Vital Times 2021 - 61

The introduction of a C-arm X-ray machine into the OR or
procedure room can require wide-spread rearrangement
on the anesthesia end of things, which may include
moving the anesthesia machine, hot air warmer, sharps
box, stands, stools and chairs in some cases. Moving
equipment increases the risk of subsequent malfunction,
such as power cords that have become dislodged with
the move.
In addition to the need to tackle the above challenges,
manufacturers should consider making their equipment
easier to use by employing methods such as:
* Placing QR code labels on equipment that directs
users to a web page containing written and video
instructions, or even embedding educational videos
directly into the equipment itself.
* Conducting formal ergonomic testing on their
products to avoid instances of " injury by ergonomic
failure, " such as occurred with the Abbott Lifecare
4100 PCA Plus II infusion pump.1
* Standardizing the mapping of arterial blood
oxygen saturation to tone pitch in pulse oximeter
equipment.2
* Offering secure remote controls like those used
at home for televisions or other methods (e.g.,
secure smartphone apps) that allow clinicians to
operate patient monitors more conveniently (e.g.,
avoiding the need to stretch into awkward positions
to restart a BP cycle should the patient monitor
assembly end up placed in a suboptimal location as
a consequence of suboptimal workspace layout).
One technical innovation that I hope will come to be
widely available is signal fusion algorithms that will
(for instance) prevent patient monitors from displaying
a false asystole alarm resulting from ECG technical
problems when arterial pressure and pulse oximeter
tracings are both present with normal waveforms.3
Signal fusion technology and related innovations
would be expected to reduce the time clinicians
spend dealing with false alarms and troubleshooting
malfunctioning equipment, thereby allowing for
improved patient vigilance.
Yet another poorly met need is for anesthesiology
journals and anesthesiology society newsletters to
publish Consumer-Reports-style reviews of anesthesia
equipment to aid departments in informed equipment
procurement.4 It is puzzling that while anesthesia
journals routinely review inexpensive anesthesia books,
I have rarely seen much more expensive anesthesia
machines and patient monitoring equipment being
similarly evaluated.
I like to teach anesthesia residents various practical
techniques that can be used to improve situational
awareness when technological failures occur. As
an example, for various reasons automatic blood
pressure (BP) modules occasionally fail to provide a
measurement. One BP backup technique I teach is to
place a manual cuff on the side of the arm holding the
pulse oximeter. This arrangement allows for " quick
and dirty " systolic BP estimate by noting the pressure
at which the pulse oximeter tracing vanishes. Add a
stethoscope to the setup and you can get diastolic
pressure too. Such practical tips can be viewed as
algorithms for obtaining data under adverse conditions.
It is worth pointing out that not all developments in
anesthesia have passed the test of time, such as the
1 Vicente, K. J., Kada-Bekhaled, K., Hillel, G., Cassano, A., & Orser, B. A. (2003). Programming errors contribute to death from patient-controlled analgesia: case report and
estimate of probability. Canadian journal of anaesthesia = Journal canadien d'anésthesie, 50(4), 328-332. https://doi.org/10.1007/BF03021027
2 Loeb, R. G., Brecknell, B., & Sanderson, P. M. (2016). The Sounds of Desaturation: A Survey of Commercial Pulse Oximeter Sonifications. Anesthesia and analgesia,
122(5), 1395-1403. https://doi.org/10.1213/ANE.0000000000001240
3 Tejedor, J., García, C. A., Márquez, D. G., Raya, R., & Otero, A. (2019). Multiple Physiological Signals Fusion Techniques for Improving Heartbeat Detection: A Review
Sensors (Basel, Switzerland), 19(21), 4708. https://doi.org/10.3390/s19214708
4 Doyle D. J. (2007). Consumer reports for anesthesia equipment: an idea whose time has come. Anesthesia and analgesia, 105(6), 1866-1867.
https://doi.org/10.1213/01.ane.0000295221.56461.14
Annual Publication 2021 | 61
https://doi.org/10.1007/BF03021027 https://doi.org/10.1213/ANE.0000000000001240 https://doi.org/10.3390/s19214708 https://doi.org/10.1213/01.ane.0000295221.56461.14

Vital Times 2021

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