The newest anesthesia machines offer advanced capabilities that should grab your attention. Here are a few of the features that would make upgrading your machines a worthwhile investment.

Versatile ventilation
Newer anesthesia machines offer several modes of ventilation designed to match the breathing rates of various patients, from neonates to the elderly, from the fit to the morbidly obese. The underlying reason for ventilation flexibility lies in a gradual change in how anesthesia is practiced, from heavy-handed to more efficient-minded care, says Michael Dosch, PhD, MS, CRNA, associate professor and chair of the nurse anesthesia program at University of Detroit Mercy in Michigan.

The old school of thought, he explains, centered on using anesthesia machines to take over the breathing of deeply anesthetized patients, whose blood pressure subsequently dropped and breathing rate slowed dramatically. By instead augmenting their normal breathing volume or rate, "you maintain their normal blood chemistry, respiratory rate and volume," says Dr. Dosch. "If you don't carry them as deep into the anesthetic state, you can keep them breathing spontaneously to some degree and get them back sooner."

More advanced ventilation modes far exceed the capabilities of basic volume-control ventilation, letting providers change between modes for hands-free emergence and extubation of patients, says Gary Friedman, MD, the vice president of Nashua Anesthesia Partners in Nashua, N.H. He points out that more sophisticated ventilation systems automatically support the spontaneous breathing of patients and "let you focus on other aspects of care instead of manually assisting patients with a breathing bag as they're weaned off the ventilator."

Automated safety checks
Anesthesia machines need to be checked at the start of each day and between cases to ensure components are in good working order. Newer machines automatically check for leaks, test O2 calibration and the integrity of the ventilation and scavenging systems in about a minute, says Bettina Dixon, CRNA, MSN, an instructor in the nurse anesthesia program at the University of Pittsburgh.

Automated checks improve anesthesia efficiencies in that machines are primed and ready to go more quickly between cases. They also improve patient safety because human error is taken out of the equation during checks of the machine's integrity. When trialing new machines, take note of how long those automated checkouts take to complete.

Dr. Friedman says automated checks are more streamlined, orderly and measurable. "You might still find and estimate the size of a leak with a manual check, but the automated process would quantify and measure it," he says. A computerized internal check could potentially detect smaller leaks that would have otherwise gone unnoticed by an anesthesia provider, he adds, as well as calibrate the O2 monitor more precisely and identify issues related to improper anesthetic gas flow.

The automated checks can also help lower anesthesia supply costs. Leadership at Biggs-Gridley Memorial Hospital in Gridley, Calif., recently purchased a pair of anesthesia machines to replace the large, outdated models that took up more space than necessary in the ORs. Raub Slack, the hospital's director of surgery, believes at least one of the old machines had an undetected leak that wasted gas during delivery.

Electronic advances
Gas machines with electronic flowmeters have no glass tubes; the flow rate is indicated with a bar graph on a monitor's screen, says Dr. Dosch, who adds that electronic flowmeters let automated anesthesia record-keepers capture fresh gas flow rates.

A machine's compatibility with electronic medical records is becoming increasingly important as more and more providers want to record vital clinical information from not only vital signs monitors, but also from the machine's components. "Being able to automatically put accurate and comprehensive physiological data into an EMR in an efficient manner are important ingredients of a properly documented anesthesia record," says Dr. Friedman.

Electronic flowmeters also let providers deliver lower flows of anesthetic gases much more accurately than they could with the mechanical components found on older machines. And delivering lower flows of expensive inhalational agents with increased accuracy results "in potentially huge anesthesia supply cost savings," says Dr. Friedman. In addition, says Dr. Dosch, tracheal heat and humidity and patient core body temperatures are better preserved at lower flows.

"Electronic flowmeters are much more accurate, which is good," says Ms. Dixon, but she warns that transitioning to push-button controls might frustrate providers more accustomed to the mechanical feel of knobs and dials. On newer machines, providers select which gas they want to adjust and push a button. "It's great that we've gone to that," she says, but with the transition to computerized care, providers have lost some of their ability to fine-tune the delivery of gas.

That may seem like a minor concern, especially when you consider that electronic flowmeters can deliver low flows of anesthetics more accurately, but just be sure your providers are comfortable with how newer machines work in practice. Bells and whistles are great for exhibit halls and brochures, but they don't do a bit of good if your providers balk at their use in the OR.

Confidence builders
In the end, your anesthesia machines should help your providers deliver more efficient and safer care. That's why Biggs-Gridley decided to purchase state-of-the-art machines that featured technologies — including more invasive monitoring and upgraded ventilation capabilities — suitable for higher acuity patients sedated during more complex procedures, says Mr. Slack. "The new machines have given our providers a larger safety net so they feel more comfortable caring for patients during the cases we host."