Over the course of two days at the recent American Society of Anesthesiologists (ASA) Annual Meeting in San Francisco, I went on an aisle-by-aisle and booth-by-booth tour of the expansive exhibit hall in search of equipment and devices that were new, neat and noteworthy. As you'll see, many of the products I'll review are designed to help us accelerate and validate our clinical decision-making.

Critical Data Viewer
How's this for an advance in ambulatory anesthesia? A sleek head-mounted display projects vital signs before your eyes through a device attached to your glasses. MicroOptical Corp.'s Critical Data Viewer lets you keep your eye on the patient while viewing vital signs, reducing your need to turn away for critical information, thus enhancing focus on the patient and the procedure. The near-eye display, which the company says is the world's smallest and lightest, comes mounted to a pair of safety glasses. You can easily attach the product's small LCD projector to the side of a normal pair of glasses with a little arm that extends over one of the lenses. Simply hook the standard video cable to your monitor's video out port, and the display shows the vital signs you would normally see on a patient monitor.

Pending FDA approval, Philips Medical will distribute the Critical Data Viewer, which will cost about $2,500. A wireless version (about $3,500) is due late next year. The viewer places the floating image on the hand-eye axis and offers a natural vision field in both eyes. The image is beamed on one eye so you can see what's in front of you. You can adjust the image to appear above or below your line of sight.

The display is remarkably unobtrusive. The left lens of the pair I tried on was partially blacked out, and vital signs floated on the upper half of my right lens so I could look down through my glasses.

I'm excited about the wireless version, which would let you, for example, call the lab for results or handle a call from the PACU without losing sight of the patient's vital signs. I'd like to play with one for a month to be sure, but this product's promise to integrate your monitor and anesthesia machine to view information in one pane of glass has lots of potential.

Datex-Ohmeda Entropy
By measuring the EEG and facial-muscle activity, entropy monitoring lets you monitor the effects of certain anesthetic agents. GE Medical Systems' Datex-Ohmeda, which launched the S/5 Entropy Module at the ASA, says this anesthesia monitor might let you awaken patients faster, prevent awareness in surgery and avoid overly deep anesthesia. Entropy Monitoring measures electroencephalography (EEG) and forehead muscle activity (frontalis electromyography), processes both signals through an algorithm and reports results. A paper by company scientists says results are as accurate as bispectral index's, but with 0.5-second response time.The paper says measuring the signals separately provides more information and prevents contamination of the EEG signal. The plug-in module is available with Datex-Ohmeda S/5 Anesthesia Monitors using L-ANE03(A) or later.

The clinician instantly receives separate information on the effect of anesthetics on the brain (SE) and facial muscles (RE). If these numbers separating, you're alerted to a change in patient status. It's thought that a quantifiable measure of facial-muscle activity can make a difference in clinical judgments about adequacy of anesthesia. Because this device incorporates EMG activity, there is potential for fewer false readings from muscle artifact. The module costs about $7,400 and sensors are $14.75 each, comparable to disposables for similar devices.

Datascope Anestar S and Dr'ger Medical Fabius Tiro
If I were opening an ASC, I would look at these two new anesthesia machines: the Anestar S (Datascope) and Fabius Trio (Dr'ger Medical).

The Anestar S, launched in September, is a new anesthesia delivery system designed for a facility with space constraints. The small footprint and lower price makes this a good option. Two installed vaporizers make it easy to use different agents for pediatric and adult cases.

The Anestar S combines the original Anestar's features, including an integrated warmed breathing system, advanced ventilation functions and a comprehensive safety platform, in a smaller, cost-effective package.

With its small footprint and $25,000-to-$35,000 price tag - half the price of a traditional anesthesia machine - Dr'ger Medical is positioning the Fabius Trio as the little brother to the Fabius GS. Besides being smaller and cheaper than Fab-ius GS, the Fabius Trio only has one vaporizer slot. There is a little docking station for a second vaporizer, so if for example you want to use one agent on pediatric induction and another on adult induction, in just seconds you can pop one vaporizer off and use the other. I've used similar docking stations on other Dr'ger machines, and it really is easy to do.

The piston ventilator is electrically driven and controlled and needs no driving gas - a real cost savings if you don't have a central gas supply. You can see the piston. A wall-mount option is ideal if fixed installation suits the workflow.

SenTec Digital Monitor System
The SenTec Digital Monitor System is a digital sensor that clips to a patient's earlobe (a measurement site physiologically close to the heart) and combines non-invasive and simultaneous monitoring of arterial carbon dioxide tension, arterial oxygen saturation and pulse rate. The system is awaiting FDA approval and will sell for less than $10,000, according to the company. There are two potential applications of the system. One is to monitor CO2 during sedation cases as a sign of over-sedation (CO2 levels, consistent with hypoventilation, will increase before oxygen desaturation occurs). The other is to monitor CO2 in the PACU, especially for patients who are still intubated.

The low-pressure ear clip makes for a good patient compliance and a secure, strain-free sensor fixation at the ear lobe, resulting in significantly reduced sensitivity to patient movement, says the company.

Belmont Buddy Fluid Warmer
We all know that hypothermia is a serious complication of surgery. The Belmont Buddy Fluid Warmer from Belmont Medical may help prevent the infusion of cold fluids from causing hypothermia. The product features close-to-the-patient fluid warming, meaning the heater unit is next to the infusion site (no water bath or jacketed tubing required) to ensure no cooling occurs as the fluid passes from the heater to the patient. The IV pole-mounted power module stores the heater, controls and displays fluid temperature, and alerts the operator to no-flow conditions.

The disposable set of the of fluid warmer features a large venting membrane that automatically vents the air routinely found in crystalloid IV bags as well as the air that is out-gassed during warming. This helps prevent air embolism.

This product warms well at low flows. I wouldn't bother using it with 500cc, but I thought it was worth considering if your facility does long cases. The warming component's small size makes it practical to use on smaller patients. The unit lists for $1,500, and disposables are $15 apiece.

S&S Med Cart and Atromick Avalo Anesthesia Cart Series
I don't buy the idea that anesthesia medications and supplies have to be locked. The OR is secure. Keeping your anesthesia meds locked up is incredibly awkward, and it also may endanger patient safety. Certainly in the acute hospital, I wouldn't want to have to unlock the cart when I rush back with a stat C-section! But others argue it's most efficient and safe to keep all anesthesia meds and supplies in a medication cart. And your accreditation surveyor will surely check to make sure your meds are stored securely.

If you're in the latter camp, I saw two medication carts for you. Both the S&S MedCart PRN-MP and the Atromick Avalo Anesthesia Cart Series offer such innovative lock systems as keyless entry magnetic stripe card swipe access with automatic relocking.

The PRN-MP allows up to 500 programmable user IDs to be maintained in a database. You can assign each code a name using the standard Partner Cart Manager software. The Silent-Partner Audit Trail feature uses the user IDs to identify who accessed which drawer and when. The PRN-MP can be custom-designed, from two cart heights to multiple drawer sizes.

Keyless access with automatic relocking is standard on the Avalo Anesthesia Cart Series. Seamless drawers and an integrated divider system keep drugs and supplies organized, and the guide system ensures drawers won't be left open. It also offers user-audit tracking.

Stryker Pain Pump2
Pain management is a tremendous patient-satisfaction issue. If I had ACL reconstruction, I would want to have a 3-in-1 block for post-op analgesia, probably with a continuous infusion for a couple days.

Some advocate tunneled catheters in the incision or continuous nerve blocks for pain relief for several days. In the ambulatory arena, not everyone agrees with sending patients home with continuous infusions for safety and economic issues. Will the pump give a predictable rate? What if the rate is too low? How do you recoup the pump's expense?

The Stryker Pain Pump continuously delivers controlled pain medication to the surgical area for post-op pain management. One advantage of this battery-powered, disposable device over other single-use pumps that are elastomeric (balloons that empty themselves) or spring-operated is that it pumps the solution in at a rate set by the anesthesiologist. Also it comes with a de-mand button, so it can be used for patient-controlled analgesia via the catheter. And it's priced as a disposable device.

Olympus EndoEye
The EndoEye is the first flexible videoscope designed for difficult intubations. The big advantage here is that the camera chip is at the tip of the scope, not up in the handle. That means there is no fiberoptic bundle that can be damaged by over-flexing the scope. Wires are much more tolerant of acute bends than are glass fibers. This should help reduce maintenance costs over time. Also, since there are no fibers, you don't get the little black spots of the broken fibers over time, and this may help you visualize your target. If I were replacing a scope in the near future, I'd think strongly about this type of technology.

In addition to providing consistent image quality, having the CCD chip distally mounted allows the surgeon to, in effect, look directly at the surgical site, rather than 'looking in through a window,' as is the case with standard scopes.

Karl Storz Endoscopy AIDA DVD (Advanced Image and Data Archive System)
I really like this idea. The key is data management and presentation. This system projects vitals signs on the monitor with the video feed. You don't have to turn around to check vitals during an endoscopy. I'm not sure this so important for anesthesiologists, but I see a big application for the GI endoscopist and other docs. Especially if you are directing conscious sedation for a procedure, it would be very helpful to have the vital signs (blood pressure, heart rate, oximetry, respiratory rate) on the same screen. This could potentially improve patient safety. If the patient is fidgeting, is it inadequate sedation or too much and low oxygen saturation? Also, the whole team can monitor the vitals, encouraging a team approach.