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keep them, where and how hard you're going to drive them, and who's
going to be doing the driving.
The bottom line with both, says Ashish Sinha, MD, PhD, vice chair-
man of anesthesiology and perioperative medicine at Drexel
University College of Medicine in Philadelphia, Pa., is that it makes
sense to balance your need for technology with your resources.
"Technology creates its own need," he says. "Once you get used to it,
it's hard to go back. You have a heated seat, now you want a heated
steering wheel. Sometimes the things you want end up being for tech-
nology's sake rather than for the sake of efficiency or patient safety. It
can be a trap. So decide on the features you need before the features
you want."
Into the flow
The feature that every major manufacturer is touting is the capability,
through various means, to reduce the volume of anesthetic gases
needed per case. Drager and GE Healthcare, for example, offer visual
displays that show how much anesthetic agent is being consumed and
at what cost, along with displays that suggest reducing fresh gas flow
when feasible. That can save money if providers heed the suggestion.
Maquet's "volume reflector" collects and returns up to 95% of exhaled
gases to the patient, says the company, and delivers fresh gas mainly
on inhalation, rather than wasting it on exhalation. Like a hybrid car,
the upfront cost for that capability is steep, but over time, you'll reap
the rewards.
A lower-end machine won't have all the features that the more
expensive brands have, but they, too, will allow for lower flows — if
anesthesia providers are willing and able to dial back. "Machines are
built differently, but designed to do the same thing," says Jeff Cryder,
CRNA at Scott & White Hospital in Temple, Texas. "Manufacturers
A N E S T H E S I A
