Contemporary anesthesia practice最新文献

A few ideas about future design concepts have been outlined and highlighted. Whether anesthetists will accept it or not, automation is the direction of the future, and data processing is increasingly important. Anesthesiology and industry need to initiate total cooperative efforts for appropriate implementation of modern technology.

The problem of waste anesthetic gases must be addressed because of potential health hazards. However, solutions must be considered within a larger context than that of the operating room or dental suite. The impact of shifting wastes from the hospital into the atmosphere must be examined for both ecologic and ethical implications. A hypothetic situation has been proposed in which the waste anesthetics are dealt with by recovery and reuse. Although potential costs and benefits can be discussed, overall feasibility and desirability cannot be assessed until certain questions are addressed. Are waste anesthetic gases an atmospheric pollutant with impact sufficient to cause concern? If not, do the economic considerations of recycling exhausted anesthetic and respiratory gases warrant implementation? Anesthesiologists need to consider these issues within the constraints of the environments in which they practice. The problem will exist as long as inhalation anesthesia is in use. Solution should not create new problems.

With proper measurement of inhaled and exhaled gas concentrations as well as end-tidal concentrations, patient concentrations of oxygen, carbon dioxide, and the volatile anesthetic agents may be inferred; additional information for vigilance monitoring, control of depth of anesthesia, and calculation of physiologic variables can be obtained. From this information, the anesthesiologist will be able to administer improved patient care through more immediate and complete knowledge and control of both equipment and patient function.

We have seen that there are serious design inadequacies in the basic anesthesia machines now in the marketplace. None of these meets criteria for technologic soundness or clinical utility elaborated in previous chapters. It is tempting to simply buy what is available and shrug one's shoulders over the situation. Those in desperate need of replacement equipment should go ahead and buy, because significant changes may be years away. However, those who are able and disposed to wait for real progress may accelerate the process by waiting not silently but loudly. Until the anesthesiologists on the firing line are consistently asking technically sophisticated questions related to safety and efficacy, expecting them to be answered, and letting their equipment budgets speak where words do not, we can expect consistent laissez-faire attitudes and actions from the anesthesia machine industry. Technology already available in other industries will continue to be overlooked or ignored, and our clinical needs will be unmet until industry is convinced that the majority of anesthetists want far-reaching substantive change in anesthesia delivery system design. We have no choice but to use what is currently available; but we can reward solid, thoughtful innovation with our capital equipment dollars, with our support of research in anesthesia technology, with our verbal and written requests to manufacturers, and with our individual time spent staying abreast of technologic issues. The ultimate beneficiaries are our patients; we cannot remain static--we must improve.

Technology for gas and vapor delivery has not changed substantively in decades. Technology possessing greater precision and reliability has been in use by nonmedical industries to regulate gas flows and to vaporize liquids. Adaptation of existing technology to the needs of anesthesia delivery systems requires stimulus from the anesthesia community and commitment from the anesthesia device industry. No insurmountable problems are evident, but the perennial problem of inertia has prevented progress consistent with that seen in other fields of biomedical technology.