San Francisco, the town that welcomed the gold rush, opened its gates in October to nearly 20,000 anesthesiologists who discussed and debated everything from dealing with obese patients to whether chili peppers can help with acute pain. Each year I make it a point to walk the show floor to meet old friends and catch up on the latest products for anesthesia providers. Here's the gold I found this year. We'll be trialing some of these products at our hospital in Minneapolis in the near future .

1. T-Line Tensymeter
Tensys Medical has devised a way to monitor blood pressure in real time without having to place an arterial catheter. The T-Line Tensymeter measures arterial blood pressure and pulse rate in adults as tall as six feet, six inches, and as heavy as 400 pounds. The single-use sensor can be used up to 18 hours to measure systolic, diastolic and mean pressure within a mean of 5mmHg. The sensor's location changes dynamically along the radial artery based on the quality of the signal. The T-Line generates a beat-to-beat radial artery pressure waveform and blood pressure values that can be displayed on its own display or on standard patient monitors.

2. S-Nerve
SonoSite has eliminated the excess of knobs and buttons and created S-Nerve, an ultrasound machine designed especially for anesthesiologists. The battery-operated machine can be mounted on an IV pole or hand-carried. It weighs just 8.35 pounds. The sleek, no-frills design has some anesthesiologists comparing it to the simple aesthetic of Apple or Bang & Olufsen products. S-Nerve has the same processing power and image quality of SonoSite's M-Turbo system, which is 16 times more powerful than SonoSite's industry leading MicroMaxx system. Images in common digital formats can be exported to a PC or Mac through a USB port and integrated into medical records, multimedia presentations and training materials.

3. OS Holster & Clamp
I've been waiting for someone to invent a place to put the sterile oral suction tip. Lynn White, MD, an anesthesiologist from Wheat Ridge, Colo., has done it. The single-use Oral Suction OS Holster & Clamp, marketed by Patient Shield Concepts, creates a closed loop for the suction tip between the patient and the holster. There's no temptation to tuck the tube somewhere on the surgical bed or drape it over a stand or a cart. The holster attaches to a clamp that easily attaches to a standard hospital bedrail. The holster can be attached in three positions. It also has notches for clamping the suction tubing, which reduces noise. The clamp is designed to be reused up to five or six times.

4. GlideScope Cobalt
In 2002, GlideScope was one of the first video laryngoscopes on the market. Since then, the manufacturer, now Verathon Medical, has steadily introduced new features to this single-use stat for video laryngoscopes. This year, Verathon created the GlideScope Cobalt single-use video laryngoscope system. With the Cobalt's disposable stat, there's no need to wait for disinfection. A reusable video baton slides into the disposable stat. The stat, supplied in sterile packaging, is available in two sizes: large, for patients 88 pounds and up, and small, for those less than 88 pounds. The video baton attaches to a glare-free color monitor, which you can mount on a pole or mobile stand.

5. Pentax-AWS
Pentax has gotten into the image-guided intubation business as well. The Pentax-AWS is handheld and powered by a pair of AA batteries that allow for one hour of operation. It can easily be carried from one room to another. The video monitor on the end of the scope displays a target symbol that, when aligned over the glottic opening, helps placement of the endotracheal tube. The image, an NTSC video signal just like at home, can be sent to an external monitor or video recorder for archiving. The single-use blade has a groove for guiding the endotracheal tube and a port for inserting a suction catheter. This allows for image-guided aspiration of secretions and foreign objects as well placement of the endotracheal tube.

6. BSmart Injection Pressure Monitor
Here's a simple solution to an everyday challenge we anesthesia providers face when administering nerve blocks. Concert Medical's BSmart pressure monitor gives you a visual reading of the injection pressure of a traditional syringe. This reading can help detect poorly compliant tissue such as nerve fascicles and tendons. The single-use pressure valve attaches to the end of the syringe with the other end connected to the block needle. Here's how it works: When the device's little piston pops up exposing only white, you're at less than 15 psi injection pressure; when the yellow band pops up, you're at 15 to 20 psi; finally, when the orange band is visible, you're injecting at more than 20 psi.

7. SLIPA Cuffless Airway
Here's another low-priced disposable device. The SLIPA is a supraglottic airway designed as an alternative to the laryngeal mask airway. The device's shape creates a seal with the tongue, without the need for an inflatable cuff. You'll know when it's placed correctly because it will "click" into place between the esophagus and the nasopharynx. Once it's in place, there's no need for straps or tape. Because it's hollow, the SLIPA can hold up to 50ml of regurgitated liquid, which reduces the risk of aspiration. SLIPA, distributed in the United States by ARC Medical, comes in six sizes, with each bridge size designed for patients of different height.

8. Episure AutoDetect
This spring-loaded loss-of-resistance syringe automatically releases the plunger when the needle enters the epidural space. The syringe provides an objective visual confirmation of loss of resistance, so there's no need to rely on the "feel" of the pressure against the thumb. Because it's automatic, the anesthesia provider can use both hands to advance the needle, which allows for more control.

9. Aloxi
I was pleasantly surprised to learn that there is pharma in Minnesota, my home state, and happy to learn that they're working on an agent for post-operative nausea and vomiting. MGI Pharma, based in Minneapolis, has FDA approval for injectable Aloxi (palonosetron), a novel 5-HT3 receptor antagonist that can benefit patients at highrisk of PONV. The biopharmaceutical company presented the Phase 3 results for Aloxi at the ASA conference. A single 0.075mg dose reduced PONV in patients for up to 72 hours after surgery, according to a multi-center study of 544 patients in 28 facilities. Aloxi should be available commercially in the spring of 2008.

10. Contiplex Stim System
B. Braun's Contiplex Stim System lets anesthesia providers change the flow of electric current for nerve stimulation from the needle to the stimulating catheter with just the flick of a switch. This eliminates the step of having to unplug the needle from the Stimuplex nerve stimulator (the source of the current) and then plug in the stimulating catheter. To further keep the anesthesia provider's attention on the patient, you can pre-load the stimulating catheter into the needle. This also reduces the chance of needle movement when the catheter is loaded into the needle during the procedure. Contiplex Stim is due out in January. Also from B. Braun is the non-invasive Stimuplex Pen. This attaches to the nerve stimulator to stimulate superficial nerves through the skin and help establish the proper angle of entry for the block needle.

11. SNAP II Consciousness Monitor
Stryker has gotten into the level of consciousness monitor business with the SNAP II EEG Monitor, which analyzes EEG signals in both the low frequencies (0-18Hz) and high frequencies (80Hz and above). The signal is generated by a single-use sensor designed to fit all types of patients. The real-time EEG graph of the SNAP Index and SNAP Trend are displayed on a high-resolution color touchscreen. The battery-powered unit is self-contained and can be mounted on a pole for easy transport. Each patient becomes part of a database of up to 300 patients and 2,500 hours of recording, including up to 18 hours per case.

12. GE Navigator Applications Suite
The GE Healthcare booth was so busy it seemed more like a village. With the Navigator Applications Suite software, GE is thinking in the right direction. They've brought a library of drug therapy information to the OR to create pharmacokinetic and pharmacodynamic models of the effects of anesthesia. The software also offers quick access to your facility's protocols when you need them during a procedure. Also at the show, GE announced that its new Pressure Controlled Ventilation-Volume Guaranteed (PCV-VG) technology is now available for the Avance Carestation, designed for anesthesia. The PCV-VG mode delivers both pressure-controlled ventilation with a guaranteed tidal volume, which can help prevent over-pressure to the lungs and avoid alveoli collapse.