Notes

Anesthesia-Machines-May-Not-Exist!
Likewise, careful attention must be given to the relative merits of the upgrading of vintage anesthesia machines with safety features that can be retrofitted versus the timely replacement of those vintage machines. The guidelines are divided into absolute and relative criteria. Only the absolute criteria are presented here. Every manufacturer uses a different approach here so it is important to learn the terminology each manufacturer uses. Here's how it works: The machine uses an integrated oxygen concentrator, which allows the machine to generate its own oxygen. Furthermore a machine should not be expected to meet all of the performance and safety requirements specified in United States or international equipment standards published after the machine was manufactured. Finally, standard-setting agencies or authorities can render something obsolete by definition through the wording of their standards or, alternatively, refuse to obsolete what a user or a group of users want to discard. Parsimonious medical facility managers look askance at physicians who want to replace old equipment and at industry that balks at servicing it. Thus, we have an interesting process of trial and error, of push and pull and the definition of obsolete assumes an additional meaning: “What can be replaced by something better, more functional, safer, or less expensive.” Industry itself can render the very product it manufactures obsolete by building or making something better.

Few academic departments can match the resources industry can tap when launching a new product development. Little wonder then, that it does not want to repair and maintain what it deems obsolete, particularly if in the meantime the old equipment no longer meets newer currently effective safety and manufacturing standards and, as a result, becomes a potential legal liability to an industry targeted with lawsuits because of its deep pocket. But “what is no longer practiced” says something about what we do with the equipment. The Oxford English Dictionary (second edition) says obsolete is “what is no longer practiced,” what has “fallen into disuse,” what is “out of date, of a discarded type,” what is “worn out.” If it were just a matter of “worn out,” we might arrive at guidelines as we have for tires with a worn tread profile. In support of that perspective, primarily in North America, the word “obsolete” also serves as a transitive verb meaning “to render obsolete,” or “to discard.” I interpret that to mean something is obsolete when we say so, when we no longer want to use it, when we are ready to discard it. All must strive to support the primary clinical mission, namely to care for patients compassionately, safely, efficiently, and thriftily.

We offer after-sales support and warranties for all of the new and refurbished equipment we sell. Of course, there are financial incentives for industry to build and sell new things. The question to be asked then: When should we, that is anesthesiologists, or for that matter, industry obsolete1 and discard what has served well in the past? That industry rather than academe deserves credit for many innovations is not to denigrate the work carried out in universities; it is a question of scale and resources. Neither anesthesiologists nor industry dares to halt or slow the progress that has done away with ether, has reduced the use of halothane, has introduced propofol, has changed the features of anesthesia equipment and monitors and will continue to enhance clinical practice. Inspired or end-tidal anesthetic concentrations will be monitored when non agent-specific vaporizers are used. Higher absorbent temperatures, resulting from scavenging of carbon dioxide produced during anesthesia, will result in greater anesthetic degradation and higher CO concentrations. If you decrease the oxygen flow rate, you will decrease the amount of agent that is used during the procedure.

The oxygen wall pressure loss failure scenario begins by administering a neuromuscular blocker to cause a cessation of normal respiration. Integral monitors (e.g., electrocardiograph, oxygen monitor, blood pressure monitor, pulse oximeter, carbon dioxide monitor) should be considered separately and are not addressed in these guidelines. More recent expensive types of products that did not achieve a sufficiently firm foothold in our practice to be considered commercial successes or routines of care include the automated anesthesia record keeper and the intra-arterial blood gas analysis system. The following guidelines have been developed to assist anesthesia providers and other health care personnel, administrators and regulatory bodies in determining when an anesthesia machine is obsolete. Clinicians must not be expected to tolerate obsolescence when safety and quality of care are at stake. It is recognized that future machines may incorporate different safety mechanisms than those in use today to accomplish the same goals. Superstar Medical Equipment are provided only for information: - Some medical centers use techniques commonly used to clean endoscopes. I really don’t like to use “obsolete” as a verb, but it emphasizes a point.
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