If you haven't looked at anesthesia machines in a while, you'll notice equipment makers are producing more compact, portable and less costly choices for smaller ORs, office-based surgery and centers that move a machine between rooms. More companies are also refurbishing the devices.

Industry experts acknowledge refurbished mach-ines can be a sound investment, but they stress the importance of the machine's age and the quality of the refurbishing work. Only buy refurbished anesthesia and monitoring devices from a known, factory-trained, factory-supported, biomedical shop.

"The most dangerous thing a surgery center does is not surgery; it is general anesthesia," says Mr. Farris. "If an adverse outcome happens to a patient under general anesthesia, the facility must be ready to defend its staff, procedures and equipment."

A new anesthesia machine should last 15 years, and a refurbished machine will last as long as you have service to support it. Equipment buyer Scotty Farris estimates facility administrators are equally likely to buy a new or refurbished machine. Typically, a new, full-sized machine costs $30,000 to $50,000, with refurbished full-sized machines starting at $12,000 and going to about $25,000.

Ask your anesthesiology provider
Talk to your anesthesiologist or CRNA, says Cheryl Castleberry, RN, the director of clinical operations for Specialty Surgicenters, Inc., of Roswell, Ga.: "Do it right the first time, rather than update it later to suit your provider." Also look for a machine that suits the center's needs, says Marlene Brunswick, RN, the director of nurses at the Findlay Surgery Center in Findlay, Ohio.

Don't be surprised if your anesthesia provider wants the same machine you already have or the one he knows best. Mr. Farris notes that anesthesia providers "tend to favor the brand with which they are most familiar." But there is some value to this in terms of operational safety.

"What do you have in the other ORs? Keep the same machines the anesthesiologist (and staff) are familiar with. There is safety in this," says Tom Green, the president of Paragon Service of Saline, Mich., a refurbishing company.

Your anesthesia providers may prefer models that offer the latest features. For example, ventilators now have pressure control and positive-end expiratory pressure (PEEP), which let you ventilate patents at lower peak pressures, notes Girish P. Joshi, MD, a professor of anesthesiology and pain management at the University of Texas Southwestern Medical Center. He notes that this feature is especially beneficial to older patients and those with respiratory problems.

Alan Marco, MD, MMM, an associate professor of anesthesiology at Medical College of Ohio suggests facility managers consider these features:

• good connectivity to patient medical records,
• integration of monitors,
• ease of use (ergonomics) and
• mobility of the platform.

Older machines are "big, heavy monsters," says Dr. Marco. If you are moving the machine for different specialties and procedures, consider a newer unit on a handcart that is easy to move.

David Barinholtz, MD, of Mobile Anesthesiolo-gists in Chicago brings a portable anesthesia machine with him for office-based surgery.

"We're using the first truly portable anesthesia machine, the OBA-1, which weighs 35 or 40 lbs. and comes with a great carrying case. It accepts one vaporizer. The unit is completely pneumatic, without any electrical components or need for a power supply," says Dr. Barinholtz.

Because he does all IV anesthesia, he says he doesn't need a ventilator. Dr. Barinholtz says you should think about gases and piping and recommends putting pipelines in a retractable ceiling mount. And if you do pediatrics, you will need a scavenging pipeline; this is also useful in a plastic surgery office to aid inhalation induction.

New or refurbished?
Unless there are new features you just can't get on a refurbished machine (it takes four or five years for a model to make it to the secondary market), a refurbished machine will often be the most cost-effective choice.

"I've only bought new anesthesia machines, but I would consider a refurbished one. I have bought other equipment refurbished, and it was reliable and serviceable. You can save yourself money up front. Just like a new car, the minute you drive off the lot, you lose value," says Ms. Brunswick.

Experienced refurbishers warn about selecting a supplier of refurbished machines.

"What do they mean by refurbishing? Do they just clean it up and resell it? You can call that refurbished, but it's not. Does this company have guidelines?" asks Mr. Green, whose company is authorized to service Draeger Medical and Datex-Ohmeda, the two leading makers of anesthesia machines.

Matthew Sweitzer of Anesthesia Plus, another refurbisher, says the company should document serial numbers; disassemble the machine; refurbish the ventilator, absorb-er, scavenger, gas proportionate systems, flow meters and controls; test all components upon reassembly; perform a safety check; and certify the machine.

Those who have bought new machines say that process is more smooth if you have a knowledgeable sales rep.

"We found it easy to select the right machines because our sales reps were helpful. They helped us to decide where to put the gasses, and so on. We got them involved early, and it was a good thing," says Ms. Castleberry, who bought three new Datex-Ohmeda machines.

A new machine should be delivered in two to four weeks. Set-up and staff in-service (to some degree) are often part of the price. The machine can be set up, calibrated and in-serviced in one or two days. Have the machine serviced four times a year; you can purchase a service contract from the manufacturer or an authorized service organization.