parts—essentially a self-inflating bag attached to a vaporizer via a series of tubes. This bare-bones device is very light and low in cost but has some major drawbacks.
Unlike the Magellan and Fabius it does not include a built-in ventilator, which means that a person is needed to manually squeeze a bag that provides air to the patient. Another major drawback is that the device is no longer produced.
The portable anesthesia machine market is a niche market with very few players in the field. It capitalized by taking already existing technologies and reducing their volume and weight while adding ruggedness to their portability, making them usable under adverse conditions.
While there is always room for improvement, portable anesthesia machines currently meet the battlefield needs of forward surgical teams, while introducing a higher level of safety and hopefully better patient outcomes. ♦