Machines of Life
THE LIFE AND BREATH OF ANESTHESIA MACHINES.
Just as with any piece of medical equipment that is used in a military environment, finding the right anesthesia machine requires a careful selection process. There are specific characteristics that military personnel look for in order to find the right machine, and that process requires the expertise and practical experience of several medical professionals.
For example, an important factor for the military to consider when choosing an anesthesia machine is the climate of the region where it will ultimately be used.
“In the current environment, we look at if a piece of equipment can survive in temperatures above 120 or 130 degrees and if it is going to be exposed to rain, or if it is going to be exposed to dust and what grade of dust,” said Captain Brandi Ritter of the Air Force Medical Evaluation Support Agency (AFMESA).
When deciding on the criteria needed for a piece of medical equipment, AFSMESA will consult anesthesia experts who are most familiar with these products. After assembling a panel of experts with various levels of experience, parameters that an anesthesia machine should meet are developed and the process of evaluating specific machines commences.
In addition to climate, some other characteristics that are important for anesthesia machines used by military personnel include the lifespan of the machine, the weight of the machine (which should not exceed 250 pounds unpackaged), how reliable it is, and whether or not it is compatible with other machines.
THE ANESTHESIA MACHINE MARKET
Oceanic Medical Products, Inc., is one of the companies that manufactures anesthesia machines that have been approved for use in the military. In fact, the Kansas-based company, unlike other manufacturers of anesthesia machines, develops its products specifically for the military market, and once they have been approved, then sells them to their civilian clientele. Because of the close work that the company does with military personnel, it was able to meet a need that was not being fulfilled when they began their partnership—a portable and durable anesthesia machine that is easy to use.
In order to accomplish this, Oceanic received specific requests of features an anesthesia machine needed to have in order to fulfill the needs of the current state of military medicine. Among the characteristics the military was looking for were a lightweight, portable machine that did not use as many gas cylinders as other machines that were available. They also needed an extremely durable anesthesia machine that would be able to sustain intense heat and cold, as well as being strong enough to withstand possibly being tossed around back of a Humvee during a mission.
The result of this work is the Magellan-2200 anesthesia machine, which is a pneumatic machine that is sold to both the military and civilian markets. In addition to being lightweight and durable, the Magellan is safer for patients because it does not use nitrous oxide—which the military specifically requested because of the number of deaths the chemical compound is responsible for—and instead is hooked up to a supply of oxygen.
The Magellan is also designed for easy set up, which is accomplished because of the color-coded ports that have corresponding hoses that are placed inside of them. Because of this, the machine can be set up in as little as ten minutes, even by a person without extensive medical training. Another user friendly feature is the machine’s ability to run on multiple power sources—which helps keep medical personnel prepared for any of the possibilities that they can experience on the battlefield. The Magellan can be plugged into a wall anywhere on the planet thanks to its ability to convert power to the correct voltage for the location it is being used in. In the event of a power outage, the machine has several back up sources of energy, including the ability to run pneumatically (by air pressure), by a backup battery, or—as a last resort—even by a car battery.
In order to keep up with the needs of military medicine, the company is in the process of developing an anesthesia machine that will completely eliminate the use of gas cylinders. The product, which will be available for sale at the end of this year, will give the military a cost-effective solution to an ongoing problem with waste.
“I am told that the number of cylinders that our troops took to Desert Storm was somewhere in excess of 100,000—all of which they left behind,” said Rod Peake, Oceanic’s president. “We’re going to try to eliminate that for them.”
Another company that supplies anesthesia machines to the military is DRE Inc., which has been selling medical supplies since 1984. Among the anesthesia machines sold by DRE are the DRE Integra AV-S Anesthesia System and the DRE Integra SP VS02 Portable Anesthesia Machine.
Like many other machines on the market, DRE’s anesthesia machines also emphasize patient safety, which in this case is accomplished through a ventilator that automatically powers up when the machine is turned on, thus ensuring that the patient will be able to breathe if the user inadvertently forgot to turn it on. In addition, the company’s products have electronic PEEP—positive end-expiratory pressure—which allows gas to flow through the machines, even if there is a leak in the system.
DRE’s machines also allow for ease of use through several unique features. Because in a busy operating room even a little bit of saved time could mean the difference between life and death, DRE’s products let up to five users to store their typical settings—allowing users to operate the machines efficiently at the touch of a button. DRE’s anesthesia machines also operate in multiple languages—English, Spanish, Italian, Turkish, and Polish—and has the ability to monitor barometric pressure in the region where the devices are being used.
Additionally, DRE’s products are useful for observation operating rooms or teaching facilities because they allow users to position a large screen color monitor to the machine from a remote location so that the machine’s activity can be watched from outside of the operating theatre.
ANESTHESIA MACHINES OF THE FUTURE
Just as any other technology, the future of anesthesia machines must evolve to meet the needs and demands of the users, making them more efficient. Experts predict that one of the advancements of anesthesia machines, like many other devices, is that they will be able to do more and more in less and less space.
“One of the things that everybody tries to look at is how much smaller can we get anesthesia machines because of the introduction of many other things into the operating room that wouldn’t have been there 15 years ago,” said Robert Bean, director of Biomedical Engineering and Purchasing Divisions for DRE Medical. “They’re trying to get more into about the same amount of space that they used to operate in. As a result, we’re trying to make things more and more compact and still keep them user friendly.” Additionally, Bean sees anesthesia machines of the future becoming more compatible with other technology, such as MRIs.
“Because of the technological advances of using MRIs, CAT scans and PET scans, they’re being used more and more for diagnosing a lot of other ailments, and some people actually have to be put under anesthesia or sedated during these procedures,” he said.
Medical professionals also predict that there will be a significant change in the way anesthesia machines of the future will administer the agents to patients. For example, Commander Darren Via, chairman of Anesthesiology at Portsmith Naval Medical Center believes that the future of the technology is total intravenous anesthesia, or TIVA, which would eliminate the use of inhalation agents and instead will administer the anesthetic through syringes.
“Depending on how TIVA goes, it could potentially in the long run do away with the big anesthesia machine and volatile anesthetic,” he said. “You’d still need oxygen or gas for breathing, but your anesthetic wouldn’t be delivered to the lungs, it would be delivered completely through the IV.”
But no matter where the future of anesthesia machines is headed, the bottom line is helping to make military medical personnel’s jobs easier as they serve our country and save lives.
“Warfighters will continue to get hurt as long as we have warfighters. Our job is to try to allow some of those kids to get to come home that might not otherwise get to,” said Peake. “Our hope is to build them rugged, non-electronic, non-failing equipment. I think that’s a door which will remain open for some time.” ♦