Category: Equipment / Product Review

The latest innovation in Anesthesia equipment is reviewed on procrna.com. Read the reviews and add your experiences in the comments section.

Product Review: enFlow fluid warming system

PROCRNA.COM presents new products of interest to the anesthesia community.   Inclusion on this web site does not constitute an endorsement of the product.  Please review this information, visit the enFlow web site and obtain a demonstration from your local representative. 

Keeping surgical patients at a normal body temperature is a daily struggle for those in the medical field. Among the 45 million inpatient1 and 34.7 million ambulatory2 surgeries occurring annually in the United States, it is estimated that 50-90% suffer from hypothermia (defined as a core temperature below 36 degrees Celsius).3 Hypothermia in the perioperative environment is caused by a variety of factors including low operating room temperatures, large surgical incisions, a core-to-peripheral redistribution of body heat as a result of anesthetics, chilled IV solutions, surgical procedure length, and more.4 Hypothermia has a significant impact on postoperative outcomes, which are almost exclusively undesirable.

Hypothermia is one of the most preventable complications resulting from an operative procedure, and prevention is most effective when warming begins preoperatively5 and continues across the surgical workflow. Vital Signs Inc., a GE Healthcare Company, has introduced an IV fluid/blood warmer that helps hospitals start the warming process early and continue warming across the patient’s care journey to reduce the occurrence of hypothermia.

The enFlow* IV Fluid/Blood Warming System is helping hospitals warm their patients with mobility, speed, and accuracy. The patient-dedicated cartridge attaches in-line to standard IV fluid/blood delivery sets at the start of procedures and moves with the patient, allowing care givers an easy, efficient, and cost effective way to warm across each stage of the surgical process. When it is time to move from one area of the surgical workflow to another, the user simply removes the cartridge from the enFlow warming unit, allowing the IV set in its’ entirety to be moved with the patient when transported. Once the patient arrives at the next area, the cartridge is easily inserted into an enFlow warming unit stationed in that area and is back to heating within seconds. In addition to mobility and speed, the system also enables accurate temperature control with a differentiated warmer that sits close to the patient (reducing the opportunity for fluids to cool in the IV line) and has eight temperature sensors ensuring fluids are the right temperature for patients.

To learn more about the enFlow IV Fluid/Blood Warming System and the impact it can have on your Anesthesia Department.  Click here to visit the enflow web site.

*enFlow is a trademark of General Electric Company

1 Center for Disease Control and Prevention, FastStats. Inpatient Surgery, Data are for the U.S. Accessed November 29, 2011. http://www.cdc.gov/nchs/fastats/insurg.htm.
2 Center for Disease Control and Prevention. U.S. Outpatient Surgeries on the Rise. Accessed November 29, 2011. http://www.cdc.gov/media/pressrel/2009/r090128.htm.
3 Young, V. Watson, M. Prevention of Perioperative Hypothermia in Plastic Surgery. Aesthetic Surgery Journal. 2006; 551-571.
4 Kurz A, Sessler DI, Lenkhardt R. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. N Engl J Med 1996;334:1209-15.
5 Paulikas, CA. Prevention of Unplanned Perioperative Hypothermia. AORN J. 2008; 88(3): 358-365. DOC1194144

Clarus Video System

Having trouble with insertion of the ET tube into the trachea? Would you rather see than feel tracheal rings to insure intubation?  There are a number of video laryngoscopes on the market, now Clarus has introduced the video intubating stylet.

The Clarus Video System allows visualization at the end of the distal point of the stylet (ie the end of the tracheal tube).  The HD screen of the CVS gives the intubater maximum visualization, making it simple to maneuver the tracheal tube into the airway for both regular and difficult intubations.  Also with a click of a  button, a red LED light will illuminate the airway and transluminate through the cricothyroid membrane providing additional insurance that the intubation was successful.

We would like to hear from CRNAs who have used this product.   How does it compare to the standard video laryngoscope?

Click here to go to the manufacturer’s web site and review the product.  Return to PROCRNA.COM and use the comments box to share your thoughts with your colleagues.

Obesity, The Airway & Good Positioning

Troop Elevation Pillow

Every anesthesia provider across the country cares for obese and morbidly obese patients. Numerous studies now support that the head elevated laryngoscopy position (HELP) facilitates intubation and in general improves airway management of the obese patient. The Troop Elevation Pillow (TEP) was designed by a practicing anesthesiologist to achieve HELP quickly and consistently yields a predictable and stable result. The TEP is meant to replace a pile of unstable blankets; click here to go to Dr. Troop’s teaching web site.

If you have experience with this device, please return after you view Dr. Troop’s  web site and write a review for your colleagues.

 

ivNOW Fluid Warmer

Patient temperature at the end of the case is an important marker of compliance with SCIP indicators of quality anesthesia care.  Achieving the goal of temperature maintenance in the anesthetized patient requires the use of several techniques including warm blankets, forced air warming, the use of a HME in the breathing circuit, and the administration of warm fluids.

To assist the anesthetist with patient warming, Enthermics has developed the ivNOW fluid warmer.  Each cavity has a control and L.E.D. display. A sensor in the heating plate detects the presence of a bag and engages the heating mechanism to quickly warm the fluid. Two temperature sensors continuously read the temperature of the fluid bag to engage the heater as necessary to maintain the fluid temperature within +0/-2ºC (+0/-3ºF) of the set point temperature. The electronic control monitors the length of time the bag has been held at temperature, displayed additionally by a status button. The control alerts users when a fluid bag has been held at temperature longer than 14 days.

Click here to go to the ivNOW web site and review the manufacturer’s product information.  If you have experience with this product, please leave a comment on PROCRNA.com and share your experience with your colleagues.

Clean Machine for MH patients

What do you do when you learn that your next patient is MH succeptible?  Do you have “clean machine” sitting in the store room or do you change the absorber, turn up the flows and let the machine air out?  Studies have shown that it can take over an hour of high flow to sufficiently reduce the residual gas in the machine to acceptable levels.  Vapor clean is a product which eliminates trace gases from the circuit immediately.

Prepare Any Anesthesia Machine for Susceptible Patients in Less than 60 Seconds

Newer anesthesia gas machines contain plastic and elastomeric components that absorb volatile anesthetics and then release residual vapor during subsequent anesthetic procedures.  The anesthesia gas machine requires high flows  and  a lengthy time period to remove most of the vapor  before the machine can be used for a patient that cannot tolerate breathing trace amounts of volatile anesthetic vapor.  The Vapor-Clean filters absorb the trace amounts of isoflurane, sevoflurane and desflurane so that anesthetic vapors do not reach the patient.

Placement of the Vapor-Clean filter canisters on the anesthesia machine allows the machine to be immediately vapor-free (less than 5 parts per million of vapor).

Click here to go to the manufacturer’s web site and review the product information.  If you have used this product or have any other information to share regarding safe administration of anesthesia to MH patients, leave a comment.

ultrasound visualization

CRNAs and Anesthesiologists  worldwide are using ultrasound visualization to improve patient safety, increase efficiency and decrease complications. SonoSite works closely with anesthesiologists to develop customized solutions that meet the rapidly expanding clinical requirements. Advanced needle visualization is just one example of our forward-thinking product enhancements. Advanced needle visualization makes the needle clearly distinguishable while maintaining striking image quality of the target and surrounding anatomy—especially at the steep angles needed on common procedures such as deep femoral blocks.

Click here to go to the manufacturer’s web page and learn about the Sonosite system.  If you have experience with the product, please leave a comment and tell us about your experience.

Remifentanil

Remifentanil is a lesser known and used rapid onset / rapid elimination narcotic.  Despite the advantage of prompt elimination when the infusion is stopped, this valuable drug has not been aggressively marketed.

Recently, the ownership of Remifentanil has been transferred to Mylan Institutional.  With the new ownership has come new marketing to educate anesthesia providers about the safe use of the drug, especially during TIVA procedures.

Click here to go to the Ultiva web site and view their instructional information. If you have experience with this drug, please write a review to share with your colleagues.

Belmont Rapid Infusion System

The Belmont Rapid Infusion System has had wide use by the Military in the Middle East war.  The system enables the rapid delivery of large volumes of warmed fluid during a resuscitation.   The following testimonial was reported on the manufacturer’s web site:

Soldiers are Alive Today Because of the Belmont
“We were able to sustain their lives long enough so the surgeons could fix them. When we were in Baghdad we pumped over 100 units of blood products through the Belmont on this single patient,and ten years ago…he would not have lived.”

This rapid infusion system is gaining popularity in trauma centers throughout the United States.  Again, a testimonial from the manufacturer’s web site:

The Anesthesiology Practice at a Major New York Metro Area Medical Center
“Switched from the Level 1 to the Belmont Rapid Infuser about three months ago. We purchased two, one for our main O.R. and one for Obstetrics. We have already used it in a case requiring more than 32 units of blood. It was flawless and clean.”
Major New York Metro Area Medical Center

For more information about the infusion system, click here to go to the manufacturer’s web site.

PROCRNA.COM would like to hear from those using the Belmont Rapid Infusion System.  How is it working for you?  Leave a comment and help your colleagues who are in need of a rapid infusion system.

LMA Supreme

Over the past 20 years the LMA has earned it’s place among the options for quick, safe, and easy airway management.

Improving upon existing technology, the LMA Supreme has been introduced to the marketplace.  The integrated drain tube allows fluids to channel away from the airway and the integrated bite block ensures airway integrity if the patient bites down.

PROCRNA.com would like to hear from those who are using this product.  Click here to view the manufacturer’s information regarding the LMA supreme.  After reviewing the information, return to this site and leave a comment.

An overview of OFIRMEV

First and only IV acetaminophen in the US

  • Indicated for the management of mild to moderate pain; management of moderate to severe pain with adjunctive opioid analgesics; and reduction of fever
  • For adults and children ≥2 years old2

Comprehensive clinical dataset

  • The approval of OFIRMEV is supported by the results of 20 clinical trials involving 1375 patients1,2
  • IV acetaminophen has been studied in randomized clinical trials across a variety of surgical contexts and patient types1,3-5

Improved pain relief, reduced opioid consumption3

  • In total hip/knee replacement surgery, OFIRMEV 1 g + PCA* morphine demonstrated significant pain relief and reduced opioid consumption compared to placebo + PCA morphine3
  • The clinical benefit of reduced opioid consumption was not demonstrated

Patient satisfaction3

  • The hip/knee replacement study also showed that OFIRMEV 1 g + PCA morphine significantly improved patient satisfaction compared to placebo + PCA morphine†3

Significant fever reduction1

  • In adults with fever, antipyretic onset of action was significantly faster and duration of effect significantly longer with OFIRMEV than with placebo1

Established safety profile and well tolerated in clinical trials1-5

  • OFIRMEV was shown to be well tolerated in clinical trials1-5
  • The safety of IV acetaminophen has been monitored through a postmarketing surveillance program, with more than 400 million doses distributed since its European approval1
  • IV acetaminophen has been used outside the US since 2002 and is approved in over 60 countries1

Dosing for adults and children ≥2 years old2

  • OFIRMEV has a well-described pharmacokinetic profile2
  • Dosing guidelines have been established for children ≥2 years old through adults2
  • OFIRMEV is the first IV analgesic and antipyretic agent approved for children ≥2 years old2

Indication

OFIRMEV is indicated for the management of mild to moderate pain; the management of moderate to severe pain with adjunctive opioid analgesics; and the reduction of fever.

Important Safety Information

Do not exceed the maximum recommended daily dose of acetaminophen.

Administration of acetaminophen by any route in doses higher than recommended may result in hepatic injury, including the risk of severe hepatotoxicity and death.

OFIRMEV is contraindicated in patients with severe hepatic impairment, severe active liver disease or with known hypersensitivity to acetaminophen or to any of the excipients in the formulation.

Acetaminophen should be used with caution in patients with the following conditions: hepatic impairment or active hepatic disease, alcoholism, chronic malnutrition, severe hypovolemia, or severe renal impairment.

OFIRMEV should be administered only as a 15-minute infusion.

Discontinue OFIRMEV immediately if symptoms associated with allergy or hypersensitivity occur.

Do not use in patients with acetaminophen allergy.

The most common adverse reactions in patients treated with OFIRMEV were nausea, vomiting, headache, and insomnia in adult patients and nausea, vomiting, constipation, pruritus, agitation, and atelectasis in pediatric patients

The antipyretic effects of OFIRMEV may mask fever in patients treated for postsurgical pain.

To report SUSPECTED ADVERSE REACTIONS, contact Cadence Pharmaceuticals, Inc.
at 1-877-647-2239 or the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

References: 1. Data on file. Cadence Pharmaceuticals, Inc. 2. OFIRMEV™ (acetaminophen) injection prescribing information. 3. Sinatra RS, Jahr JS, Reynolds LW, Viscusi ER, Groudine SB, Payen-Champenois C. Efficacy and safety of single and repeated administration of 1 gram intravenous acetaminophen injection (paracetamol) for pain management after major orthopedic surgery. Anesthesiology. 2005;102:822-831. 4. Atef A, Fawaz AA. Intravenous paracetamol is highly effective in pain treatment after tonsillectomy in adults. Eur Arch Otorhinolaryngol. 2008;265:351-355. 5. Memis D, Inal MT, Kavalci G, Sezer A, Sut N. Intravenous paracetamol reduced the use of opioids, extubation time, and opioid-related adverse effects after major surgery in intensive care unit. J Crit Care. 2010;25:458-462.

*Patient-controlled analgesia.
†Subjects were asked to evaluate the study treatments, overall, using a 4-point categorical scale.

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