October 2007 Anesthesiology News
The following article appeared in the October 2007 Anesthesiology News. Editors chose the Top Five new technologies that would change the way anesthetists practice.
Tomorrow's OR Today
When talkng about healthcare information technology, gurus are wont to wax oracular, making predictions about the shape of the world 10, 15 years ahead. In 2020, these forecasts typically go, Americans will tote their electronic medical records alongside their drivers’ licenses, right beside the digital map of their genome and the warranty for the implanted radiofrequency chip in their arm.
But for those interested in what technology is available today, with a phone call or online, such prognostications are little more than parlor talk. With that in mind, Anesthesiology News asked several independent experts for their picks of new systems and devices now on the market that promise to make the most difference to clinicians and their patients.
The result: a Top Five list of advancements, each of which elevates a particular aspect of anesthesiology practice. They apply frequently, in field emergencies and in the perioperative period—pre-op to post-anesthesia care unit (PACU). Their collective contribution: they open airways, measure blood levels and deliver medications faster, safer and more precisely—with better documentation, monitoring, accountability and results.
Anecare ANEclear emergence device
Many tools to induce sleep, few to bring patients safely from it. That is what led Derek Sakata, MD, and Joseph Orr, PhD, two of the three original inventors of the ANEclear, to seek a better way to take patients from a plane of deep anesthesia to fully awake, with spontaneous drive to breathe and protected airways.
The disposable device connects between the anesthesia circuit and the patient’s breathing tube. It has a re-breathing hose that allows patients to inhale some of their own exhaled CO2. It also removes the exhaled anesthetic agent from the expired breath, so none returns to re-anesthetize the patient.
The ANEclear “changes the pharmacokinetics of inhaled anesthetics,” explained Dr. Sakata, assistant professor of anesthesiology at the University of Utah School of Medicine in Salt Lake City. “By allowing CO2 to be rebreathed, it allows us to increase ventilation at the same time, which you can’t do by any conventional means today without decreasing brain blood flow. It helps the body do its optimal best to eliminate anesthetics. CO2 is very beneficial, especially during emergence. Clinicians mostly believe it should be eliminated, but patients need it.”
Patients receive therapeutic levels of anesthesia until the end of surgery; with ANEclear, they emerge safer, more predictably, faster and with higher alertness. The device is intended for use with inhaled volatile anesthetics and in operations where tapering the anesthetic is not an option, such as neurosurgery and ophthalmologic, urologic, gynecologic, orthopedic back, vascular and plastic, and ear/nose/throat surgeries.
“Unknown to many clinicians, more respiratory complications are associated with emergence than induction,” Dr. Sakata said. Published studies have found that the ANEclear cuts emergence time by up to 60%, to the point where endotracheal tubes [or a laryngeal mask airway or face mask] can be removed from a patient, and reduces PACU time between 25% and 30%, Dr. Orr said.
However, some anesthesiologists consider the ANEclear as a merely high-tech means of hastening emergence. Dr. Voltz, who tested the device in a non-random study, noted that “with proper anesthesiology education, one can time the emergence from anesthesiology quite precisely. This raises the question of whether the cost of the device is acceptable. Many agents we currently use come out of the system at a very rapid rate.”
Dr. Sakata has heard this complaint before, and he underscored that “the ANEclear is a more complete patient safety device, because it brings pharmacokinetic benefits, protects the airway and allows clinicians to keep patients absolutely still until the end of an operation. And it can be used when tapering isn’t appropriate.”