Innovative airway management devices, ultrasound advances and medication documentation solutions highlight some of the new technologies that were on display at the American Society of Anesthesiologists Annual Meeting in San Diego, Calif., in October. If you weren't able to tour the expansive exhibit hall, here's a sampling of what caught my eye.
Centurion Medical Products
FlexView Articulating Video Laryngoscope
This innovative new device is the only articulating video laryngoscope on the market. It articulates from 45 degrees up to 115 degrees, compared with the 60-degree angle found on most competing rigid video laryngoscopes.
Any video laryngoscope provides excellent views of the glottis, but placing the endotracheal tube can prove difficult. The articulation on this device helps solve that issue. You insert the scope, and articulate the blade as you focus on the uvula and work through unique airway anatomy. When the glottis comes into view, you slide the endotracheal tube through a pre-lubricated channel built into the side of the blade. The tube goes exactly where you're looking. While using the FlexView on a difficult airway model at the Centurion booth, the articulation really helped me access the airway and place the endotracheal tube right where I intended. The device took some getting used to I had a tendency to go too deep initially but I bet the average provider could get up to speed after a few intubations.
The FlexView runs on 2 CR123 lithium-ion 3-volt batteries. Company reps said the price of the scope has not yet been determined ahead of a scheduled launch early next year.
TE7 Ultrasound Unit
The TE stands for "touch enabled," and this unit delivers on that promise the power control is the only button on the unit. The rest of the system's settings and parameters are controlled with a touch interface, much like your smartphone or tablet. For example, you can call up patient information or connect to anesthesia work lists and drug ordering information with a few swipes on the screen.
Three transducers with customizable presets are built into the back of the unit. You can customize settings to specific blocks and parameters such as depth, frequency and gain, so 90% of physician-specific settings are programmed before cases start. Providers can use the touchscreen controls to measure distances between anatomical landmarks or activate needle visualization software that highlights the needle on the screen, which is especially helpful when placing deep blocks at tough angles. You can save images and video through 4 USB ports or send them wirelessly or through an Ethernet using an integrated HDMI port.
The touchscreen controls are incredibly slick. Block nurses at my facility set specific block parameters on our ultrasound machines, but the touch-enabled interface would be an efficient option for providers who have to ready the imaging settings, click through controls and place blocks themselves. My one concern: Mindray's image quality is improving, but in my opinion still lags behind some of the other devices on the market. The unit costs between $30,000 and $40,000, depending on the number of transducers.
AIR Smart Glasses
The Augmented Interactive Reality (AIR) Smart Glasses generated considerable buzz on the floor, with Masimo's booth teeming with anesthesiologists watching regularly scheduled presentations on the company's latest prototype in information connectivity solutions. AIR Glasses feature a heads-up display that lets providers view relevant patient information, real-time monitoring or device data without taking their eyes off the patient. If cleared by the FDA, the glasses will let providers upload specifically chosen data that they can then choose when and how often to access. Incredibly, the wearer reaches out into air to "touch" the controls he sees on the heads-up display. It really is futuristic and fun to see in action.
There's no doubt this is impressive technology that any tech-loving provider would want to try. Will it catch on in the mainstream? I'm not sure the constant stream of clinical data in a heads-up display is needed for every patient, and I'd be concerned about sensory overload after wearing the glasses for a full day of surgery. That said, this is an exciting prototype that offers a glimpse into the potential future of anesthesia care.
The cuff of Teleflex's LMA Protector is made of silicone, a soft material that provides a higher seal pressure, but less mucosal pressure, and therefore less effect on airway anatomy. A company rep said research has shown that sore throats related to LMA use should occur in less than 13% of cases, and should be mild and short-lived. However, according to the rep, the current sore throat rate is approaching 50%, likely because providers are overinflating cuffs on supraglottic airways.
He said a new inline pressure valve manometer called the Cuff Pilot measures the LMA Protector's intracuff pressure, which should be no more than 60 cm of water pressure an amount that puts very little pressure on the mucosa. Exceeding that pressure for longer periods of time restricts blood flow and causes necrosis of the tissue, meaning the patient might awaken with a severe sore throat, dysphagia or lingual nerve damage. With this device, you insert the airway and inflate the cuff until the needle on the Cuff Pilot sits in the green zone, which indicates the cuff is inflated to between 40 and 60 cm H2O.
When the LMA Protector is inserted properly, it should sit at the upper esophageal sphincter. If active or passive regurgitation occurs, the regurgitant enters the mask, spills into a reservoir along the back and empties out equally through female and male ports on either side of the device. Unlike other supraglottic airways, which have a single gastric tube that runs through the center of the device, the LMA Protector is designed to channel fluids away from the airway through the dual reservoir.
The LMA Protector is designed with a simple but effective way to determine if it's placed properly. Once it's inserted, inflated and taped down, you cover the device's male port with a sliver of KY jelly and put your finger over the female port. If the gel stays in place when you ventilate, the tip of the mask is properly positioned. If the gel blows off, air is leaking between the tip and the esophageal sphincter, indicating the mask needs to be repositioned.
Many supraglottic airways on the market have tapering connectors, which can limit the size of the endotracheal tube you can place through them. The connectors on the LMA Protector don't taper, enabling the placement of a full-size endotracheal tube. That's important for a device frequently used for difficult airway management.
With its built-in bite block and taping tab, the features on this LMA all make perfect sense. I'm most impressed with the dual reservoir for filtering away regurgitant, especially because aspiration risks increase with the use of supraglottic airways. Yes, patients are told to be NPO before surgery, but that doesn't guarantee they'll follow the directives. And even if they do, there's still a risk that gastric content will come up during the procedure. Working with a device designed to reduce aspiration risk would be a welcome addition to my OR.
Anesthesia providers have to document an incredible amount of medication administration information. This smartly designed system relieves some of that burden. You simply click a syringe wrapped in specially encoded labels (produced by the company's syringe labeler) into the system's base, which automatically reads the labels to provide audio confirmation of the drug and real-time alerts of patients' allergies on the system's tablet. It also records the type and volume of injected medications, and routes the drug, dose and time to the patient's electronic medical record.
The system currently integrates with EPIC and Cerner EMR systems. (A different configuration also supports paper-based recordkeeping.) Reps at the show didn't provide specific pricing information, but said adding the system and tablet to 10 ORs would cost about as much as one anesthesia machine, or, broken down per patient, the same as a low-cost disposable.
I really liked the usability of this system. The digital readout of exactly how much drug is being infused is definitely neat, but I'm more impressed with the system's automated documentation capabilities. It might not be ideal for surgery centers, where cost is the bottom line and the automatic recording of medication use might be viewed as a luxury, but hospitals forced into using EMRs would benefit tremendously from Intelliport's real-time documentation capabilities.
This medication management solution is an extension of Kit Check, the company's core tracking system, into the OR. Pharmacy (or whoever manages your medication supplies) applies proprietary RFID tags to all medication vials in an anesthesia tray or automated medication storage workstation. After cases, pharmacy removes the medication liner or drawer and places it in the Kit Check cabinet, which scans the RFID tags and automatically generates a report showing which drugs were used, which are set to expire or have been recalled and which need to be replaced. The process takes 30 seconds instead of 30 minutes.
Anesthesia Check extends that technology into the OR, where providers wave a tagged medication vial in front of the system's RFID reader to produce a syringe label, which contains an embedded RFID tag. Providers then wave the label in front of an RFID reader at the bedside. The reader records medication use or emits an audible alert if the medication is expired, previously used or ordered for another case.
RFID tracking from Kit Check and Anesthesia Check automatically records drug history from vial, to syringe, to administration. The data can be used to measure medication use and waste amounts, and can be integrated into EMRs to eliminate the hassle of waste recording and reconciliation discrepancies. RFID technology is fast and accurate, said a company rep, so it saves time and improves the accuracy of medication management.
Anesthesia Check might be best suited for hospitals that are mandated to use EMRs. I was a hospital pharmacist in a past life and know all too well what's it's like to slog through medication drawers between cases. There's no doubt hospital pharmacists would appreciate the time savings offered by this system. The company says it installs the technology in exchange for the purchase of 2,000 RFID tags per OR, although its reps did not reveal the price of the tags.
Stimuplex Ultra 360
This is an example of a simple, but effective, design. The needle features a new echogenic X-pattern that's laser-etched around the surface to reflect more ultrasound waves back to the probe and help providers identify the location of the needle and tip during placement of blocks in challenging anatomy. The markings are segmented along the needle, because a continuous pattern would appear as a solid line on the ultrasound screen and defeat the purpose of the innovative design. This design would prove useful during the placement of any block, but would be especially helpful when approaching the target at steep angles of 45 degrees of greater. Puncturing the needle through the skin is made easy thanks to the same 30-degree bevel found on previous generations of the needle.
Nimbus Ambulatory Infusion System
A new take on the traditional pain pump, the Nimbus system lets providers delay the start time of the infusion therapy so the pump is not working while the initial regional block is still providing analgesia. A countdown clock lets patients know when the infusion will begin, but they remain in control of the pump and can abort the delay and start the infusion if breakthrough pain becomes more than they can handle. Delaying the start to infusion therapy could limit the amount of pain medication needed in the pump and ultimately lead to cost savings. Perhaps more importantly, it shows patients that you're interested in extending the duration of post-op pain management for as long as possible.
This pump also lets you capture objective infusion history. At the conclusion of therapy, patients send the pump in a prepaid envelope to, which downloads the therapy data to a cloud-based database with the goal of showing facility leaders, physicians and payers that patients recover faster and better when regional anesthesia is used.
AMERICAN SOCIETY OF ANESTHESIOLOGISTS EXHIBIT HALL
Perseus Safe A500 Work-station
You can tell this workstation was designed with surgical professionals in mind. The spine that houses monitors and screens sits in the middle of the unit, putting them well within arm's reach. Turnover teams will appreciate the machine's smooth surfaces, which are easy to wipe down. Cables, cords and plugs are integrated into the back of the unit, keeping them off the floor and eliminating the need to clean them between cases.
The workstation is optimized for low-flow gas delivery to drive down the cost of anesthetic agents. Electronic and mechanical mixing capabilities are nice features for those who like the precision of digital settings, but aren't yet ready to let go of the knobs and dials they've used throughout their careers.
Like other Draeger workstations, this system is designed with an integrated heated breathing system. When running lower gas flows, condensation can build up in the breathing circuit, because the patient's breath is warmer than the cool air being delivered. Warming the air before it enters the patient lessens the temperature differential and prevents condensation from forming.
Draeger replaced the bellows traditionally found on anesthesia machines with an innovative piston system that employs a turbo vent technology. The piston spins up to 1,000 rounds a second very fast on inspiration, and very slow on expiration so the patient doesn't have to "work" as hard to breathe during surgery.
With the Naso-Flow pharangeal airway, anesthesia providers are able to administer up to 8 L/min of oxygen while simultaneously measuring CO2 in the distal end of the sampling tube, where it's not contaminated by the oxygen flow.
This DEHP-free fixed-flow-rate infuser for pain management features an elastomeric balloon inside a plastic shell to provide a continuous flow of medication to targeted areas. It's available in 13 different designs that infuse between 100 ml and 250 ml of medication in 12 hours to 7 days. The clear plastic shell protects the balloon and includes volume markings, which provide patients with an important visual indicator that the infuser is working. Four models of the 250 ml pumps have dual catheters, so they can infuse medications to separate sites.
Mobile Device Disinfection
Tablets and smartphones are becoming commonplace in the OR, but are they properly disinfected before being used at home? Your staff and surgeons can send their mobile devices through this unit, which employs UV-C technology at close proximity to kill bacteria on surfaces and in crevices where wipes don't necessarily reach.
VitaHeat Patient Warming Solution
This new player in patient warming employs conductive-ink heating, which is comprised of silver particles and carbon, to warm patients with an underbody pad that contours to the patient's body. Software determines which one of 8 sensors is measuring the highest temperature and automatically adjusts the heat distribution for safe, consistent warming across 6 temperature zones.
ProneView Protective Helmet
Launched last month, the newest version of this patient positioning aid features the adjustment mechanism in the helmet system instead of in the mirror, providing a much easier way to adjust the helmet's height. The redesign gained about three-fourths of an inch in height profile, so the patients' necks can be elevated into a more neutral angle when they're placed in the prone position. Another plus: Cleaning the mirror between cases is much easier now that the knobs are no longer on its surface.
APA Video Laryngoscope
CareFusion recently acquired this airway device from Venner Medical and implemented a prism redesign that provides a wide view of the airway with no horizontal restriction. The scope is comprised of 3 pieces the screen, handle and camera module that come apart for easy cleaning. The scope runs on a single, rechargeable AA battery, which will last for about a month with average use. It costs approximately $5,000 and disposable blades of various sizes range from $6 to $20.
GE showcased a new 510K-pending anesthesia workstation designed for the ambulatory setting. This simple-to-use, compact unit was created with space-conscious surgery centers and smaller hospitals in mind. The company's premium anesthesia machines are equipped with digital gas mixers, but this unit features mechanical gas flow controls to provide a digital "hybrid" feel.
Like GE's higher-end anesthesia machines, this unit features the company's ecoFLOW technology, which graphically displays the minimum oxygen required within the fresh gas flow to maintain a pre-selected inspired oxygen concentration.
Monitoring CO2 levels during upper endoscopy procedures is challenging. Currently the only other option is a cannula with an independent bite block. This device integrates both into a single system, so you can simultaneously deliver oxygen and monitor CO2 from both the mouth and nose.