This is my second tour of duty covering the latest products on display at the American Society of Anesthesiologists' annual meeting. Last year, I told you about tools for airway and pain management, proving that not everything that happens in Vegas stays in Vegas. This year I traveled to Atlanta and discovered exciting new equipment for patient warming and brain-function monitoring. Here's a look at what I found while weaving my way around the exhibit hall.

Patient warming
Arizant debuted a single-use Bair Paws OR Gown, which I think is an excellent addition to the patient-warming market. A company spokeswoman modeled a gown. It was soft and tied on the sides for improved patient modesty. Upon entering a facility, patients don the gown and get hooked up to a Bair Hugger forced-air warming device; the gown has a valve to which nurses attach the Hugger's hose. Patients can wear the gowns in the OR during short procedures on extremities. Patients can also control the heat level in pre-op and PACU with a handheld remote control.

Each gown costs between $11 and $15. I liked that you can also purchase a patient-warming kit, which includes a gown, socks, booties, bonnet and personal garment bag. Arizant's rep says you can place your logo on the gown, a feature you might consider in this era of competitive healthcare marketing.

Enthermics Medical Systems' booth was an interesting stop. The product on display, the WarmRight line of blanket warmers, wasn't new, but what I learned during my stop was. You shouldn't heat injection or irrigation fluids in blanket-warming devices, but we all know people who do exactly that. Enthermics' blanket warmers, however, are the only devices FDA-approved to also warm irrigation and injection fluids. The cabinets reach 104 degrees for heating fluids and 200 degrees for blankets; you can switch between the two settings with a push-button toggle.

Belmont Instrument Corporation already has a fluid warming device for pediatric patients, the Buddy Fluid Warmer. Next year, the company says, it will release a similar product for use with adult patients. The power unit of the buddy is mounted on an IV pole while the heater itself sits next to the incision site, minimizing the distance traveled by the fluid after heating and therefore preventing line cooling. The power unit also has an audible alarm to alert users when fluid runs out. I liked this product. Many fluid heating devices incorporate a tube-within-a-tube design - the inner tube carries the fluid while hot water flows through the outer tube, heating the inner tube. The Buddy, however, clips onto the tubing and heats the fluid as it passes through.

The fledgling company Augustine Biomedical and Design introduced its Hot Dog warming devices, a line that includes blankets for patient warming, single-arm wraps for ease in IV placement and clinician warming vests. The Hot Dog is a minimalist approach, using conductive heating to warm patients; the blanket itself is made of conductive fabric to distribute heat evenly while cutting down on heat lost to radiation. Using the same technology, Augustine makes warming vests for OR staff to use. Patient comfort is vital, but it's nice to have someone looking out for us caregivers.

Smiths Medical Level H-1200 Fast Flow Fluid Warmer can heat one liter of liquid in one minute, says the company. The warmer isn't new, but Smiths has upgraded the device's capabilities by adding an automatic air detector. When unwanted air enters the circuit, the fluid warmer clamps the line to prevent air emboli from forming. An alarm then sounds, alerting clinicians to the problem. Once you replace the IV bag, the Level H-1200 resets itself and proceeds with warming the fluid.

The most interactive booth at the show belonged to Dynatherm Medical, Inc., which showcased its VH1 patient-warming device by demonstrating it to all comers. The VH1 maintains normothermia by heating a patient's hand in a clear, plastic, heated mitt. When you turn the VH1 on, the mitt forms a vacuum around the patient's hand. The combination of heat and vacuum opens up the palmar arteriovenous channels in the palm and warms the blood that flows directly to the body's core. This is a neat product, and one that warms the patient without getting in the way of surgery. Because the hand is the only body part covered, the surgeon should have clear access to most surgical sites.

Brain-function monitors
Hospira's Sedline brain-function monitor uses four active leads that span bilateral frontal and prefrontal areas of the brain, providing a wider look at brain activities. The electrodes themselves - there are six of them - attach to the patient's forehead and don't require additional adhesives.

The newest brain-function monitor comes from Danmeter. The company's Cerebral State Monitor differentiates itself from the competition because of its size. This monitor is compact (4.5 inches by 2.7 inches by 1.2 inches), making it ideal for monitoring at the point of care in pre-, intra- and post-op. The CSM has wireless capabilities for easy transfer of case data; you can watch a timeline of the case (drugs administered and their effects on the patient's cerebral state) in real-time or at the conclusion of the case via a printable report. Two of the monitor's three sensors are placed on the forehead, the third behind the patient's ear. By not covering the entire forehead, the sensor placement of the CSM could make it appropriate for facial plastic surgery.

Airway management
Saturn Biomedical Systems didn't release a new product, but instead improved upon its Glidescope Video Intubation System by adding a color screen to the setup. I trialed the new scope at Saturn's booth and loved the quality of the color display. Color gives a clearer idea of what's happening around the tube, a feature that would be especially helpful when working on a difficult airway. Saturn also released a smaller version of this video system, eliminating the need for a bulky video cart in the OR. For around $8,800 you can take home a video system with a rechargeable battery; a non-rechargeable model lists for $7,800.

The Endoflex, by Medline, is a new endotracheal tube that will work especially well for intubations of difficult airways. This device has a flex-tip that you can manipulate with a simple squeeze of the fingers on a lever near the scope's handle - think of the action involved in depressing a syringe. The company says the scope also has a smooth tip to prevent damage to the airway, but the articulating feature is what really separates this product. For standard intubations, you can use the Endoflex like any other endotracheal tube.

Getting a clear view of the airway is always important during intubation, and Teleflex Medical unveiled a clever product to aid the anesthesiologist. The Viewmax uses a lens system to refract images 20 degrees, giving an anterior view of the airway. Anesthesiologists look through a viewfinder - like a telescope - when manipulating the scope. This is a great idea, bridging the gap between a basic laryngoscope and costly high-tech video models.

The Vital View Laryngoscope by Vital Signs has an anti-roll tip and a softer, thinner membrane meaning it takes less air to establish a seal. The tube itself is more flexible, therefore causing less airway trauma during intubation. Blades used for this system are single-use and lightweight. I really liked the feel of the blades, especially the rubber grip on the handle. The built-in light was also impressive; Vital Signs incorporated an LED source, meaning the light is white and noticeably brighter than other blades on the market. For about $3 per single-use blade, I was impressed.

An innovative product that I enjoyed learning about was the Microstream Smart BiteBloc by Oridion. A specialized nose cannula fits into the top of the BiteBloc, allowing for continuous oxygen administration and CO2 monitoring during upper endoscopy procedures. The BiteBloc also protects the scope and maintains scope maneuverability during the procedure.

OxyArm added two new sizes to its OxyMask product line: oversized and pediatric. The company designs a unique open mask that delivers oxygen through a focused diffuser inches from the patient's mouth and nose. The design allows for easy communication with the patient, as well as placement of an endo tube. As patients are increasing in size, even if they're not considered obese, providing a larger size of this mask is a good move.

Anesthesia machines and workstations
New capital equipment doesn't come along too often - small improvements are the norm nowadays - but there are a couple brand new additions.

Paragon Medical unveiled the Platinum SC430. I liked its compact design, ergonomic placement of dials and switches, and the 8.4-inch color touchscreen. Standard ventilation modes include volume mode (with fresh gas compensation), pressure mode and pressure support mode. The machine costs $32,900; $34,900 with one vaporizer.

As for anesthesia workstations, Penlon America arrived with its Prima SP3 Anesthesia System. The system comes in several bright colors (I saw yellow, blue and green) and has lots of useful features. It boasts four GSX mounting rails on both sides of the workstation for a great deal of equipment-mounting flexibility. Three vaporizers come standard, as do six ventilation modes. The feature I really liked was incorporated into the system's screen display. Users can toggle between touch screen or switch control when cycling through displays. That's helpful, since we're all used to different control mechanisms.

Medication management is a huge concern of anesthesiologists, and Omnicell miniaturized one of its workstations to aid in that process. The Anesthesia TT operates like many of the company's workstations, offering touch-screen controls, locking single-dose medication drawers and automatic monitoring of dose and patient records. The biggest change in the Anesthesia TT is its small size. The workstation is designed as a tabletop model, ideal for use in a GI or procedure room.

DocuSys displayed its DocuCart OR, a workstation from which users can dispense and document medications using a bar coding system. Instead of recording drugs that are removed from a cart, the DocuCart OR lets anesthesiologists scan medications as they're used. The workstation's software is then able to keep an electronic record of the medication you give during a case, as well as a time-stamped log of users who opened drawers.

Pain management
Stryker's PainPump 2 BlockAid has a self-contained fluid reservoir, a 400ml capacity and a separate refill port for replenishing the drug supply up to 1,000ml. Patients can use the PainPump 2 for up to seven days. This pump has all the bells and whistles: programmable flow rates, patient bolus settings and a digital readout screen. At $300, it's a high-end disposable infusion pump, but the extra cost is worth it if you want total management of pain control after administering peripheral nerve blocks.

The On-Q PainBuster, by I-Flow, provides continuous infusion of a local anesthetic directly into the patient's surgical site for up to five days, making this device ideal for pain relief after breast augmentation surgery or ACL repairs. I-Flow also offers a third-party payer system. The company invoices the patient's insurance company, collects the reimbursement and lets you use the On-Q PainBuster in your facility at no additional cost.

When I send a patient home with a pain pump, the reliability of the catheter is one of my biggest concerns. Controlling patient pain is paramount, but to be honest, a catheter that becomes disconnected also means a trip to my center for replacement. That's an inconvenience for the patient and my practice. The Perifix Catheter Connector by B. Braun attempts to eliminate these concerns. The connector, nicknamed "The Alligator," seems promising. You can feel the catheter hit the back of the connector, then hear and feel a click when closing the connector. B. Braun claims it won't become loose after closing. If that's true, this product would be a huge help to anyone who sends pain pumps home with patients.

Smiths Medical also displayed its Advantiv Safety IV Catheter. The company touts the catheter as a passive safety device and I can see why. Its needle tip is fully encased inside the tip protector until the user activates it with a large push-off tab. A note about the needle: it's a V-point needle, one that's very sharp, so insertion is easy. As safety sharps start to take hold in the healthcare community, this is a nice product. The users' hands never come close to the needle's tip.

For reducing liquid medication into a spray, Wolfe Tory Medical offers the Madgic. The long, tubular device attaches to the end of a syringe and delivers a fine spray once the syringe is depressed. It's a malleable device, making it an ideal product for topical medication delivery before intubation, bronchoscopy and endoscopy.

IRadimed's MRI IV Pump is a clever product. The infusion system is designed for MRI suites, providing a high-tech means for fluid delivery. The reason I really liked this device is the vented syringe adapter located on the top of the pump. When using standard machines, users have to open a compartment on the box, place the syringe in a holder, shut the box and wait until the pump's driver administers the medication. On the MRI IV Pump, you can insert syringes in a port on the top of the device, allowing for easy delivery of syringe fluids. This is a user-friendly feature, and a smart idea.

Monitors and labels
OxiMax added a forehead monitor to its OxiMax Pulse Oximetry System, a sensor that the company claims relays more consistent and accurate patient readings than digit or ear sensors. Placing sensors on the forehead makes readings less prone to patient movement; the forehead is also more accessible to anesthesiologists during surgery. In addition to the forehead sensor, the OxiMax Pulse Oximetry System upgraded its monitor box to accept new technology upgrades without the need to purchase a whole new system.

Measuring levels of gases used during surgery is critical, and Philips recently released its Essential Gas Module, a setup that displays (based on the anesthesiologist's choice) inspiration and expiration levels for sevoflurane, isoflurane, halothane, desflurane, enflurane, nitrous oxide, carbon dioxide and oxygen. The EGM is compatible with many of Philips' patient monitoring systems, is compact and easy to move, and users are able to customize the screen displays to meet their needs.

Nihon Kohden upgraded its monitor line with its Cap-One CO2 sensor, designed for non-intubated patients. It's all-inclusive: The single module setup means I'd be able to monitor CO2 and other vitals with one box. The Cap-One uses unique disposable oral and nasal sensors to measure CO2 levels right at the site of expiration. I also liked the display numbers on this monitor, which were big and easy to read.

With JCAHO's emphasis on proper labeling of drugs in 2006, TimeMed released a new series of medication labels. Each label is 1.5 inches by .5 inches, and identifies each medication by drug name, strength, amount, expiration date, and the time and initials of the person giving the medication. In addition, the labels are colored-coded by class of drugs (green for anticholinergic agents, gray for local anesthetics and yellow for induction agents). Labels also differentiate look-alike and sound-alike drugs with tall letters (ATRAcurium versus DOXAcurium, for example).