Outpatient Surgery Magazine commissioned me to scout the exhibit hall at last month's American Society of Anesthesiologists meeting in Boston in search of the new products on display that I thought would really interest your anesthesia providers. I walked up and down every aisle and visited (most) every booth. Here's a report of what I saw. Senior Editor Jim Burger accompanied me, taking great notes and these great photos.

NO MORE CHIN THRUSTS Dr. Hickman tries on the aerFree Non-Invasive Airway Management System, which applies negative pressure to a patient's neck to support the patency of the upper airway. One of its advantages: It can free up busy PACU nurses who are caring for multiple patients, says Dr. Hickman.

Smiths Medical | aerFree Non-Invasive Airway Management System
I'd never seen anything like this before, but it's definitely an interesting idea. Basically, it's a precautionary device for busy PACUs with heavier patients and/or patients with undiagnosed (or diagnosed) sleep apnea. The system uses wall suction to pull the soft tissue around the airway forward, so you don't have to worry about sedated patients obstructing, and PACU nurses can confidently go about the business of caring for multiple patients instead of having to periodically wake patients up and do chin thrusts to make sure they're breathing.

The vacuum forms a seal around your lower jaw and neck, but it's not uncomfortable; it's just a little pressure. And of course, the patients who need it probably aren't going to remember anyway. Obviously, you won't use it on patients who are awake and moving, but for those who are snoring (a sign of sleep apnea), or whose oxygen saturation is dropping, I think it would be a reassuring helping hand. It runs about $60 and is disposable.

TWO IN ONE The LMA Gastro can secure an airway and provide a pathway for the GI scope to follow.

Teleflex | LMA Gastro
This is such a great idea, I can't believe it's just coming out in 2017. When you're doing an upper GI procedure and administering propofol, it's helpful to be able to monitor and maintain the airway with an LMA. But LMAs typically get in the way of GI scopes. The LMA Gastro lets you secure the airway and at the same time maintain a channeled pathway for the scope to follow.

That way, if a patient desaturates, you don't have to pull the scope and reintubate, or deflate the LMA (which is a really bad idea). And since you don't have to intubate, you don't have to use a neuromuscular blocker that can turn a 6-minute procedure into a 40-minute procedure.

It's not for every patient, but the population is getting heavier, and we're seeing a few more comorbidities in the outpatient environment, so the risk of airway compromise is increasing. This is a great tool for the roughly 10% of patients who don't need an endotracheal tube, but who might warrant a little more caution than the average patient.

KEEP ONE ON HAND? The Glidescope Go provides a good image at a good price.

Verathon | Glidescope Go
It's small enough to fit in the palm of your hand, but the new Glidescope Go provides a solid image in addition to convenience and affordability. At about $4,000, it may be within reach for facilities that have been resisting the inevitability of video laryngoscopy. And its easy portability makes it a solid adjunct for those who'd like to be equipped for unexpected emergencies.

It fits onto all types of blades, has auto-recording capability and comes with a rechargeable battery that provides about 100 minutes of continuous use. Just plug it into a docking station to recharge it. It's also fully submersible without special caps, so it's relatively easy to clean.

TRIPLE GUIDANCE When you hit the target with the CompuFlo Epidural Instrument, you feel it, see it and hear it — all at the same time.

Milestone Scientific | CompuFlo Epidural Instrument
When placing an epidural, it can be hard to know where the tip of your needle is when you're relying on the traditional loss-of-resistance technique, which is both blind and subjective. But with this cool machine, it's very obvious when you reach the target. You feel the pop, you see it and you hear it, all at once. It works by measuring pressure at the tip of the needle and providing audio and visual feedback.

If you do a lot of regional anesthesia, you know it can be confounding when you're in the inner spinous ligaments. You've got to get through the ligamentum flavum to get into the epidural space. You may think you feel a loss of resistance and that you're in the epidural space, but are you? Or, if you go too far, you can be responsible for a dural puncture and a spinal headache, the worst type of headache anyone can imagine.

This device provides peace of mind for pain management procedures, labor and delivery, or any type of lumbar epidural procedure. It might also be useful with total joints in the outpatient environment.

CUSTOM DESIGNED The Care Station 600 Series is just right for smaller surgical facilities. It's sleek, small and easy to move.

GE Healthcare | Care Station 600 Series
The rep says this machine was specifically designed for outpatient surgery centers, and it's easy to see that it's true. They really went through the extra effort to see what's needed in our environment, and what isn't.

It's sleek, it's small and it's easy to move. They scaled it down so it works in smaller spaces, but they still have an excellent ventilator and good monitors, among other features. We don't need a lot of what's in the typical hospital setting.

One of the things I really like about it is that you can run your flows low, measure the gas you're using and actually measure the cost — what you pay for sevoflurane, isoflurane or whatever. I think that's going to help facilities significantly cut costs.

It's also scaleable. You can add on different software as your surgery center evolves. For example, if you start doing total joints and ventilation becomes more challenging, available software can accommodate that.

Bottom line: It's simple and safe, and the fact that it can help control your costs is very helpful.

PORTABLE ULTRASOUND With the Clarius wireless system, you just grab the transducer and go. It works with any smart phone or pad.

Clarius | Handheld Wireless Ultrasound Scanner
The freedom that a small wireless ultrasound machine like this provides is terrific. Say you have a patient with a pain pump in physical therapy, and it appears his continuous catheter isn't working well. You can grab this, take it over, set it up in 30 or 40 seconds, and see exactly what's going on.

It has built-in Bluetooth, so you can use it with an iPhone, an iPad or an Android, and the images are pretty amazing. They're not quite where you'd want them to be to do nerve blocks, but you can see tendons and joints really well, so it's great for musculoskeletal ultrasound.

And the price is great because all you need is the transducer. You don't have to spend an extra 20 or 30 thousand dollars for the ultrasound machine.

MIDDLE GROUND The C-MAC Video Stylet provides a third option between a video laryngoscope and a fiber optic flexible scope.

Karl Storz | C-MAC Video Stylet
Here's another tool for your airway-management armamentarium. In the continuum of managing potentially difficult airways, it falls somewhere between the video laryngoscope and the fiber optic flexible scope.

In an emergency situation, you may not be able to get anterior enough with a video scope, and you may not have time to fiddle with a flexible scope. The video stylet is a rigid alternative that hooks on to a video scope and comes with a flexible tip that can help you navigate through the vocal cords and into the trachea.

It can also record both video and still photos, and it's easy to clean and reusable, says the company. You may need it only very occasionally, but it'll be good to have when you do.

STOP THE MUSIC With Canary Sound Design, the music in the OR automatically goes down or off when there's a crisis.

Canary Sound Design | Canary Box
Imagine you're in the OR and suddenly realize that the patient is in life-threatening distress. But the music is so loud, you have to shout to get anyone's attention.

Alistair MacDonald, MD, experienced that scenario and decided to do something about it. The result is the Canary Box, which interfaces with patient monitors and automatically turns music in the OR either down or off, depending on preset vital sign increments.

The machine is compatible with most major monitors and can be set to respond to heart rate, oxygen saturation, and invasive or non-invasive blood pressure. You can select as many or as few criteria as you'd like, and set whatever thresholds you deem appropriate.

One important feature: The danger signs have to be within the preset zone for a certain amount of time before they muzzle the music, so there are few, if any, nuisance triggers.

It's a pretty neat idea, depending, of course, on how much your surgeons like rock and roll. In my experience, some of the younger guys do really like to crank it up.

It's in the pilot stage right now (the FDA considers it information technology with no need to regulate), but the company expects it to go for about $1,000.

WAIST OF WARMTH Operation Heatjac is an inexpensive way to stop providers from shivering.

Operation Heatjac | Operation Heatjac Heated Apparel
Chilly in the OR? Operation Heatjac is a lightweight garment worn under the scrubs around the torso. It comes in 3 sizes and can be powered by transformers, rechargeable batteries, or, in the case of the least expensive model, air-activated hand-warming packs. Prices range from $105 to $279, and all models provide more than enough heat for the average procedure. I think a lot of people will be glad to pay those prices for some OR comfort.

Mark Silverberg, DDS, MD, the inventor of this device, has an interesting theory about the controversy surrounding forced hot air systems and surgical site infections. To the extent that there are related infections, he says, they're more likely caused by anesthesia providers (and others) who briefly remove the hoses from the systems and put them down their shirts or up their pant legs to warm themselves in frigid ORs. I have to admit, I've seen it happen many times.

6 MORE PRODUCTS I SAW AT ASA
Would Any of These Look Good in Your ORs?

The disposable NerveGuard from Pajunk Medical Systems helps prevent nerve damage while administering regional blocks. A pressure-sensing device compresses a spring and makes the syringe impossible to push if it's not where it's supposed to be. It's an improvement over other systems because there's no need to look at a monitor for yellow and red warning indicators while you're trying to administer the block. Providers who aren't as experienced and want to make sure they're as safe as possible may find it very useful.

An endoscopy suite that's doing a lot of sedation but doesn't have monitors for end-tidal CO₂ would be the perfect landing spot for Sentec's Digital Monitoring System. It's a disposable noninvasive sensor you can put on the cheek or forehead of high-risk patients to provide continuous measurement and make sure they don't succumb to respiratory depression. It might also be very useful in the PACU of an ASC that's doing, for example, interscalene blocks or other procedures that require more careful monitoring. The sensors run about $22 to $25 per patient, and the company rents, leases or sells the monitor.

The Xperius Point-of-Care Ultrasound, a joint effort from B. Braun and Philips, is a mobile system that enhances needle visualization and guidance during ultrasound-guided regional anesthesia. An articulating arm lets the screen move with the practitioner, and a touchscreen lets you increase or decrease depth with a quick swipe.

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This tray, from Safecare Tools, would be a nice convenience in a lot of outpatient centers that don't have pharmacists, and where anesthesia providers come in in the morning and load up all their supplies for the day. Designed by an anesthesiologist to help prevent medical errors, it uses international color-coding standards and provides an easy way to organize your workspace. It retails for $11.99, but can be volume priced.

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The Waffle Grip Positioning System from Augustine borrows from the same idea that keeps your rugs from sliding to help keep patients in place when they're in the Trendelenburg position. It wraps around the table and over a warming pad to help keep patients both safe and comfortable. There's also a draw sheet designed specifically to tuck arms in, which is a pretty cool idea.

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3M's Bair Hugger Temperature Monitoring System, which attaches to the patient's forehead, is much more convenient than an esophageal probe for monitoring patient core temperature during long procedures. It's also a lot more consistent and useful than the small strip a lot of outpatient centers use, since it displays average temperature over 5-minute periods. My only concern is that it's another monitor and another wire in an already-crowded OR.

— Gregory Hickman, MD

OFF THE CUFF CareTaker's finger cuff monitors blood pressure without the hassle of an arterial line.

CareTaker | Wireless Vital Sign Monitor
CareTaker has come up with a much easier way to monitor blood pressure in the OR and elsewhere.

Instead of having to deal with the hassle of an arterial line, a simple finger cuff does the job, providing beat-by-beat blood pressure measurements instead of just the occasional spot check. The continuous aspect is a nice feature, since no one's blood pressure is static, and a given spot check may or may not be indicative. With this, you get a nice waveform that shows trends for both heart rate and blood pressure, all without any wires or hoses.

It's Bluetooth enabled, so you can use any Android device as a monitor, and the company plans to add both Apple and Windows connectivity next year.

AROUND THE BLOCK The Nimbus Pain Pro is both versatile and affordable.

InfuTronix | Nimbus Pain Pro
For regional anesthesia with continuous peripheral nerve blocks, this evolving electronic pain pump is both inexpensive and customizable.

Essentially, it provides all the options you want and want your patients to have. You control the rate of infusion — whether boluses will be automatic or patient-controlled (or both) — the length of the lockout between boluses and so forth.

That versatility is helpful because different practitioners like different approaches, and different settings are appropriate for different procedures. For example, with interscalene catheters, a low, slow infusion works best. But with TAP blocks, or adductor or femoral blocks, an intermittent bolus might be better because it can provide better spread.

No matter what procedure you use it for, at around $250, it's extremely competitively priced, and it comes in both disposable and reusable models.

PRESSURE'S ON Mizuho's pressure maps tell you which parts of the body may be in danger of pressure sores or nerve injuries.

Mizuho OSI | Pressure Sensor Pad
This table pad can help prevent pressure sores and nerve injuries by showing you where the pressure points are when patients are on the operating table. Hot colors on the pressure map screen indicate areas of higher pressure, and cooler colors indicate lower pressure. The goal is to let clinicians make adjustments when certain body parts are being subjected to ongoing pressure, or, if a patient can't be repositioned, to document the areas that might merit special attention in PACU.

The "brains" of the system attach to the side rail and the monitor can be placed anywhere. The software also monitors total tissue load over time, and alerts you when something reaches a saturation point. The modular system comes with 3 different pads for the different parts of the table, and can run up to $5,000 for all 3. So it's probably most appropriate for facilities that host longer cases in which pressure is more likely to become an issue.

It's also a risk management tool, says Mizuho, because it lets you document that you were aware of a potential pressure-related situation and did what you could, but the adverse outcome was ultimately unavoidable. That, says the company, could end up saving you from having to incur any expenses related to readmission — or a medical malpractice suit. OSM