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Objectives: Anesthesia is a technology driven specialty, technological advancement in anesthesia and monitoring equipment has made sophisticated surgery possible. Safe anesthesia is possible when machines are in good condition. The chain of survival as used by the International Liaison Committee on Resuscitation refers to a series of actions that, properly executed, reduce the mortality associated with cardiac arrest. A similar chain can be applicable to anesthetic equipment for optimal patient care. Early acquisition of appropriate equipment, appropriate training of end users, prompt preventive maintenance, timely repair, and replacement at the end of the equipment lifespan. In 2002, the Federal Government of Nigeria (FGN) commissioned a project to refurbish eight teaching hospitals which was later upgraded to 14. This paper assessed the functional status of 10 frequently used equipment in anesthesia and intensive care units among the beneficiaries. Material and Methods: A structured questionnaire was sent to heads of anesthesia departments in the 14 beneficiary hospitals of the FGN/VAMED intervention. They reported on the status of 10 equipment commonly used by anesthetists in the operating rooms and intensive care units. Results: All hospitals had the equipment installed in the past 7–14 years with end user training on all the equipment, biomedical engineers were available in the immediate post-installation period. There has been no routine scheduled preventive maintenance of the equipment. Faulty equipment are being used in all the hospitals, 54.6% of the installed equipment are spoilt and no longer in use. The weakest link in the equipment chain of survival is the absence of preventive maintenance. Conclusion: Routine scheduled preventive maintenance and the constant availability of trained and skillful biomedical engineers will no doubt increase the lifespan of anesthetic equipment.

Background Bacterial transmission within and between successive surgical cases occurs in operating rooms (ORs), often includes anesthesia equipment as a reservoir, and can be monitored by collecting samples and identifying bacteria by genetic testing. We evaluated how to choose cases for active surveillance to quantify the effectiveness of interventions in 2 groups of ORs (eg, rooms with germicidal lighting vs those without). Methods Data were from a 7 OR single-specialty gastrointestinal endoscopy suite and from a typical 8 OR multispecialty surgical suite. Results At the multispecialty hospital, 40.3% (SE 1.2%) of the total number of cases could be used for surveillance (ie, followed by another case of the same specialty and matched with a corresponding pair of cases from the other OR group). Random selection obtained fewer matched pairs than deliberate selection: mean ratio of random/deliberate = 0.64 (0.01) for the single-specialty and 0.51 (0.02) for the multispecialty suite (P Conclusions The efficiency of sampling to obtain pairs of successive surgical cases of the same specialty is impaired markedly by randomly selecting pairs of cases (or using convenience sampling) as compared to choosing pairs deliberately. This is important because the number of cases that can be suitably used for surveillance of bacterial transmission will typically be less than one-half the total case number.

Risk for complications and even death is inherent to anesthesia. However, the use of guidelines, checklists, and training can decrease the risk of anesthesia-related adverse events. These tools should be used not only during the time the patient is unconscious but also before and after this phase. The framework for safe anesthesia delivered as a continuum of care from home to hospital and back to home is presented in these guidelines. The critical importance of client communication and staff training have been highlighted. The role of perioperative analgesia, anxiolytics, and proper handling of fractious/fearful/aggressive patients as components of anesthetic safety are stressed. Anesthesia equipment selection and care is detailed. The objective of these guidelines is to make the anesthesia period as safe as possible for dogs and cats while providing a practical framework for delivering anesthesia care. To meet this goal, tables, algorithms, figures, and “tip” boxes with critical information are included in the manuscript and an in-depth online resource center is available at aaha.org/anesthesia.

Background Anesthesia is mainly needed in surgical services, for diagnostic services in almost all fields of specialty in medicine. When anesthesia services are inadequate, difficulties are experienced. There are multifactorial reasons for the inadequacy of anesthesia services in sub-Saharan countries. The aim of this study is to assess the challenges and problems of anesthesia practice in Ethiopia. Methodology An observational survey carried out in 60 hospitals of the Nine regional states and two city administrative states of Ethiopia in 2018. A structured questionnaire sent to each hospital, the questionnaire consisted of eight sections to assess the availability of basic Anesthesia equipment, Drugs, and Professional Anesthetists. The head of anesthetists represented in each Hospital. The data were analyzed using Statistical Package for Social Sciences (SPSS) version 20.0, the results are presented in appropriate statistical tools, and the findings discussed. Results This study shows that 81% of the anesthetists do have challenges and problems, which weigh down the provision of Safe anesthesia service. Eighty-three percent (83%) of anesthetists working alone without assistant. 83.2% of Anesthetists have main difficulties to perform pre-anesthetic evaluation. Around 55% of hospitals/anesthetists/have no minimum standard of monitoring devices. The availability of Anesthetic drugs in the Operation room is inadequate, for instance, 89.6%, 97.9%, and 45.8% Operation rooms/Anesthetists/have no Isoflurane, Etomidate, and Propofol respectively. Due to lack of Analgesics, only 22.9% of Anesthetists administer Analgesics Intraoperatively. 67% of Anesthetists have no emergency drug kit and 81.2% of Anesthetists have no Cricothyrodtomy set to Manage difficult airway. The overall Challenges stated by Anesthetists include Shortage of workforce, drugs & equipment, Lack of skills & Knowledge in some specialized procedures, less payment in comparison with Work overload, risks & stress, and Lack of insurance to the Anesthetists. Conclusion Since the Anesthesia service is least addressed, Major focus in terms of Anesthesia working force, Anesthesia drugs, and equipment is required to bring up to date and improve the safety of anesthesia for patients in Ethiopia.

Many anesthesia-related adverse incidents involve the failure of anesthesia equipment and could potentially be prevented by proper checkout of the anesthesia workstation. Guidelines have been put forth by the American Society of Anesthesiologists along with other committees for conducting a thorough preanesthesia checkout. These are explained in detail. The guidelines are intended to be combined with manufacturer recommendations for an institution specific machine check. Equipment quality assurance including support and retirement is also discussed.

Magnetic resonance imaging (MRI) is a widely used diagnostic modality with 30 million scans done annually in the United States alone, according to a U.S. Food and Drug Administration report from 2016. During MRI, the patient must remain in a confined, noisy, sometimes hot environment for periods varying from 30–60 minutes or longer. Familiarity with anesthesia equipment, the environment, and basic monitoring principles are vital to the safe and successful administration of anesthesia in the MRI environment. Equipment design and knowledge of the principles of monitoring in the MRI environment require a thorough understanding of the effects of the magnetic field and the underlying principles behind the challenges, limitations, and even the location of MRI equipment.

You have been assigned to work in a medical mission in rural Uganda. Today you are working with a surgeon who is repairing facial deformities. As the only anesthesiologist, you are in charge of the anesthesia equipment. The first patient of the day is a large man (180 kg) for repair of facial deformities. His neck is over 40 cm. You would prefer to do a fiberoptic intubation but the patient is terrified and wants to be asleep. In addition to this, you cannot speak his language and are reliant on a translator.

Rationale: Sevoflurane-induced seizures are most often caused by high concentrations of sevoflurane during anesthesia induction. However, in this case, we found a rare case of seizure-like movements caused by residual sevoflurane inside the anesthesia machine. Therefore, we propose that the detection of residual anesthesia-inhaled drugs should be included in pre-anesthesia checkout procedures. Patient concerns: An 11-year-old girl with a history of epilepsy was scheduled for emergency appendectomy under general anesthesia. The patient presented with seizure-like movements caused by residual sevoflurane inside the anesthesia machine after pre-oxygenation during rapid sequence induction. Diagnoses: Based on the clinical presentation and previous history of seizures, sevoflurane-induced seizures were diagnosed. Interventions: A washout procedure was performed by turning the oxygen flow up to 10L/min to wash out the residual sevoflurane from the anesthesia machine. Outcomes: The seizures ceased spontaneously, and the vital signs of the patient were stable during the washout procedure. Rapid sequence anesthesia induction and total intravenous anesthesia maintenance were uneventful. Surgery was performed as planned, and there were no postoperative problems. The patient was discharged after 4 days without complications and was well on follow-up. Lessons: The check-up procedure of residual anesthesia-inhaled drugs inside the anesthesia machine should be included in the checkout design guidelines, or else the washout procedure should be performed in the pre-anesthesia checkout procedures.

This article presents an approach to the development of an abdominal phantom with respiratory function for robotic surgery. A review of existing similar devices is made, showing materials of various types used to manufacture phantoms of human organs. A comparison of materials for the manufacture of phantoms of the abdominal area and human liver is carried out. Suitable materials for working with ultrasound and computed tomography are identified. A conceptual model of a deformable phantom of the abdominal zone has been developed. Possible upgrades of the phantom are also proposed, expanding its functionality. For example, to synchronize the operation of the breath simulation module with the patient's anesthesia equipment. An approach to the development of movable phantoms of the abdominal zone has been formed, which is supposed to be used when creating new systems and technologies in the field of robotic surgery.

A variety of lung isolation techniques are used for the purpose of one-lung ventilation, which is a prerequisite for many thoracic, cardiac, and esophageal surgical procedures. The equipment used to facilitate the lung isolation includes double lumen tubes, bronchial blockers, and the single-lumen endotracheal tubes. The bronchial blockers are used in two ways, attached to single-lumen tube Torque Controlled Blocker Univent® or with a standard single-lumen tube like the wire-guided endobronchial blocker Arndt® blocker [1], the Cohen® tip-deflecting endobronchial blocker [2], or the Fuji Uniblocker™ [3]. The recent development of newer lung isolation devices such as the Silbroncho DLT along with the use of different kinds of video laryngoscopy equipment like the Glidescope® [4] has greatly facilitated lung isolation in patients with difficult airways.

Clinical monitoring and technology are at the heart of anesthesiology, and new technological developments will help to define how anesthesiology will evolve as a profession. Anesthesia related research published in the JCMC in 2018 mainly pertained to ICU sedation with inhaled agents, anesthesia workstation technology, and monitoring of different aspects of depth of anesthesia.

As complicações anestésicas parecem relativamente raras, em contraponto trabalhos recentes sugerem que há maior prevalência em gatos do que em cães. As particularidades anestésicas observadas em felinos podem estar diretamente relacionadas às maiores taxas de complicações observadas nestes animais. Aspectos importantes nesta espécie, tais como, ansiedade e estresse perianestésicos são exemplos peculiares, outras causas que podem ser elencadas como coadjuvante na ocorrência de complicações anestésicas é o monitoramento perianestésico, o papel desempenhado por doenças subjacentes assim como o uso correto de equipamentos de anestesia e da anestesia total injetável que por vezes são negligenciados pelos anestesistas. Diante disso, o trabalho objetivou revisar e discutir as principais particularidades anestésicas em felinos, possibilitando ao veterinário compreender os aspectos mais importantes da anestesia destes pacientes, evitando complicações perioperatórias associadas a doenças pré-existentes, agentes anestésicos, controle das vias aéreas, manejo e monitoramento. Esses dados podem ajudar os veterinários a cuidar do paciente sob anestesia e direcionar maior atenção à avaliação e tratamento do paciente antes, durante e após o procedimento.

Moist heat is employed in the medical device, pharmaceutical, and food processing industries to render products and goods safe for use and human consumption. Applications include its use to pasteurize a broad range of foods and beverages, the control of microbial contamination of blood products, and treatment of bone tissue transplants and vaccines. In the pharmaceutical industry, water heated to 65°C to 80°C is used to sanitize high-purity water systems. In healthcare, it has been employed for decades to disinfect patient care items ranging from bedpans to anesthesia equipment. There is a good understanding of the conditions necessary to achieve disinfection of microorganisms at temperatures ranging from 65°C to 100°C. Based on this information, the efficacy of moist heat processes at a range of exposure times and temperatures can be quantified based on mathematical models such as the A0 calculation. While the A0 concept is recognized within the European healthcare community, it has yet to be widely adopted within the United States. This article provides information regarding the A0 concept, a brief overview of the classification of thermal disinfection for use with healthcare applications within the United States, and recent data on reinvestigating the thermal disinfection of a selected panel of microorganisms and a mixed culture biofilm.

Introduction A burn center with a high volume of burn admissions was looking for ways to decrease the pain and anxiety experienced by patients during wound care. Patients requiring surgical dressing removal or demonstrating difficulty in coping during wound care were of particular concern. Discussions between anesthesia providers and the burn team led to the concept of anesthesia safely providing deep sedation in the inpatient wound care center for select dressing changes. Nursing management began to work through the challenges of implementing the Burn Center Deep Sedation Program. Methods Processes for identifying, scheduling, and recovering patients were established. All Burn Acute Care Unit (BACU) patients requiring a surgical dressing removal or demonstrating poor coping during wound care would qualify for deep sedation. Nursing management worked to create an online scheduling system, and designated a room which was set up with anesthesia equipment and supplies. Candidates were reviewed for deep sedation and a schedule created for the following day. All patients required a Burn Intensive Care Unit (BICU) nurse during the recovery period. A BICU room adjacent to the wound care center became the deep sedation recovery room, and was staffed by the BICU charge nurse. BICU nurses received additional training in post anesthesia care prior to the program implementation. Once all educational needs and logistical changes were addressed, the deep sedation program began operating seven days per week. Results Starting in January 2016 deep sedation has been provided to approximately 400 cases per year. No additional staff was required, only shifting responsibilities of existing nursing personnel. Designating a specific room for deep sedation has ensured that anesthesia providers have access to the appropriate equipment and has minimized disruptions to the flow of other dressing changes occurring throughout the day. The impact of the program on pain and anxiety is currently under evaluation. Informal feedback from patients and staff members has been very positive. Conclusions The challenge in developing this program was the amount of education and planning required prior to implementation. Once the program was active, the challenges that occurred involved the scheduling system. An additional benefit of the program was the teamwork required between BICU and BACU nurses to safely handoff patients. The deep sedation program has also strengthened the burn team’s relationship with the anesthesia providers, whose commitment to the project was appreciated by all involved. A team approach and a collective mission to improve care for burn patients have driven this project to its current success. Applicability of Research to Practice The collaboration between the burn team and anesthesia has resulted in an improved wound care experience for the patient.

The chapter describes operating room setup for shoulder arthroplasty. The operating suite has one main entrance for the patient and a secondary door for sterilization area; during the surgery, the main door should be closed to minimize the staff traffic. Anesthesia equipment is located at the head of the patient; power source, cautery generator, and tubing for suction are located at the foot of the patient. Two Mayo stands, which contain the most commonly used instrument, and other one table, for the specific prosthetic equipment, are positioned on the operative side. The main light is positioned above the left shoulder of the surgeon and the secondary light on the right shoulder of the surgeon but more on the head of patient.

You find yourself in a foreign land on a medical mission with plastic surgeons repairing facial deformities. As the only anesthesiologist, you are in charge of the anesthesia equipment. You are requested to anesthetize a large man (180 kg) for removal of scars from his face. His neck is over 40 cm in diameter. Unfortunately, your box with airway equipment like a fiber-optic scope, gum elastic bougies, etc. has not yet arrived. Through a translator (you don’t speak his language) you tell him them you would like to attempt an awake intubation under local anesthesia. The patient is terrified and wants to be asleep. You realize that you may need to have a gum elastic bougie as a backup. You start looking for possible ways of making a bougie from what you have available. The 18 Fr nasogastric tube would be too soft and the suction catheters you have are too short.

The physical design of an oral and maxillofacial surgeon's office is highly individualized and unique. Every office must incorporate certain essential equipment and features to safely deliver office anesthesia, regardless of the scope of anesthesia services provided. Furthermore, the office design and anesthesia armamentarium must take into account patient safety and comfort. This article discusess the necessary elements, ranging from preanesthesia assessment forms and intraoperative records to office design, anesthesia monitors, and equipment related to the safe and successful administration of office-based anesthesia by oral and maxillofacial surgeons and their staff.

New Zealand born, Dr. Royden McIntosh Muir, MBChB(Edin), DA(RCS&RCP), emigrated to Cape Town in 1921 having specialized in anesthesia in London after World War 1 and became one of South Africa's earliest and leading anesthesiologists. He was appointed honorary anesthetist and clinical teacher by the University of Cape Town at South Africa's first medical school in 1922, and lecturer in 1927. Aware of Cape Town's isolation at the southern tip of Africa, he undertook extensive tours studying anesthetic practice at major hospitals in London, the United States and Canada in 1933 and 1938. He became a lifelong friend of Ralph Waters in Madison, who coached him in the use of cyclopropane, and he subsequently introduced cyclopropane into England and South Africa. In the United States, he met Richard von Foregger, founder of the New York based Foregger Company, from whom he later commissioned a purpose-built anesthetic machine marketed by Foregger as "The Muir Midget." Muir was a founder member of the South African Society of Anaesthetists in 1943 and was elected as its second president the following year. Based on what he had seen in academic hospitals in the United States and England, he fought until his retirement for the improved recognition of the specialty in South Africa and the establishment of adequately staffed departments of anesthesia at teaching hospitals in that country.

Introduction The provision of anesthesia outside the operating room provides a unique set of challenges. The standards and principles that underlie the care of the patient should not be abandoned in satellite locations. However, patients who are referred for procedures in satellite locations may present with minimal preoperative information, possess challenging physical and anesthetic histories, and be scheduled in such a manner as to limit preparation time. The layout and special requirements of the satellite location can create unexpected barriers and may limit access to the patient and the availability of the anesthesia equipment. The challenges for the anesthesiologists include an unfamiliar environment, inadequate anesthesia support and insufficient number of trained personnel, and cramped, dark quarters and variability of monitoring modalities. In radiation oncology, MRI and occasionally the GI suite problems with noise and suboptimal positioning of the patient may be an issue.

SummaryBackground and objectivesPerioperative hypoxemia is common in cardiac surgeries, and atelectasis is the main cause. Besides, we can mention extracorporeal circulation (ECC), dissection of internal thoracic arteries, and previous clinical status of the patient among others as its causes. The present study elaborated an anonymous questionnaire to observe ventilatory strategies for hypoxemia in cardiac surgeries adopted by five thousand anesthesiologists all over the country.MethodsQuestionnaires were sent via e-mail for five thousand anesthesiologists in Brazil.ResultsOut of the questionnaires sent, 81 valid responses were received. Among the answers, 65 (80%) anesthesiologists use volume-controlled ventilation (VCV), while 16 (20%) prefer pressure-controlled ventilation (PCV). The tidal volume (Vt) used is lower than 10 mL.kg-1, for 46 (61%) versus 20 (30%) who adopt a Vt greater than 10 mL.kg-1. Forty-seven (58%) use PEEP and 15 (21%) use FiO2 above 60%. In the case of intraoperative hypoxemia, 20.9% increase or introduce PEEP, 70.3% increase the FiO2, 19.7% use alveolar recruitment maneuvers, 13.5% increase the tidal volume, and 20.9% check for the presence of failures in the anesthesia equipment. Responses were sent from 15 states.ConclusionsThe conducts described in the questionnaires are compatible with those of the international literature. Adjusting the questionnaires format and the way to approach anesthesiologists, new studies could be undertaken.

INTRODUCTION: Mixed exhaled CO 2 and CO 2 excretion (VCO 2 ) are not routinely monitored during anesthesia because they are difficult to measure using standard equipment. We conducted two experiments to test the hypothesis that the ventilator bellows contains mixed exhaled CO 2 . METHODS: In the laboratory experiment, a lung model was assembled with a CO 2 source. The gasses were sampled from the bellows and VCO 2 was calculated. These values were compared to VCO 2 measured by the NICO monitor (Novametrix Medical Systems), a commercially available mainstream capnometer. In the clinical experiment, gasses were sampled from the ventilator bellows in nine subjects under general anesthesia. VCO 2 was calculated and compared to values obtained from the NICO monitor. RESULTS: VCO 2 measured from the bellows connected to the lung model resulted in an overall precision of 26 mL/min, bias of -24 mL/min, and average error of -12.0% compared to set CO 2 flow. In the clinical trial, calculated VCO 2 sampled from the bellows compared to measured VCO 2 from the NICO monitor had a bias of -0.15 mL/min, and precision of 33.16 mL/min. CONCLUSION: VCO 2 calculated from the bellows was not as accurate as NICO VCO 2 in the laboratory; however, it can be done using standard anesthesia equipment. Furthermore, in nine anesthetized subjects, the bellows method of VCO 2 determination had an overall percent error of 1.34% from NICO VCO 2 . Given this small percent error between the bellows method and the NICO monitor, we believe that the bellows method of VCO 2 determination is suitable for clinical practice.

Leroy D Vandam, MD was a remarkable man—an intricate amalgamation of an artist, scientist, and physician. He was a bastion of medical historical knowledge. Dr Vandam became a most influential anesthesiologist, some say, a giant. He was an example of someone who, with resolve, overcame adversity. His artwork is displayed in countless places, and several of his paintings form part of the Wood Library Museum Heritage Series. Dr Vandam was first a surgeon, but he abandoned surgery and pursued a career in anesthesiology under the leadership of Robert Dripps. He completed his residency training at the University of Pennsylvania and joined its staff in 1949. When he arrived at Brigham and Women's Hospital in the 1950s as director of anesthesia, he embarked on one of the most illustrious careers in American anesthesiology. Dr Vandam published more than 250 original articles, chapters, abstracts, and other reports on a wide variety of subjects including history, art, and pharmacology. His classic article on the complications of neuroaxial blocks is a seminal work in anesthesiology. This article describes how an anesthesiologist who shared an interest with Dr Vandam in the history of anesthesiology came to produce a movie based on his career, the evolution of anesthesia equipment, and the transformation of our specialty.

An operating room (OR) setup must be standardized to ensure safe and efficient operating conditions for neurosurgical procedures. This article reviews the basic OR setup at the Barrow Neurological Institute for neurosurgical procedures, the requirements for surgical equipment and supplies, and equipment storage and maintenance. Anesthesia equipment and the special requirements for pediatric, intracranial, spinal, and stereotactic procedures are also discussed.

In this study we evaluated, in our residency program, the understanding and management of a simulated oxygen pipeline failure. Performances of 20 residents were evaluated by 2 raters. Fourth-year residents did not perform better than second-year residents (P = NS). The majority of the participants either did not have the knowledge to change the oxygen cylinder or did not attempt to change the oxygen, even after prompting. We conclude that the delegation of gas machine maintenance to perioperative personnel, such as respiratory therapists and technicians, may have created a new gap in knowledge and resulted in inadequate training.

The practice of “safe” and “modern” anesthesia requires awareness of the regulatory and voluntary standards governing anesthesia equipment and practice. Individual practitioners are subject to federal and state regulations regarding the use of this equipment, which are strongly influenced by international standards and agreements.

Availability of physiologic monitoring equipment to ensure the safe administration of anesthesia is an expected standard in many parts of the world. Many hospitals in China may not have an adequate quantity and variety of anesthesia delivery and patient monitoring equipment to assure safe administration of anesthesia patient care. We present some typical cases of hospitals of different sizes and located in regions with different economic levels; our data demonstrate that there is a lack of available anesthesia administration and patient monitoring equipment in small hospitals and hospitals in economically underdeveloped regions.

For several decades, anesthetic gases have greatly enhanced the comfort and outcome for patients during surgery. The benefits of these agents have heavily outweighed the risks. In recent years, the attention towards their overall contribution to global climate change and the environment has increased. Anesthesia providers have a responsibility to minimize unnecessary atmospheric pollution by utilizing techniques that can lessen any adverse effects of these gases on the environment. Moreover, health care facilities that use anesthetic gases are accountable for ensuring that all anesthesia equipment, including the scavenging system, is effective and routinely maintained. Implementing preventive practices and simple strategies can promote the safest and most healthy environment.

The clinical practice of anesthesia has undergone many advances in the past few years, making this the perfect time for a new state-of-the-art anesthesia textbook for practitioners and trainees. The goal of this book is to provide a modern, clinically focused textbook giving rapid access to comprehensive, succinct knowledge from experts in the field. All clinical topics of relevance to anesthesiology are organized into 29 sections consisting of more than 180 chapters. The print version contains 166 chapters that cover all of the essential clinical topics, while an additional 17 chapters on subjects of interest to the more advanced practitioner can be freely accessed at www.cambridge.org/vacanti. Newer techniques such as ultrasound nerve blocks, robotic surgery and transesophageal echocardiography are included, and numerous illustrations and tables assist the reader in rapidly assimilating key information. This authoritative text is edited by distinguished Harvard Medical School faculty, with contributors from many of the leading academic anesthesiology departments in the United States and an introduction from Dr S. R. Mallampati. This book is your essential companion when preparing for board review and recertification exams and in your daily clinical practice.

Pulmonary dead space is the volume of gas that is delivered to the lungs but does not participate in gas exchange. Knowing pulmonary dead space in patients under general anesthesia is clinically useful because it can aid in detecting disease processes such as pulmonary emboli or low cardiac output states. Dead space can be simply calculated by using the Bohr equation; however, it is difficult to measure mixed exhaled carbon dioxide (PECO(2)) with a standard anesthesia machine. Previously, a study at our institution demonstrated the carbon dioxide (CO(2)) concentration in the bellows of a standard anesthesia machine is an accurate approximation of PECO(2). In this study, we used the bellows PECO(2) measurement and arterial CO(2) (PaCO(2)) to calculate pulmonary dead space. We verified the technique by adding known apparatus dead space volumes during anesthesia.Subjects were under general endotracheal anesthesia. A sampling line was positioned inside the ventilator bellows and connected to a capnometer. Measurements of PECO(2) and PaCO(2) from an arterial catheter were taken at baseline and after adding 100 mL and 200 mL of dead space to the endotracheal tube. Dead space was calculated using the Bohr equation (alveolar dead space/tidal volume = [PaCO(2) - PECO(2)]/PaCO(2)) at baseline and after adding 100 mL and 200 mL of apparatus dead space.The dead space at baseline was 265 ± 47 mL (mean ± SD) in 10 study subjects. After adding 100 mL of dead space to the endotracheal tube, the measured dead space increased by 110 ± 46 mL. The measured dead space increased by 158 ± 39 mL after adding 200 mL.Our baseline dead space measurements were in the expected range under general anesthesia. When dead space was added, we were able to calculate that an increase in dead space occurred. Our calculation was more accurate after adding a 100-mL volume than after adding 200 mL. We present a simple way to detect trends in dead space in ventilated patients using a Narkomed GS anesthesia machine (Dräger Medical, Lübeck, Germany).

Background : The laryngoscope has been identified as a potential source of cross-infection, because of blood and bacterial contamination. In India, there are no guidelines for cleaning and disinfection of anesthesia-related equipment. Practices for decontamination of laryngoscopes vary widely and in most healthcare institutes, laryngoscope blades are re-used after cleaning with tap-water. Materials and Methods: We prospectively compared two techniques for decontamination of laryngoscope blades - a) washing with tap-water and b) washing with tap-water followed by disinfection by immersing in 5% v/v (volume/volume, 1:20 dilution) aldehyde-free biguanide agent for 10 min. We calculated the cost-effectiveness of using 5% v/v aldehyde-free biguanide agent for disinfection of laryngoscopes. We also conducted a survey to assess the decontamination practices in other Indian hospitals. Results : Overall bacterial growth was 58% (29 out of 50 blades) after tap-water cleaning (of which 60% were pathogenic organisms) versus 3.4% (one out of 29 blades) after tap-water cleaning followed by immersion in disinfectant (all of which were commensals). The cost of disinfection with biguanide was Indian Rupees 1.13 (20 US cents) per laryngoscope. Most hospitals in India do not have guidelines regarding laryngoscope decontamination between uses, and cleaning with tap water is a commonly used method. Conclusion : Cleaning of laryngoscope blades with tap-water is a commonly used but inadequate method for decontamination. Washing with tap-water followed by disinfection with 5% v/v aldehyde-free biguanide for at least 10 min is an effective and inexpensive alternative. National guidelines for the decontamination of anesthesia equipment are necessary.

Surgery is increasingly recognized as an effective means of treating a proportion of the global burden of disease, especially in resource-limited countries. Often non-physicians, such as nurses, provide the majority of anesthesia; however, their training and formal supervision is often of low priority or even non-existent. To increase the number of safe anesthesia providers in Haiti, Medecins Sans Frontieres has trained nurse anesthetists (NAs) for over 10 years. This article describes the challenges, outcomes, and future directions of this training program. From 1998 to 2008, 24 students graduated. Nineteen (79%) continue to work as NAs in Haiti and 5 (21%) have emigrated. In 2008, NAs were critical in providing anesthesia during a post-hurricane emergency where they performed 330 procedures. Mortality was 0.3% and not associated with lack of anesthesiologist supervision. The completion rate of this training program was high and the majority of graduates continue to work as nurse anesthetists in Haiti. Successful training requires a setting with a sufficient volume and diversity of operations, appropriate anesthesia equipment, a structured and comprehensive training program, and recognition of the training program by the national ministry of health and relevant professional bodies. Preliminary outcomes support findings elsewhere that NAs can be a safe and effective alternative where anesthesiologists are scarce. Training non-physician anesthetists is a feasible and important way to scale up surgical services resource limited settings.