Anesthesia machines have come a long way since the ancient Boyles apparatus. Over the years, the machines have evolved from a simple pneumatic device to a complex array of electrical, mechanical, and computer controlled systems for patient safety and user convenience. The most common type of anesthetic machine in use in the developed world is the continuous-flow anesthetic machine, which is designed to provide an accurate and continuous supply of medical gases (such as oxygen and nitrous oxide), mixed with an accurate concentration of anesthetic vapor (such as isoflurane), and deliver this to the patient at a safe pressure and flow.

Anesthesia machine manufacturers and technology start-ups are continuously introducing technological advances in newest models for myriad benefits, such as, improved patient care, enhanced financial oversight and responsibility, outcomes research, and many others. The major improvements in the machine over the past 10 years have been seen in ventilation modes that were previously only used in ICUs. These include pressure support ventilation (PSV), synchronized intermittent mandatory ventilation (SIMV), synchronized mandatory minute ventilation (SMMV), and various derivatives of each mode. These modes are a very nice feature for orthopedic cases where the patient initiates the breath and the ventilator completes the breath.

Modern systems tightly integrate various subsystems, such as, an anesthetic ventilator, a circle absorber, a flow control systems, an anesthetic gas scavenging system, vaporizers, and alarm systems, resulting in a minimized workload and better usability for the anesthesiologist. New devices also offer the option of being ceiling-pendent-mounted rather than floor mounted for optimum space utilization. Moreover, the current systems present in the market are high-luminance and come with wide display screens with different sizes and touch/non-touch variants. Also, with advancements in perioperative care, there is tremendous improvement in anesthetic tools with the passage of time and hence, the list of safety features is also rapidly expanding. Ultramodern anesthetic machines are programmed with a computerized safety self-checkout feature which is initiated at start up. Pre-use check along with regular maintenance is the key to circumvent mishaps due to machine faults. 

Indian Market

 The Indian anesthesia equipment market in 2017 is estimated at Rs. 181 crore, a 7.5 percent increase over 2016 and at 5625 units, a 10 percent increase over 5115 units in 2016 in volume terms. Prices across all segments declined by about 10 percent. 

GE maintained its market share, with major contribution by 9100c NXT based on GE/Datex Ohmeda’s legacy of 100+ years of innovation and trust. Mindray entered the super value segment and had success with orders from government hospitals in 2017. These included Government of Andhra Pradesh, which procured 29 units; Bihar Medical Services and Infrastructure Corporation Limited (BMSICL) purchased 20 units; Government of Uttar Pradesh bought 70 units of mid-tier systems for its various district hospitals and healthcare facilities. Procurement was also made by Government of Kerala; new AIIMS facilities; and Rajendra Institute of Medical Sciences (RIMS), Ranchi. Some brands including Philips, Maquet, Schiller, and Omya, are not visible anymore.

Some brands are giving competition to the high-end machines by offering similar features in competitively priced models, and with no major technological breakthrough, the mainstay continued to be the mid-tier and value segments, with a combined 57 percent market share in value terms. Low-flow anesthesia continued to be a priority.

Global Market

The anesthesia devices market was valued at USD 8.69 billion in 2017 and is projected to grow at a CAGR of 11.64 percent from 2017 to 2021, predicts Mordor Intelligence. The market is driven by the technological advancement, aging population, increase in the prevalence of chronic disease, increase in minimal invasive surgeries around the world along with medical tourism and rising healthcare expenditure in emerging economies. However, lack of skilled and trained anesthesiologists and high cost of machines are the main barriers for this market. Also, there exists a refurbished and used market for anesthetic machines which can serve as a restraining factor for the market.

The vast global rise in the prevalence of pollution- and lifestyle-related respiratory conditions is the key factor driving the market. The market is expected to witness a significant rise in growth prospects in the near future owing to the increased patient pool of conditions such as obstructive sleep apnea and chronic obstructive pulmonary diseases. The vast technological advancements taking place in the market and the introduction of innovative, precise, and highly effective product varieties are also leading to the availability of better treatment options for patients. These factors are also increasingly promoting the global demand for a variety of anesthesia and respiratory devices.

Geographically, North America holds the major share due to advanced healthcare infrastructure and is followed by Europe and Asia Pacific, respectively. Asia Pacific is emerging as a dominating market for anesthesia machines due to their high healthcare awareness and augmented disposable income. Amongst the Asian countries, India and china are more promising due to large population pool and increased number of hospitals.

Technology Trends

Manufacturers are continuously introducing technological advances in their machine which focus both on patient safety and efficiency. The anesthesia machine of today is trending toward a compact ergonomic design for ease of use and surfaces that are easier to keep clean to reduce nosocomial infections. This machine has integrated cutting-edge monitoring that is versatile and customizable to increase diagnostic confidence. The advancement of low-flow technology, savings on anesthetic agent spend, and integration to the hospital information system (HIS) has been in focus. Target controlled, low-flow anesthesia systems have been around for a few years now, but now these machines can automatically adjust flow and vaporizer settings based on end values preset by the anesthesiologist. Also, new technology for the CO2 absorbers such as the spiralith which is a lithium-based absorber that does not generate the dust that traditional soda lime canister does. Soda lime dust is a huge issue in maintenance.

Integrated systems. Recent models have added new ventilation modes and most manufacturers are trying to increase the similarities between their ventilator and anesthesia monitor interfaces. The new machine has ICU quality ventilation across all patient categories and has low flow and minimal flow anesthesia modes to improve anesthetic delivery and reduce financial impact. Anesthesia machine using the latest vent technology such as turbo vent ventilation with airway pressure release ventilation (APRV), and volume auto flow which provides protective ventilation therapy in the OR for all patient categories is worthy of the initial investment.

Many new advancements are also focused around IT integration and software enhancements but, generally, technology is moving anesthesia machines from mechanical to electronic systems where possible. Electronic controls and advanced algorithms can help clinicians improve clinical care and help administration manage costs, but it is important that any incorporation of electronics does not negatively impact the safety concepts behind the machine such as maintaining the ability to deliver fresh gas and agent to the patient even without power.

MRI-compatible. The MRI suite presents unique challenges to the anesthesiologist. For some scans which require breath holds, i.e., for arterial mapping where even the slightest motion can interfere with image acquisition, general anesthesia may be necessary for those too young or unable to cooperate. Recent technological advances have improved safety and efficiency in providing patient care in this setting. Like other out-of-OR locations, adequate preparation and thoughtful consideration of environmental factors is of utmost importance.

Newer MRI scanners combine a wider bore with high-field systems to facilitate obese or claustrophobic patients’ comfort in the scanner, as well as decreasing the duration of the scan. With the current advanced technology various data such as end tidal carbon dioxide, along with the patient’s vitals, can be transmitted to a remote monitor accessible to the anesthesiologist and even imported into an electronic medical record.

AI in anesthesia. Medical researchers, informatics specialists, and digital entrepreneurs have been exploring the use of artificial intelligence (AI) in the healthcare sphere for decades, but it is only within the past couple of years that the technology has really begun to take off. Indications are that in healthcare, AI, now commonly known as machine learning (ML) is set to explode, in fact. Imagine an environment in which machines capable of cognitive computing and processing vast amounts of data can support you with unprecedented accuracy, efficiency, and patient-specificity on everything from monitoring the depth of anesthesia, determining the amount of anesthetic gas to administer, somatosensory evoked potential monitoring, classifying patients and mitral valve analysis to coding and billing. All clinicians, including anesthesiologists and nurse anesthetists, are likely to find themselves incorporating ML tools and capabilities into their practices in the not-too-distant future.

Outlook

Anesthesia machines are being increasingly incorporated in healthcare systems as they are seen as a key medical apparatus. These machines are also proving to be extremely helpful in ambulatory units and nursing homes. Anesthesia machine and the technology behind it have constantly evolved over the years. The advance version of the machines offers higher patient convenience and care. The contemporary machines are incorporated with suction unit, patient monitoring devices, and ventilators. The technology advances in anesthetic delivery are going to see the market demand more anesthesia machine that benefits patients across all categories. However, there is still considerable potential for innovation.

The new machines will be easier for the provider to use and will have a low consumption of costly anesthetic agents. Setup, self-checks, and routine maintenance will be fast and simple in the near future. Accessibility to patient data and complete clinical information will be on fingertips in one compact ergonomic system that will ensure a good return on investment. As the technologies will grow older and more commonplace, the technologically advanced machine will likely become more affordable and more broadly used leading to increased safety and faster patient recovery times. All these advances along with rising population of the country, increasing occurrences of invasive surgeries, and innovation in technology is encouraging its increased adoption in the healthcare sector as they become more effective and are expected to support the growth of the market in years to come.

Industry Speak

Affordable Cost of Ownership and Dependable Service Backup our Key Drivers for Growth

It is not a faith in technology. It is faith in people - Steve Jobs

 Our vision at Allied Medical since its inception has been to provide affordable quality products with a dependable service backup and these have been the key elements for our success. This is a very exciting time to be involved in the anesthesia equipment market in India. India’s spend on healthcare as a percentage of GDP (2.5 percent) is amongst the lowest globally. With the recent reforms taken by the Government of India removing various impediments for manufacturing growth in the country offers a huge opportunity for medical equipment manufacturers in India.

For medical institutions, acquiring an anesthesia workstation is a capital investment. With rapid technological advancements having a quality equipment with affordable cost of ownership, and dependable after sale services are the key challenges before any buyer. We have always believed that growth of any company depends on its attitude towards servicing its customer needs and we have grown with this ideology over the 35 years, despite having a fairly limited marketing network.

The safety features offered by anesthesia workstations are at a huge advantage and substantially minimize chances of any accidental incidents during anesthesia. Modern day anesthesia workstations are equipped with a twin station manifold for mounting two selectatec type temperature compensated vaporizers with interlocking safety, an anti-hypoxic system, an in-built integrated ventilator with direct switching controls from the circle absorber system. The display screens are available in touch/non-touch variants to meet varied customer requirements. The ventilators offer a choice of ventilation modes comprising of CMV, PCV, SIMV, and manual modes. The advanced versions offer an addition of PSV, SIMV with pressure/flow triggers, spontaneous mode of ventilation. The workstations are offered with a choice of monitoring options starting from hemodynamic monitoring to advance anesthesia monitoring parameters.

Aditya Kohli
Director – Marketing & Sales,
Allied Medical Limited

Industry Speak

Technological Advancements and Emerging Trends in Anesthesia

 Advancements in digital technology are driving a new generation of smart techniques in the anesthesia domain. Device manufacturers are focusing on exploring opportunities to improve the efficiency of anesthetic gas delivery to address the cumulative requirements of extra flexibility, increased patient safety, and improved patient care.

Direct Infusion of Anesthetic Agents

In order to negate the influences of pressure and temperature on anesthetic agents and to guarantee controlled titration, the practice of direct infusion of volatile anesthetics is a modern advancement. In this technology, the device stores anesthetic liquid in a reservoir and travels to a dosing chamber for pressurization. Later, a specific dose of agent is released into a heated vaporizing chamber for vaporization and delivery into the breathing system. This method guarantees higher precision and stability of the set gas concentrations.

Lithium-Based Carbon-Dioxide Absorbents

Soda lime is the conventional CO2 absorbent used in breathing systems. The latest innovation in the CO2 absorbent category is the lithium-based carbon-dioxide absorbents. A solid sheet of lithium-based carbon-dioxide absorbent consists of absorbent powders bound together by a polymer matrix, which can be recycled and reused.

Target Controlled Low-Flow Anesthesia

This technology focuses on optimizing the efficiency of anesthetic delivery by minimizing anesthetic gas waste. Target controlled low-flow anesthesia systems achieve the user set end-tidal percentage by automation of fresh gas flow rate and vaporizer settings. Modern ventilators with target controlled low-flow anesthesia are equipped with a gas consumption data display that can help in mitigating wasteful over-delivery of fresh gas flow.

Anesthesia Information Management Systems (AIMS)

AIMS is designed to record data from the anesthesia machine and to transmit the same to the electronics health record (EHR) in the hospital. AIMS allows the automatic collection, storage, and presentation of patient data. Modern day systems have clinical decision support systems (CDSS) integrated to AIMS to flag improper diagnoses or other issues in a clinical workflow.

Even-though the advancements in anesthesia delivery are moving in the right direction, there is still room for improvement and engineers have a front row seat along with anesthesiologists to continue to drive the innovation.

Ann Mary Chacko
Senior Engineer – R&D,
Skanray Technologies


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