anesthesia equipment review

Research: Optical Fibers for Nerve Block placement

The application of technology to practice has enabled the CRNA to deliver patient care that is safer and more reliable than at any other time in history. The placement of nerve blocks has always been challenging. Thirty years ago, soliciting paresthesia or trans arterial needle placement were common methods for administering an axillary block. The Ultra sound guided nerve block has increased not only the success rate but also safety to the patient. What can be done to improve on Ultra Sound?

Desjardins AE et al recognized that the success of a nerve block depends upon the proper placement of the needle. They developed a stylet with optical fibers that could collect light for analysis of optical reflectance spectrometry. The theory was that different tissues reflect a different wavelength of light and the stylet could be used to differentiate between nerve and vascular tissues. Click here to read an abstract of their work.

Taking the concept one step further, Balthasar A, et al used the technique on human subjects. They reported that the stylet with optical fibers was able to differentiate between nerve and vascular tissue an on 2 cases detected actual vascular penetration by the needle. Click here to read an abstract of their study.

Will the optical stylet replace ultra sound for nerve block placement? Probably not. However, the addition of the optical stylet which detects penetration of the needle into either vascular or nerve structures could add another element of safety to nerve block placement.

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.