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What I Saw at ASA
A look at the latest products for anesthesia, monitoring and warming.
Kumar Belani
Publish Date: December 1, 2008   |  Tags:   Anesthesia

As a teaching hospital-based anesthesiologist, I'm always interested in trialing the latest technology to see how it will shape the future of the field. So every year I make a point of visiting the exhibit hall at the American Society of Anesthesiologists' annual meeting and reviewing the newly introduced products. Here's what stood out when the group convened in Orlando in October.

B. Braun's Space Infusion Pump System looks like a flexible, easy-to-use, drug delivery option. Its compact, lightweight and modular syringe and large-volume pump units let you station multiple, independently operating infusion sources at bedside with a minimal footprint. The rechargeable-battery-operated units stack together for IV pole or rail mounting, or can be plugged into the portable Space Station housing, which can accommodate and power up to four pumps. The company says the units list for about $2,800 each.

B. Braun also highlighted its Stimuplex HNS12 nerve stimulator, which features the new SENSe (sequential electrical nerve stimulation) software. The new technology builds on traditional nerve stimulation's two short pulses per second with a third, longer pulse for greater sensitivity and improved neural response. This seems like it would make placing nerve blocks quicker and easier. The unit retails for $900.

Teleflex Medical is adding new safety and infection control features to its Arrow StimuCath Continuous Nerve Block Kits. The trays will now include SafetyGlide Injection Needles, SharpsAway II Locking Disposal Cups and StatLock Catheter Stabilization Devices in the name of sharps safety. They'll also now offer a choice of skin preps, including Tinted ChloraPrep Hi-Lite Orange, as an alternative to povidone-iodine.

Airway management
LMA North America introduced two new advances on the traditional laryngeal mask airway. The LMA Supreme ($25), a single-use device, features a larger, pre-curved cuff that lets you position it faster and more accurately to obtain a good seal without exerting much pressure. It also has a built-in drain tube for channeling fluid and gas from the airway, and a built-in bite block.

The LMA Classic Excel ($319), on the other hand, is reusable up to 60 times. It improves on the LMA Classic by exchanging the aperture bars, which blocked intubation, for a figure-eight shaped epiglottic elevating bar, past which an endotracheal tube can be inserted.

AES has also innovated the laryngeal mask airway with its Ultra Cuff Pilot Valve. The latex-free, single-use airway, available in neo-natal to adult sizes, measures and reports the air pressure in the cuff by way of an attached valve. The colored indicator bands on the valve provide instant feedback to potential changes in placement. It's a small improvement that lets you inject safety into the process. The device comes in two models: The 100 percent silicone cuff and tube version costs $11, while the PVC tube with silicone cuff version costs $9.

Two Teleflex Medical products seek to reduce cross-contamination in laryngoscopy, says the company. The R??sch EquipLite laryngoscope blade, available in a full range of Miller and Macintosh sizes, offers the strength of metal, but in a single-use blade. It's compatible with conventional handles and includes an LED light source. The R??sch TruLED laryngoscope handle features a removable, rechargeable, autoclavable battery cartridge for repeated use. Another Teleflex product, the R??sch TruView EVO Infant, features a hybrid Miller and Macintosh blade coupled with a prism and lenses to allow a view into the smallest patients without having to hyperextend their necks. All three Teleflex products are scheduled for January availability and have not yet been priced.

In an effort to serve patients of all sizes, Verathon Medical showcased its addition of a GVL 5 blade, for morbidly obese or bariatric patients, to its line of reusable GlideScope video laryngoscope blades. The company also offers a single-use Cobalt 1-2 Video Baton for its GlideScope Cobalt pre-term/ neonatal video laryngoscope. The pre-existing systems list at about $10,000 to $11,000, say company representatives, with blades costing about half that.

One way to improve airway management is to ensure you're dealing with healthy airways. In the exhibit hall of its own show, the ASA promoted its "Be Smoke-Free for Surgery" campaign (www.asahq.org/stopsmoking/provider). Since smokers have an increased risk of perioperative respiratory, cardiac and wound complications, and since quitting reduces those risks, the campaign suggests that patients scheduling surgery should quit smoking, and that anesthesia providers, being respiratory specialists, can effectively advise them to.

A non-invasive, immediate and continuous hemoglobin count is now available as a function on Masimo's Rainbow SET technology platform. The measurement, which once required a needlestick and a trip to the lab for a delayed snapshot of a patient's hemoglobin situation, now employs a fingertip sensor and light absorption to produce numerical results on a monitor screen. This means no drawing of blood and no waiting for lab results. If you have a Masimo pulse oximeter (which costs about $4,000), adding the hemoglobin software and license costs about $4,000.

In some orthopedic cases, such as rotator cuff surgery, a patient who is anesthetized and ventilated in the supine position then moved into the beach chair position will experience significant oxygen desaturation in the brain. With CAS Medical Systems' Fore-Sight Absolute Cerebral Oximeter, providers can non-invasively and continuously monitor the O2 sats of a patient's cerebral tissue and take action against hypoxia if needed. Disposable sensors placed on the forehead — and sized for infants as well as adults — beam infrared light through the scalp and skull to deliver the results. The system costs $35,000, says the company.

Smiths Medical has miniaturized end tidal CO2 monitoring with its BCI Capnocheck capnometer. The pocket-sized, 2.1 ounce device connects to a mask, endotracheal tube, LMA or other airway conduit and delivers its data on an LED digital display. It runs on two AAA batteries and can even be worn on a lanyard. The sensor body itself costs $1,000 and the single-use airway adaptor tube $10.

Sometimes elderly patients are dehydrated or otherwise show low blood volume. Hospira's Voluven (6% Hydroxyethyl Starch 130/0.4 in 0.95 sodium chloride injection) is a plasma volume substitute intended to effectively treat hypovolemia so you can safely anesthetize them. The substance costs $45 per 500ml IV bag, and is sold 15 bags to the case.

Pain management
Smiths Medical says its CADD-Solis Ambulatory Infusion System, which lists at $4,500, lets you program your best practices into a mobile pump. The compact device, whose software lets you establish standard pump protocols and hard and soft dose limits with safeguards and visual alerts, features onscreen graphs and trend reports for intuitive auditing. An ergonomically designed remote control for dosing is also available.

The advances made in implantable neurostimulators for chronic pain in recent years have been impressive. Medtronic's RestoreUltra is palm-sized and 9mm thick. The percutaneous leads that plug into it are programmable to treat specific areas of pain management needs and are adaptable if pain patterns change. The company says the unit can run for nine years if the battery is charged once a month, which the patient does by wearing a recharging harness for about an hour. That shouldn't be too much of a burden. The RestoreUltra lists for about $20,000.

A conventional anesthesia mask is strapped on top of the patient's face and can easily be displaced. The Sedation Mask from Sedation Systems, on the other hand, fits under the chin for stability. The single-use mask, designed by a board-certified anesthesiologist, aims to improve the quality and safety of monitored anesthesia care. Its inflated cushion seals in anesthetic agents, and a separate port below the breathing circuit port for continuous end tidal CO2 monitoring allows the mask to stay on throughout the procedure.

Respironics, now a division of Philips Healthcare, has innovated its PerformaTrak non-invasive ventilation masks with the CapStrap headgear system. For patients who depend on continuous positive airway pressure machines, the new feature — which lets you flip the mask open and shut so that patients may be fed, hydrated or medicated — means that providers won't have to remove and replace the mask several times a day. The single-use mask retails for less than $30.

The Hot Dog Patient Warming System looks like a high-tech, purple electric blanket. Using low voltage and a semi-conductive polymer fabric, it provides the patient with even and precisely controlled warmth throughout the perioperative process. The company, Hot Dog International, says that its product holds a number of advantages over forced air warming, including that it's silent, it's reusable, it uses less electricity and it won't blow airborne contaminants around the patient or the OR. The system, which consists of a controller and the blanket, costs about $2,500.

LMA North America's PerfecTemp Patient Warming System aims to protect patients against hypothermia and pressure injuries at the same time. It's a viscoelastic foam OR table pad that incorporates a heating element for uniform and monitored warmth from beneath the patient. It's quiet, radiolucent and leaves the surgical team with access to all areas of a patient's body. The system, including the pads and a pole-mounted control unit, list for about $9,800 to $10,000.

Patient warming is undoubtedly important, but surgical staff members get cold, too, especially over by the anesthesia cart. Arizant's Solor Vest offers a solution without cords or hoses. The machine-washable fleece vest, available in five sizes, incorporates a rechargeable battery-powered lumbar heating unit. When worn beneath a scrub shirt, the vest can keep a chilly clinician warm for up to six hours. The vest, with battery pack and charger, costs $225.

GE Healthcare's LOGIQ e system combines ultrasound technology with a touchscreen interface to offer users real-time clinical images and controls on the same flat-panel monitor.

The system is operable via a laptop device, but users can also control the imaging, change parameters or annotate the image without looking away from the touchscreen. An articulating arm offers flexibility in the viewing angle. The company says the instrument lists at $50,000 to $55,000, depending on its configuration.

Pajunk's SonoPointer, recently approved by the FDA and scheduled for U.S. availability this month, uses ultrasound to orient and guide the anesthesia provider to the puncture and the precise placement of the cannula for accurate nerve block administration. Determining the exact location and angle for the puncture point with an ultrasound monitor isn't always easy, but the SonoPointer projects a crosshair on the patient at the site indicated by the ultrasound transducer.