The sprawling exhibit floor at the annual meeting of the American Society of Anesthesiologists in Chicago was so large that we called on the expertise of 3 anesthesiologists to help us cover it. Here's a look at some of the more interesting and compelling displays, as seen through their eyes.

Our ASA Product Review Panel

Jaime Baratta, MD, director of regional anesthesia at Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia.

Eugene Viscusi, MD, a professor of anesthesiology and the director of acute pain management at Thomas Jefferson University in Philadelphia.

Ashish Sinha, MD, PhD, DABA, MBA, vice chair of anesthesiology and perioperative medicine at Drexel University College of Medicine in Philadelphia.

EASY CONTROL The Medtronic McGrath video laryngoscope is light enough to manage with 3 fingers.

Medtronic
McGrath MAC video laryngoscope
This device, designed to make video laryngoscopy more affordable, combines a traditional Macintosh blade with video technology and an ergonomic design — attributes that impressed Philadelphia anesthesiologist Ashish Sinha, MD, PhD, DABA, MBA.

"We don't need larger screens — we need better screens," says Dr. Sinha. "The image is an appropriate size and it's clearer than some other devices. The handle is lighter and more ergonomic. You can manage it with 3 fingers, so it lets you have finesse rather than power — and finesse, not power, is what we need for intubations 99% of the time."

Another attractive feature: The proprietary battery, which lasts for 250 minutes, provides a minute-by-minute countdown of its remaining life, instead of diminishing percentages or shrinking lines.

Medtronic was offering a special at the conference — $2,500 for the video laryngoscope handle, 5 lithium ion batteries and 2 boxes of disposable blades (with a choice of size). The goal is to have the scope be financially within reach for every OR, explained one of the reps.

"Our first look should be with a video laryngoscope," says Dr. Sinha. "The flip side of that argument is people say we might lose our ability to do direct laryngoscopy. But maybe we don't need to worry about that."

VIRTUAL TASK TRAINER Airway EX lets you practice difficult maneuvers and effectively visualize scope configuration of medical devices.

Level EX
Airway EX
This virtual surgery app (level-ex.com) lets physicians practice intubating difficult airways on their mobile devices. With life-like simulations based on real-life cases anesthesiologists have submitted to the company, providers can practice decision-making and maneuvering through and around challenging pathologies and other airway issues. Make a bad move and the simulation can even cough out the scope. The app is free and can be used to earn CME credits — though you have to pay for those.

"It's a nice simulation program," says Dr. Sinha. "They can create a simulation of a rare event, like a tumor in the airway, and let practitioners practice on scenarios they're not ordinarily going to see. Ideally, you don't want to have to deal with something like that for the first time in an OR setting, if it is possible to practice it without the sphincter-tightening that may be associated with a real live situation."

It would be nice, says Dr. Sinha, if you could simply create your own model with an MRI scan and be able to practice in virtual reality with every potentially challenging patient who crosses your path. That capability may be coming down the road. One minor drawback is that with the simulation you use your fingertips, not your thumb and wrist: "It's a visual aid not a tactile aid," he says.

RIGHT FIT Pajunk (above) and B. Braun are out in front of new tubing connector regulations with new luer lock designs.

CONNECTOR DESIGN
Tackling the Challenge of Tubing Misconnections

Tubing misconnections, the accidental connection of different delivery systems, can result in serious patient harm, even death. Pajunk and B. Braun unveiled their NRFit luer locks designed to make it impossible to accidentally connect an epidural line to an IV line, an IV tube to a blood pressure cuff or any other number of potentially disastrous mistakes. The different-sized, small-bore connectors comply with ISO 80369, a new design standard for medical device tubing. California will require all hospitals to use the new luer lock connector for epidurals beginning Jan. 1.

— Jim Burger

PAIN SCORE The PMD 700 can help providers minimize the discomfort felt by unconscious patients.

Medasense Biometrics
PMD 700
Patients under general anesthesia can't tell you how much pain they're in, but this finger-mounted probe can.

"It's a really interesting concept," says Jaime Baratta, MD, director of regional anesthesia at Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia. "With it, you could end up having patients in recovery who are more comfortable, because they got the optimal amount of analgesia intraoperatively."

The sensor tracks changes in nociception pain caused by external stimulation and uses an algorithm to convert that data into a number between zero and 100, indicating the level of pain the patient is feeling.

"As things stand now, we have to rely on hemodynamic parameters — things like heart rate, blood pressure and respiratory rate if patients are breathing spontaneously," says Dr. Baratta. "And it can be difficult to tell how much to titrate. You want to make sure patients wake up quickly and comfortably, but if you give them excess opioids, they may have respiratory depression."

The company expects the product to be available in Europe as soon as this year, and anticipates FDA approval in about a year.

"If patients are more comfortable in the PACU and also awake, they could be ready to discharge faster," says Dr. Baratta. "If this improves patient flow, it could be a good investment."

BETTER VIEW The APA Video Laryngoscope comes with a screen that snaps on for unexpectedly challenging intubations.

BD
APA Video Laryngoscope
Another entry in the effort to make video laryngoscopy more affordable, BD's APA scope can be used as a standard Macintosh scope or as a video scope with a 3.5-inch screen that snaps on for challenging intubations.

It comes with MAC 3 and MAC 4 blades and 2 difficult airway blades — one channeled and one unchanneled. Both of the difficult-airway blades have 60-degree angles to help you see around the corner in difficult situations, and the channeled blade can accommodate a small endotracheal tube or bougie.

The price can be as low as $2,250 per scope, but only if you're buying several at a time, said a rep. The company offers various rebates and incentives to bring the price down.

It's a good price for an ASC that wants to have video capability, says Dr. Sinha, adding that, "video scopes are part of the algorithm now for difficult airways."

The image, which is dependent on the number of pixels, is "moderately good — middle of the pack," he says, "but considering their price point, I think it's a reasonable cost. It will work just fine."

TWO ADVANTAGES Ambu's disposable bronchoscope is more mobile and eliminates the need for reprocessing.

Ambu
aScope disposable bronchoscope
A disposable bronchoscope — the only one on the market — could have some real advantages when it comes to unexpected emergencies. Sterility and mobility are the biggest, and the overall cost compared with traditional bronchoscopes could be favorable when you consider not only the cost of reprocessing, but also the cost of repairs.

"Bronchoscopes tend to be very fragile devices," says Dr. Baratta. "Frequently we'll turn ours on and find that half the picture is out."

As far as mobility goes, "the bronchoscope carts we have are massive and cumbersome to move about," she says. "Something like this that's both disposable and easily portable could make things a lot better when you're dealing with emergency airways."

There are 3 sizes of scopes: the aScope 3 Slim, for thoracic cases, a standard size that fits down size 6 ET tube, and a recently FDA-approved large size that fits down a size 7 ET tube and provides a bigger working channel. It begins functioning the moment you turn it on, says the company, and it can take both stills and videos, and take them simultaneously.

Does it save money? "The reusable scopes do break frequently, and the cleaning is costly," says Dr. Baratta. "Without knowing the exact numbers, it seems like the cost comparison may be equivalent or maybe even somewhat better. It's a really interesting product."

TIGHT SEAL The LMA Supreme Airway is designed to handle more challenging airways.

Teleflex
LMA Supreme Airway
The new LMAs designed by Teleflex are designed to mitigate some of the most common airway risks — patients with COPD, smokers, obese patients and others who may require a lot of pressure to ventilate — by securing airways with higher seal pressures than those provided by competitive products.

Additionally, a rep explained, the goal is to reduce the use of laryngoscopes — thereby reducing reprocessing and repair costs and protecting patients from things like irritated vocal cords or, in the worst scenario, laryngospasms.

The LMAs also have dual-gastric access with suction to provide a conduit of least resistance in the event of aspiration. The company is planning a limited release in the next few months, and a full-market release in mid-2017. The question, says Eugene Viscusi, MD, a professor of anesthesiology and the director of acute pain management at Thomas Jefferson University in Philadelphia, is whether decision-makers will be willing to pay more in the absence of hard data showing benefits.

"It does look like a better product," he says. "I like it, I think it's really cool. But ultimately it's all about the evidence. I need to be able to convince the C suite to pay for a more expensive product. And for that, I may need hard data."

UNIQUE OPTION Magaw's Co-Pilot VL Plus has a 4.3-inch screen and a bougie port.

Magaw
Co-Pilot VL Plus
Magaw is launching its newest video laryngoscope in early 2017, featuring a larger (4.3 inches) high-res LCD panel and at least one feature that sets it apart from the competition — a bougie port. Their pitch: Video laryngoscopy should be available in every OR, but it has to be big enough to be useful, and yet not so big that it's obtrusive.

The new model "lives on the IV pole" and is affordable enough to place in every OR, they say. How affordable? The current model is $3,000, but Magaw is discounting it by $500 and says it will trade out the old version for the new for free, once it starts shipping. Included will be a stylet, 2 boxes of disposable blades and a box of bougies.

The visualization (640 x 480 pixels) is sharp and crisp, says Dr. Sinha, and the bougie port "is definitely taking it one notch higher in the video laryngoscopy market," he adds. "This gives me 3 options: direct laryngoscopy using a blade, video using a blade and camera, or just a bougie-guided intubation. A bougie makes it very easy to ride the ET tube over the bougie once the bougie is in the airway."

MANAGEMENT SYSTEM Intelliguard's innovative system tracks inventory without interrupting workflow.

Intelliguard RFID Solutions
Linked Visibility Inventory System
Intelliguard takes medication management to a new level with its new system. There's no disruption to work flow. When providers open the drawer and remove medication, the automated process begins. The read surface on top reads the RFID tag, and when the drawer closes, the machine scans the remaining contents and automatically updates inventory data globally for all machines in all ORs.

"Like the refrigerator in my hotel room," laughs Dr. Viscusi. "Automatic inventory is a real advantage over other systems."

It also updates the pharmacist, delivering a message either by computer or phone if medications are out or running low. By recording how much medication is used over time, and how many reach par level thresholds, it can also help facilities proactively manage inventory. It tracks expiration dates and recalls, as well. And it helps ensure narcotics aren't left unattended. If a provider logs out with a narcotic on the read surface, it flashes a bright red light and notifies both the physician and the pharmacy. OSM