They say that the most dangerous thing a surgery center does isn't surgery, it's anesthesia. That reason alone makes choosing your anesthesia machine an important decision. You need to be confident in your equipment. But, experts say, the right machine for your facility can also increase efficiency and benefit your bottom line. Here's their advice on making the purchase.

Do the research
Managers in the market for an anesthesia machine should make sure they research the features of the models they're considering, and know why they need them.

"The technology now is very mature," says Scotty Farris, a technology planner for EQ International. "There are not a lot of advances to be made in the machines themselves. But with the ventilators and monitoring equipment, integral parts of the machine, there are a lot of options.

"Remember," he adds, "that users need to develop the specifications of the machines they're going to buy, not the vendors."

Michael Mitton, CRNA, BS, issues another caveat. "There is no perfect anesthesia machine," he says. "Some administrators may try to compare them, side by side, as if they're the same machine. But each is significantly different, and there are certain things one may do well that the other doesn't do as well."

As director of clinical affairs for GE Healthcare's Life Support Solutions division and a part-time anesthetist in Janesville, Wis., Mr. Mitton pointed out that those differences could weigh heavily on a decision.

"If any anesthesia provider has any reason to demand particular features - when the difference makes a difference - that is a clinical argument that almost never loses," he says.

Listen up
Who has more purchasing power when it comes to anesthesia machines - OR managers or anesthesia providers? "Most anesthesiologists don't have anything to do with buying the machines," says Adam F. Dorin, MD, MBA, medical director at the Sharp Grossmont Plaza Surgery Center and a member of San Diego's Anesthesia Services Medical Group. But Dr. Dorin says that involving the anesthesia providers from the onset is critical. Just as no facility manager would choose a new laparoscope system or new suture without involving the surgeons, he wonders why it should be different for anesthesia machines. "As with any other technology or instrument," says Dr. Dorin, "getting input from the end-user will be paramount in successful implementation."

In Mr. Farris's view, the most important task for a facility manager considering buying an anesthesia machine is seeking consensus from anesthesia providers. This agreement should extend to what kind of machine will be used in each room, he adds. If possible, equip each room with the same kind of machine. "This decreases the variability and decreases the risks," says Mr. Farris. "Some facilities will choose to buy a different machine than the one they have, and that's fine if the anesthesia provider is OK with it. But you don't want four ORs with four different machines."

This consistency is important for two reasons: safety and cost. Having different machines in each room with different alarms, sounds and settings, switch locations and different capabilities can interfere with the anesthesia provider's ability to focus on the patient, which could affect safety. From an economic viewpoint, having to maintain service contracts and technicians' proficiencies on multiple machines can be costly. If you do choose to have multiple machines (for example, in a training program or during the transition from one manufacturer to another), increased vigilance is important.

Look at yourself, and your future
"You have to understand what you need," says Mr. Mitton. "The big question might not be 'What kind of anesthesia machine should you buy?', but rather, 'What kind of practice does your facility have?'"

Understanding your specialty, patient demographics, anesthesia use, airway management methods and other factors may point the way toward what is needed. "There is no solution to the right of an equals sign unless there's a well-defined problem to the left," he says. "You have to know what problem you want to solve."

Don't forget to question what's ahead. "What are (your anesthesia providers) doing now? What could they be doing, if you could allow them to do it? How can you make work more efficient?" asks Mr. Mitton. "Where's the practice going in the next couple of years? I think anesthesia machines need to be purchased with an eye on the future, not the past." For example, if you are considering a bariatric program, machines with ventilators that have a pressure-cycled mode in addition to the volume-cycled mode would be useful.

Consider value, not just cost
"The industry has many new technologies that can be of great assistance to anesthesia providers and healthcare institutions," says Mr. Mitton, "and those institutions should not turn away from machines on price alone. Many purchasers opt to buy the least expensive machine they can get their hands on, and frequently that's a mistake. Ask yourself, which anesthesia machine provides the best benefit?"

For a growing practice, for instance, a higher-end machine could deliver a return on its investment promptly. Its quality construction will likely mean that it will operate consistently and for a long time, and the efficiency it adds to the OR might speed cases through, improve patient care and decrease expenses of providing that care. Having to close a room because the anesthesia machine is having emergency service is a problem for everyone. Likewise, a machine with convenient grab-handles and smoothly rolling wheels will make the OR team's job easier.

Not every practice grows in the same way, Mr. Mitton admits, but managers must consider an anesthesia machine's overall cost to the center, including the hard-to-quantify hassle factor, not simply the individual cost of the machine.

New or pre-owned?
Refurbished anesthesia machines are a growing market, and may offer an economical choice, but choose carefully, warns Mr. Farris.

"There's no universally recognized definition for refurbishing," he says. "There are a lot of people who say they refurbish, but that word differs from company to company."

While one refurbisher may "truly re-manufacture" machines, another may simply "spray and pray," he says, advising potential buyers to investigate whether the refurbisher is manufacturer-authorized and the extent of their training and support. Just as in buying a used car, knowing what to look for can get you a great deal from the corner lot; otherwise you'll do better overall and still save money with a dealer's certified pre-owned vehicle.

Dr. Dorin says he's seen great value in pre-owned equipment. "I've been at a few start-up surgery centers, and most of them have gone with refurbished machines," he says. "Especially freestanding centers. For one thing, they're a lot less expensive. You can get them for 10 percent or 15 percent off the list price of a new machine. And you don't have to worry about them going bad. These things are like old Chevys: they just keep going."

With their simple mechanics, lack of complex computer programs and ease of maintenance, they only require the availability of product service to keep running, he says. "I've always preferred, when given the option, to spend my capital budget buying new anesthesia tools and monitors rather than purchasing new anesthesia machines," says Dr. Dorin.

Experts say that a new anesthesia machine can be expected to last 12 years to 15 years, or longer with proper maintenance, while a refurbished machine can last as long as service is available. They note, however, that not all older machines are upgradeable, and advancing technology may leave those older machines further out of date.

What's possible
"An anesthesia machine is not just the sum of its parts: a vaporizer, breathing system, ventilator and monitor," says Mr. Mitton. "It is extremely dynamic. It's not static. The new technology, along with a new understanding of how those technologies can be employed and exploited, can let a practitioner do more than he ever thought possible."

Just as in the automobile industry, the basic product hasn't changed much over the past decade, but the options available have increased dramatically. Having the ability to choose (or upgrade to) the anesthesia equivalent of side-curtain airbags and electronic stability control is important. Like your old 1969 VW Beetle, the old standard anesthesia machine will get you where you're going, but it's not the same ride as a 2005 Chevy Monte Carlo.