Anesthesia Alert

I've been working near the epicenter of the COVID-19 pandemic in New York City, intubating patients on a special team formulated specifically to manage the airways of COVID-19-infected patients. I know all too well the urgent need for ventilators and have heard of hospitals hooking up six patients to a single ventilator. With the COVID-19 pandemic essentially bringing elective surgeries to a temporary halt, thousands of operating rooms across the US are vacant. The anesthesia machines housed inside these operating rooms can quickly be converted into ventilators, offering lifesaving support as the virus peaks across the country.

The situation here in the tri-state area is grave enough that many hospitals have already performed these conversions in their dormant ORs. The conversion, which is simple for any anesthesia professional to perform, involves removing the anesthetic gas vaporizers and adding a humidity-heat-viral exchange filter to the breathing circuit. That's it.

A ventilator is just one of the many components that makes up an anesthesia machine. When a patient is unconscious, anesthetic medications we use cause the patient to stop breathing; the built-in ventilator takes over that function for the patient by means of mechanical ventilation. If you simply place the patient on an anesthesia machine and do not turn on the anesthetic gases, it's essentially a ventilator.

An anesthesia machine's vaporizers house anesthetic gases, which you won't need when using the machine as a ventilator. It's important to remove them so someone doesn't inadvertently turn on anesthesia while a patient is being ventilated. The heat and humidity exchange filters add humidity to the breathing circuit, ensuring the airway stays warm and moist. The exchange devices also filter bacteria and viruses, helping to keep the anesthesia machines clean and safe to use.

Anesthesia professionals need to always be present to operate the anesthesia machine and manage its use as a ventilator. Ideally, an anesthesia provider can oversee three or four of these machines at once. If an alarm goes off on the machine, an anesthesia provider would need to be ready to tend to that alarm, which is only heard in the patient's immediate area. They cannot be tied to a central monitoring system as you would typically find in a traditional ICU. The close monitoring of patients is imperative.

The FDA has approved repurposing anesthesia machines for use as ventilators in an emergency-use authorization, intended to increase access to life-saving treatments for COVID-19 patients. Anesthesia machines in use as ventilators require special supervision by properly trained anesthesia professionals in order to ensure patient safety. In the current situation, we are doing things that wouldn't typically be done. Using anesthesia machines as ventilators is one way we are responding during this desperate time to save lives. OSM