As Jay Horowitz, CRNA, shopped for a new vital signs monitor, he'd often flash back to his old IBM 286 computer, a clunky relic with one floppy drive, a 40 MB hard disk and monochrome screen that still sits in his home: no longer useful or wanted, obsolete before its time, even though it's in good working order. He didn't want the same fate to befall the monitor he'd recommend to the Surgery and Endoscopy Center in Sebring, Fla. Especially because it will measure the oxygenation, ventilation, circulation and temperature of the first patients to receive general anesthesia at the two-OR facility about to add invasive plastics cases.

"I'm 48 years old. I would expect the monitor we buy to last for the rest of my professional life, which could be 15 years or more," says Mr. Horowitz. "But the problem is, like TVs, stereos and computers, the next greatest thing comes along long before the machine is ready to be retired."

Here are 11 tips to ensure that a vital signs monitor serves you well for years to come.

1 Consult your anesthesia providers.
Let your anesthesiologists and nurse anesthetists have input into the purchase, our experts say. "Letting the user have some say in the decision is important," says Jeff Heyman, who tests and evaluates medical equipment with ECRI's Health Devices Group. "They're the ones who have to ultimately use it and figure out how to use it safely." Ask your anesthesia providers about the size of the display, the ability to print graphs and alarm features. "Defer to the anesthesia provider to select the features and to make sure you're within the standard of care," says ophthalmologist T. Hunter Newsom, MD, one of the Surgery and Endoscopy Center's owners.

2 Know which parameters you want to measure.
While the most basic of monitors can measure non-invasive parameters such as respiration and non-invasive blood pressure, the more sophisticated monitors provide information about specific anesthesia gas concentrations. Monitors can work side-by-side with such adjunct monitoring technologies as consciousness monitoring and nerve monitoring. Plug-and-play modules let you add on capnography or level-of-consciousness monitoring.

Mr. Horowitz asked the plastic surgeon what kinds of procedures he'll perform, how long they'll take and about his preference for anesthesia technique. He studied magazine articles and huddled with sales reps.

"Anesthesia providers, administrators, surgeons and the people writing the checks must be on the same page," says Mr. Horowitz.

3 Stress interchangeability.
The best monitors are versatile, allowing both battery and AC power supplies, says San Diego anesthesiologist Adam F. Dorin, MD, MBA, the medical director at Grossmont Plaza Surgery Center in San Diego. "If a monitor can be used in the operating room, then follow a patient on a stretcher to the PACU, and then travel with a patient to an adjacent radiology suite or the hospital, then its value is far greater than some big clunker fixed atop your anesthesia machine," he says.

Another important point: The most user-friendly surgical facilities have the same cables and monitors in all areas of patient care.

4 Go small and lightweight.
In order to be practical and easy to use, service or transport, a surgeon or nurse should be able to easily carry a monitor. It should fit nicely on the edge of a patient gurney. "Likewise, in the operating room," says Dr. Dorin, "monitors that take up less space on the anesthesia machine afford less clutter and more room for supplies and other patient care items."

"The more integrated, the better," says Andrew Herlich, DMD, MD, professor of anesthesiology, otolaryngology and pediatrics at Temple University School of Medicine. "Don't keep adding one thing after another to the point where it looks like the Tower of Babel." His suggestion: Buy a plug-and-play monitor. This way, if a particular channel goes down, you can pull that channel out and send it out for repair rather than sending the whole monitor back.

5 Buy lots of BP cuffs.
Make sure you get one pediatric blood pressure cuff, one regular adult and one large adult cuff with each monitor you buy, says Dr. Dorin. Also, buy a few extra of each size so there are enough around if you have, for example, a lot of large patients in a given day (or you need to clean and dry a cuff after a patient use), he says. Facilities that specialize in small children and infants will need the various smaller size-cuffs as well.

6 Consider EKG.
Make sure you have the capability (and the appropriate cords) to monitor both three and five leads on your machine, says Dr. Dorin. For more accurate and vigilant cardiac monitoring, make sure your model allows ST segment monitoring for ischemia detection, he says. Clinical pearl: The EKG cables that are flat are less likely than the flared clip-on type to catch on patient bedding/clothing, break and irritate soft tissue. These flatter-tipped EKG leads may be harder to press on if they dislodge after the sticky patch is applied, so just get a new patch and reapply in a new location, adds Dr. Dorin.

7 Buy backup pulse oximetry attachments.
Negotiate a backup clothing-pin type finger piece for each machine (or else, buy a few boxes of the disposable, single-use attachments) in the event one is crushed, dropped or otherwise broken, says Dr. Dorin. "Few things are as useless as a pulse oximetry monitor without the finger piece," he says. The disposable attachments are also invaluable for earlobes or other alternative sites in patients with poor circulation or anatomical limitations to fingertip monitoring, says Dr. Dorin.

8 Focus on the OR.
Rather than focusing on using the same monitors in the pre-op, intra-op and post-op clinical areas, build your monitor around the central needs of the operating room, then make subtle changes if necessary for the other settings, suggests Dr. Dorin.

9 Shop and compare.
It goes without saying: Try to get the best price possible whenever possible. "Because there are a lot of technical similarities between many of these devices, take price into account," says Mr. Heyman. "As you get into the do-it-all monitors, you can be sure that, like the price of gas, it will go up quickly," says Dr. Herlich. Over at the Surgery and Endoscopy Center, Cindy King, the administrator, took Mr. Horowitz's recommendations and then set out to negotiate price. "I'm bottom-line dollars. That's my role. I don't know all the switches and knobs and so forth," says Ms. King.

10 Make sure it's versatile and easy to use.
Can you quickly switch between pediatric and adult cases? Is pulse oximetry motion-tolerant? You don't want a monitor that will go haywire when you use electrocautery. You don't want a monitor with confusing, disorganized displays that are difficult to read in dark rooms or from different angles. And you don't want a monitor that requires a mechanical engineer to install recording paper.

11 Buy from a trusted source.
Whether you buy new or refurbished, your monitor must be reliable. "When the machine is down, that's a day you're not doing surgery. That means there are going to be unhappy patients and unhappy surgeons," says Mr. Horowitz. The main issue that comes up with older devices is the ability to service and support the unit, so be sure you can obtain parts and service support from the manufacturer, says Mr. Heyman. "Many parameter-measurement technologies are fairly mature, but some of the more mechanically-driven parameters may be subject to failure after extended use and parts may require replacement to continue using the monitor," he says. What's the repair turnaround time? "If your monitor goes down, does your warranty state that you'll have a replacement within 12 or 24 hours?" asks Dr. Herlich.

How many years?
It's reasonable to expect a vital signs monitor to last for seven years to 10 years, says Mr. Heyman. As you add capabilities and multiple invasive measurements, you increase the price and decrease the life expectancy. Dr. Herlich warns that the best monitors turn obsolete before their time. The trend toward miniaturization and routine upgrades means that "what you buy almost becomes outdated in two or three years," he says. "Monitors are getting smaller and smaller and people want them to do more and more."