The customer is increasingly looking for technologically advanced machines that simultaneously enable automated correction of physiological abnormalities and yet take into consideration patient safety and lower running expenses.

Anesthesia equipment has evolved over the years from basic pneumatic devices to highly sophisticated computer systems. Both technological advancements and the increasing number of surgical procedures requiring anesthesia have created demand in the anesthesia equipment market. There has been a spiraling increase in the number of surgical procedures performed. The focus is on developing high-quality and, cost-effective products. In the consumables segment, the trend is currently favoring disposable over reusable equivalents. There has been a strong demand for reliable and
easy-to-use products that can flexibly adjust to any upgrades.

Revenues in the anesthesia equipment segment are dependent mainly on replacement purchases. Limited healthcare budgets have meant that purchasing departments tend to buy only the most urgently required equipment each year. A potential strategy to maintaining revenues would be for manufacturers to offer bundled solutions, wherein advanced versions of anesthesia machines and monitors would be sold as a package, along with other equipment. Anesthesia consumables could be included in such packages. Technological innovation in the anesthesia consumables segment would further stimulate interest in the purchase of advanced technologies that support enhanced clinical outcomes.

Indian Market Dynamics

anesthesia-marketThe Indian anesthesia market showed a growth of 8–10 percent in 2015-16, over 2014-15. The major growth came from the super-premium and premium segments. However, the mainstay was the mid-tier and value segment, which continued to contribute 63 percent to the market. The performance segment stagnated, whereas the super value declined, yet continued to have some presence.

The government sector made major procurements. These included AIIMS; HLL; SKIMS Medical College and Hospital, Kashmir; NEIGRIHMS (North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences), Shillong; BMSICL (Bihar Medical Services & Infrastructure Corporation) Patna; and NIMS (Nizam's Institute of Medical Sciences), Hyderabad. Equipment was also procured by Narayana Hrudayalaya, Bangalore, for its facilities in Malaysia and Cayman Islands, and Global Hospitals and Apollo Hospitals for their facilities in Central Africa.

The year 2015-16 was the year of changing trends. The buyer is showing less inclination for refurbished systems and lower-priced imported competitive ones.

Challenges

The conventional anesthesia machine works well and meets almost all needs. Machine-related morbidity and mortality are usually attributable to human misuse such as unrecognized breathing circuit disconnection rather than to true equipment failure. Conventional machines are at the end of their evolutionary cycle, however, and the introduction of a new generation of machines is well under way. Next-generation anesthesia machines present many challenges to anesthesiologists in terms of their increased complexity, changed layout and function, and integration of new technologies.

anesthesia-marketMajor unique challenges with NORA include those related to the patient, procedure, and environment. Physicians who are unfamiliar with NORA typically underestimate the fact that patients undergoing procedures involving new and advanced technological equipment are at higher risk.

These patients include pediatrics, geriatrics, and medically challenged patients who are too weak for surgical management but able to obtain some benefit from a procedure. Whether the procedures (or surgeries) performed by NORA are simple or not, each patient should be prepared in accordance with general anesthesia because the sedation can be converted to general anesthesia at any time.

The anesthesiologist must understand the nature of the procedure, including the position of the patient, how painful the procedure will be, and how long it will last. In addition, prior discussion with the anesthesiologist must include contingencies for emergencies and adverse outcomes. Other staff must be trained to assist or carry out immediate cardiopulmonary resuscitation. Unfamiliar locations, lack of monitoring devices, inadequately trained or insufficient staff, and unavailable medication or equipment in emergency situations places both patients and anesthesiologists at risk.

Various factors that need to be considered with the use of improved techniques in anesthesia are the validation data, patient outcome, safety profile, cost effectiveness, awareness of the possible adverse events, and knowledge of technical principles and ability of the convenient routine handling. So far, there is a lack of substantial evidence if these new improved monitoring techniques have improved patient outcome.

How often these improved monitors are used for a particular indication also varies from institution to institution. Most of the new monitoring techniques have been evaluated to a limited degree. Moreover, the main barrier to research evaluating the patient outcome with these new monitoring techniques includes its non-uniform availability.

Road Ahead

The anesthesia system of the future will have an additional advantage that it would enable automated correction of physiological abnormalities simultaneously, pharmacokinetic-based anesthesia infusion pumps with DOA monitoring or newer ventilators that can automatically adjust the ventilator settings by monitoring lung mechanics. These new monitoring techniques can potentially reduce the element of human error. New and improved monitoring techniques have undoubtedly led to dramatic changes in anesthesia practice.

The 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 non-invasive monitoring bracelet.

Dr Anil Kumar Jain, Vice-Chairperson, Dept. of Anesthesiology, Pain & Perioperative Medicine, Sir Ganga Ram Hospital,New Delhi
Second Opinion
Managing Risks

Anesthesiologists manage highly potent drugs, critically sick patients, and complex surgical procedures. To ensure precision anesthesia delivery and patient safety, use of technology in the form of equipment and monitors has become an absolute necessity. Recently, backed by rapid advancement of technology, anesthesiology and surgery has undergone accelerated development.

Although main site of action of anesthetics is brain, we still do not have a precise monitor to gauge its effects. Hypoxia, whether due to disconnection, hypo-perfusion, or other accidents and failure, still remains the cause of morbidity and mortality related to anesthesia care delivery. Gas monitoring and pulse oximetry are available but a non-invasive monitoring of partial pressure of oxygen in peripheral tissues, if available, facilitates patient's safety. Atelectasis remains an important problem in anesthetized patients who are ventilated during an anesthesia episode. Non-invasive estimation of atelectasis extent would help in taking steps for pre-correction.

Further refinement and cheaper transechocardiography would lead to universal application of this technology. Non-invasive measurement of blood flow in the vital organs has the ability to prevent problems like acute kidney injury. Finally, affordable and safer infusion technology for rapid fluid resuscitation would prevent catastrophic air embolism incidences.

Anesthetic's main site of action is brain. Minimum alveolar concentration, BIS, and cerebral function monitor still lack precision of monitoring; one requires to see the drug effect and also the impact on other systems, CVS being prominent.

Dr Anil Kumar Jain
Vice-Chairperson,
Dept. of Anesthesiology, Pain & Perioperative Medicine, Sir Ganga Ram Hospital
New Delhi

Dr Sushma Saroa,Anesthesiologist-Department of CT& MRI, Sir Ganga Ram Hospital,New Delhi
Second Opinion
Trend of Anesthesia

With advances in anesthesia, procuring refurbished anesthesia equipment has become the trend in healthcare organizations. Now networked anesthesia workstations comprising anesthesia machine, monitors, and anesthesia information systems are available. They are innovative, accurate, reliable, patient-friendly, safe, advanced, easy-to-use, flexible, adjust to any upgrades, high-quality, cost-effective, and easy availability of spare parts for keeping the machines in proper working order

Anesthesia workstations required for inhalation general anesthesia differ in appearance, size and degree of sophistication but have a complex collection of equipment. An anesthesia workstation has three major components – a gas mixing and delivery system; an anesthetic breathing system (circuit) and a ventilator; and an array of monitors. It ensures accurate concentrations and limits the minimum amount of oxygen. It incorporate automated record-keeping systems, which help to document and integrate the information. It has self-checking and monitoring capabilities so that problems can be easily identified. There is also always a back-up system so that if the system fails, or there is a power blackout, the anesthesiologist can safely carry the patient through such a crisis.

But still the continuous presence of an anesthesiologist is recommend to monitor vitals and to evaluate their patients, the progress of the operation, and to make necessary moment-by-moment adjustments to the drugs and fluids during anesthesia and operation and also to monitor the functioning of the anesthetic machine.

Dr Sushma Saroa
Anesthesiologist-Department of CT& MRI, Sir Ganga Ram Hospital
New Delhi

A preoperative airway exam will have been performed using smartphone-based telemedicine. Smart pumps, computer-controlled infusions, and barcode technology have made medication errors negligible, on the rare occasions when such errors occur, sophisticated monitoring systems alert the clinician while also providing patient and medication-specific decision support.

The rapid pace of development of consumer technology has great potential to merge commercial products into anesthesia practice and education. The demand for anesthesia machines is increasing due to increase in surgical procedures that require safe anesthesia equipment. The future will be technologically advanced and user-friendly machines taking into consideration patient safety and lower running expenses. Availability of innovative, accurate, and reliable patient-friendly devices would motivate the institutions to replace their existing basic equipment with advanced anesthesia machines.

Indian Market Dynamics is based on market research conducted by Medical Buyer in January 2016.


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