Significant advances in the realm of computer and microprocessor technology, together with improved understanding of drug pharmacokinetics-pharmacodynamics and availability of novel monitoring equipment, has led to development of various automated anesthetic drug-delivery systems in recent years.

Technology has been integrated into almost every facet of anesthesia practice, from patient monitors and anesthesia machines to documentation and drug delivery. In the course of a typical day, anesthesia practitioners care for patients using an array of technologies whose sophistication and utility are continually increasing. Meanwhile, researchers and innovators are constantly working on leveraging new technologies for myriad benefits: improved patient care, enhanced financial oversight and responsibility, outcomes research, and many others.

Indian Market Dynamics

Indian Anesthesia Equipment Market Unit-Wise Total 5520 UnitsIn 2014, the Indian anesthesia equipment market is estimated at Rs.176 crore, with sales at 5520 systems. A gradual shift is perceived toward a more premium product. The premium anesthesia systems are high on the wish list. GE, Maquet, and Drager with their Aisys, FLOW-i, and Zeus, respectively, offer high-end anesthesia workstations with digital simplicity and precision. Spacelabs is also launching ARKON in March 2015. Other major players in this segment are Philips, Mindray, Skanray, Shenzhen, Comen, Schiller, Allied, and Omya.

In the premium and performance segment, high-acuity models are gradually replacing the older, obsolete machines as the favored equipment for facilities. There is a strong demand for technologically advanced, reliable, and easy-to-use products that can flexibly adjust to upgrades. These modern anesthesia workstations focus on automation, advanced ventilation modes, user-friendly design, and increased functionality. 2014 saw the buyer extremely aggressive, and what was earlier perceived as a premium system is now offered as a performance machine.

Technology Trends

The intrusion of technical trends has changed the mindsets of anesthesiologists significantly, especially in the institutions and the bigger health centers. Nowadays, technology available to anesthesiologists is unparalleled. They can monitor heart rate, blood pressure, and oxygen levels in blood on a second-to-second basis. They can also monitor oxygen administered to and carbon dioxide exhaled by the patient on a breath-to-breath basis. The new technological advancements have helped in robust growth of anesthesia practice, which almost parallels the pace of these technical innovations.

Smart infusion pumps. They have a plethora of functions and features along with the range of alarms to help alert the user and the patient that infusions are nearing completion, have ended or their range of sensors has detected that the infusion pump, or the patient, requires attention. Smart infusion pumps incorporate drug libraries and dose-error reduction systems that intercept errors, such as the wrong rate, wrong dose, and pump setting errors, and have been shown to reduce programming errors.

Indian Anesthesia Equipment Market Value-Wise Total Rs, 176 CroreNoninvasive monitoring systems. Monitoring in anesthesia practice usually refers to the display of both the patient's physiological variables and the variables assessing the anesthesia machine function. Continuous monitoring is believed to cause an early recognition and thus the correction of any physiological abnormalities. New monitors also incorporate software like anesthesia information system, which has completely replaced the paper recording system. Electronic anesthesia record is more contemporaneous, complete, and legible than the handwritten records. A feared problem with its use may be increased malpractice exposure as some evanescent perioperative physiological changes and the artifactual data from the monitors may be misinterpreted in the event of unfavorable patient outcome. Hence, although introduced almost 25 years ago, its use in clinical practice is still limited, due to which there is no evidence of improved patient outcome with its use.

Anesthesia information management systems. Perioperative outcomes research using anesthesia information management systems (AIMS) is an emerging research method that has not been comprehensively reviewed. Use of AIMS for perioperative outcomes research can address clinically relevant topics that traditional research methods have been unable to adequately address, mainly because of the innate challenges presented by perioperative anesthesia practice. It is expected that perioperative effectiveness and outcomes research using large AIMS databases will be more widely embraced in future to generate useful evidence and knowledge to improve anesthesia care.

Advanced workstations. High-standard anesthesia workstations provide a new level of efficient performance and safety, and allow the anesthesiologist to focus on the primary task - the patient. These advanced anesthesia workstations have distinctive features like auto self-check and open architecture, and incorporate flexible monitoring that includes continuous measurement of exhaled CO2, oxygen, anesthetic-gas monitoring, pulmonary functions, and various ventilation parameters. Continuous monitoring of these parameters may not be required in all and should be considered depending upon its availability, and patient population anaesthetized. Monitoring of these parameters has been an integral part of the newer anesthesia workstations, but no trials have been attempted for comparing the patient outcomes with or without their use.

Dr Jayashree Todkar, Laparoscopic and Bariatric Surgeon, LH Hiranandani, Mumbai

"Laparoscopic bariatric surgery is one high-end avenue in terms of skill and expertise of the surgical and anesthesia team. All bariatric operations are done laparoscopically and using high-definition cameras in view of abundance of fat intra-abdominally, which comes as a hindrance in the visual acuity. The operations demand a precise vision and accurate measurements in terms of pouch and limb creation of the gastrointestinal system. The patient is operated in a nearly 45 degree upright position, wherein advanced operating tables with safe tying mechanics for the patient are essential. Advances in technology, gases, medication, and equipment for anesthesia have avoided the need for respiratory or ventilatory support. Deep vein thrombosis pumps and sophisticated monitoring systems make it a very simple procedure for the patient almost like a daycare.”

Dr Jayashree Todkar
Laparoscopic and Bariatric Surgeon,
LH Hiranandani, Mumbai

In future, these technological advances will be increasingly complementary and interoperable, so that anesthesia providers will use EHR-AIMS to document an anesthetic in a patient whose preoperative vital signs and lab values were assessed with his smartphone and a wearable noninvasive monitoring bracelet. Smart pumps, computer-controlled infusions, and barcode technology have made medication errors almost-never events; on the rare occasions when such errors occur, sophisticated monitoring systems alert the clinician while also providing patient- and medication-specific decision support. This rapid pace of development of consumer technology has great potential to merge commercial products into anesthesia practice and education.

Indian Market Dynamics is based on market research conducted by Medical Buyer in January 2015.

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