THUMBS UP Dr. Sinha test-drives the new Olympus BF-H190 bronchoscope.

The Big Easy. That's where this year's American Society of Anesthesiologists' annual meeting took place, and appropriately enough for New Orleans, it was big and it was easy. Easy, that is, to see a lot of interesting and innovative products. Here's a closer look at some that stood out.

HANDS FREE Fukuda Denshi's Finger-Mounted Ultrasound Probe helps ease the pressure.

1 Fukuda Denshi Finger-Mounted Ultrasound Probe
One Digit Is All You Need
The company's new one-finger device is a nice alternative to traditional probes. The technology isn't new, but the application is. The finger-mounted probe helps overcome the unsteadiness that characterizes traditional probes. You just rest your hand on the patient's body, and you know it's not going anywhere. The gentle pressure from your hand, along with being more comforting to the patient, also makes it less likely you'll accidentally collapse a vein. There's also a convenience factor in that there's no need to put the probe down and pick it up again during the procedure, or to have someone hold it for you. You can even slip a glove over it. I can see it being used in more challenging applications — for example, if you're trying to find a patient's antecubital, or radial artery. People should be able to pick up the technique very quickly.
fukuda.com

EARLY WARNING The BSmart from B. Braun tells you when injection pressure is too high.

2 B. Braun BSmart
Injection Pressure Monitor
Too Much Pressure? Stop the Injection
This clever device is like a tire-pressure gauge for peripheral nerve blocks. If the injection pressure reaches a certain level, you know your needle is probably in the wrong tissue. It's likely to be especially helpful when you're using a second person to inject a block — one to hold the needle in the right place, and one to inject. If the needle slips, or the patient moves, you can easily end up in the wrong tissue. I like the simplicity. It's not technically challenging.
bbraunusa.com

IN FOCUS Edan's point-of-care system achieves a new level of clarity.

3 Edan Acclarix LX8 Ultrasound System
Impressively Clear Ultrasound Images
I was impressed by the clear focus and well-defined borders displayed by this competitively priced, point-of-care ultrasound system. It's a big improvement over the usual shadowy ultrasound images. The company says it uses tissue-adaptive imaging, a technology that continuously and automatically optimizes the image based on returning echoes from the patient. However they do it, they've really managed to improve the clarity. FDA approval is imminent, says the company.
edanmedical.com

UP TO THE MINUTE The ExSpiron 1Xi can tell you whether further opioid dosing might impede recovery.

4 Respiratory Motion ExSpiron 1Xi
Calculate Minute
Ventilation in the PACU
This innovative non-invasive device assesses respiratory function in the PACU, telling you how patients are recovering. It uses an electrode strip that measures tidal volume and respiratory rate to calculate minute ventilation, so you can determine whether further opioid dosing might be problematic. Studies suggest that as many as one-third of PACU patients have 80% or lower minute ventilation and may have their recoveries impeded by opioids. This is a big issue. The ability to separate the effect of paralytics vs. the effect of narcotics is key. When to send patients from the PACU, which is expensive, to the floor, which is less expensive, is a judgment call. Is the patient ready? This gives you empirical numbers.
respiratorymotion.com

LIQUID GOLD Patients who drink Clearfast before surgery are likely to have fewer complications.

5 BevMD Clearfast
Forget NPO, Drink This
This product makes a world of sense. Why starve and dehydrate our patients? As a pre-operative nutritional supplement, it's definitely an improvement over NPO, and it's definitely a component of ERAS (enhanced recovery after surgery). For a patient having an outpatient procedure, the company recommends drinking one bottle before retiring and another about 2 hours before surgery. Each drink has 44 grams of complex carbohydrates and is quickly absorbed. A new formula, just out this year, has fewer simple sugars, replacing them with stevia, a natural sweetener, and includes LCitrulline, which helps promote blood flow and muscle tissue repair. Plus, it tastes pretty good.
bevmd.com

NOSE BEST The nose is a fail-safe way to measure oxygen saturation.

6 Xhale Assurance Nasal Pulse Oximetry
Follow Your Nose for Better Pulse Oximetry
What's not to like about an unobtrusive pulse oximetry sensor that's designed for the nasal ala? For some reason, when we start looking for a signal, we do the fingers, the toes and then the ears. But the nose is vascular, it's warmer, it gives you a better signal and a more rapid response to changing signals. Why put a big clip on the finger, which often slips off, when you can use the nose? There's a huge anastomosis there, after all, so it always works. The only time you couldn't use this is with facial surgery, but other than that, I can't think of anything not to like about this product.
xhale.com

UNDER YOUR SKIN Ezono's magnetic imaging shows clearly where the needle is headed.

7 Ezono 4000 Ultrasound
An Innovative Approach to Ultrasound
This product has some distinct advantages and is ideal for providers who either don't do a lot of blocks, or haven't yet. Tutorials are built into the system, so if you're doing, say, an interscalene block, you can see the live image on the bottom and, simultaneously, a guide on top to help you know what to look for. The company also has a web portal, so providers with different approaches can upload them. Meanwhile, magnetic imaging shows very clearly where your needle will be if you continue a given approach. That's big. If you're working with students or residents, it's much easier to tell them what to do with their hands, what to do with their wrists, what to do with the needle, and whether to advance, stop or change the angle. You can see what's going on under the skin much better. And the price (between $20,000 and $30,000) seems very reasonable.
ezono.com

PUMPED UP Smiths' new pain pump uses a new and more effective approach.

8 Smiths Medical
CADD-Solis Infusion Pump
Programmed Bolus Improves Results
Recent studies show that compared with continuous infusion, a "programmed intermittent bolus" leads to better penetration and distribution of medication and better outcomes. So instead of having a continuous infusion of, say, 10 ml/hour, the pump delivers a 10 ml bolus every 60 minutes (or whatever time interval you choose). If the patient self-administers a bolus before the hour is up, the pump locks out and pushes the next scheduled bolus back a pre-determined length of time. The company says patients who have programmed intermittent boluses use less anesthesia overall and have better pain scores and satisfaction ratings. The price is the same as that of previous pumps, and the company will upgrade their pumps to the next level for free.
smiths-medical.com

WHAT'S SHAKING A new dantrolene formulation has distinct advantages and disadvantages.

9 Eagle Pharmaceuticals Ryanodex
A Rapid Loading Dosefor MH Emergencies
This product is a lot more expensive than the alternative dantrolene formulations, but also much more convenient. Traditionally, if you have a 100 kg patient in the midst of an MH crisis, the first thing you do is call for help, and that's for one reason — to shake those darn vials. With other dantrolene products you'd need to reconstitute 12 or 13 vials (at 20 g each) just to get the loading dose. The new product uses nanoparticle technology to constitute the needed dose for a 100 kg patient (250 mg) in 1 vial that can be reconstituted in less than 60 seconds. But the new product also has a shorter shelf life, which magnifies the added cost (3 vials of Ryanodex will run you about $6,900, vs. about $3,000 for 36 vials of the alternative). Some will balk at the price, especially since MH incidents are rare, but when you think about the patient, the patient's family and the anesthesiologist, well, it's a tough call.
eagleus.com

THE PRICE OF GAS The Iso-Gard Mask can improve staff safety.

10 Teleflex Iso-Gard Mask
Eliminate Dangerous
Gases in the PACU
Teleflex has come up with an interesting product to address a largely unknown and invisible problem: anesthetic gases expelled by patients in the PACU. Seventy percent of patients in recovery continue to exhale gases above OSHA- and NIOSH-recommended safety levels for waste anesthetic gas exposure, the rep explained. For staff, that can lead to nausea, fatigue, headaches, and — in extreme cases — miscarriages, sterility and birth defects. The Iso-Gard Mask, which can be worn by patients, has a one-way valve. When the patient is given oxygen, exhaled gases are scavenged off and pulled into a suction device. It's a good first step, but I have some practical concerns. The first few minutes in PACU are probably the most important, but patients may continue to expel gases for 2 hours. You can't add 2 hours to everybody's PACU time. Compliance may be an issue, too. How long will patients put up with the mask? And what about patients who refuse to wear it?
teleflex.com

NEW TWIST The Olympus BF-H190 is more maneuverable than previous bronchoscopes.

11 Olympus BF-H190
Video Bronchoscope
A Stronger and More Flexible Scope
The new scope offers several advantages. Along with tremendous image quality as a diagnostic tool, it's both sturdier and more maneuverable, so there's less twisting and reaching, and less danger of compromising the sterile field. Previous scopes have had fiber-optic cabling that eventually broke after being bent enough times. The new optical system will hold up longer and it allows for more torquing capacity than just what the wrist can do. With a 220-degree rotation capability, it allows another 90 degrees or so after your wrist freezes, so doctors can keep their hands steady and introduce the working channel without having to put down and pick up the scope.
olympusamerica.com