A team of French anesthesiologists has developed an automatic delivery system of propofol and remifentanil, which they recently tested in a multi-center trial involving 196 surgical patients. The researchers reported in Anesthesia & Analgesia that the system, which uses a Bispectral Index (BIS) monitor as a guide, performed better than manual administration. We have developed a proportional-integral-derivative controller allowing the closed-loop coadministration of propofol and remifentanil, guided by a Bispectral Index (BIS) monitor, during induction and maintenance of general anesthesia. The controller was compared with manual target-controlled infusion. The controller allows the automated delivery of propofol and remifentanil and maintains BIS values in predetermined boundaries during general anesthesia better than manual administration. Abstract in Anesthesia & Analgesia: Closed-Loop Coadministration of Propofol and Remifentanil Guided by Bispectral Index: A Randomized Multicenter Study…

Cellphones have come a long way with the rise of the smartphone. What used to be simply a means of making phone calls remotely, now is the way by which we can send emails, text messages, photos, and…acquire fetal images! You can thank Redmond, Washington-based Mobisante for that last one, because it has announced that its MobiUS ultrasound imaging system has received FDA approval to be marketed in the United States. MobiUS is the world’s first smartphone-based commercial ultrasound system. It consists of an ultrasound probe and a Toshiba Windows Mobile-powered smartphone with Mobisante’s software on it. Since the system is based on smartphones, it is extremely portable and very affordable compared to traditional ultrasound systems. In addition, it can utilize the cellular network and Wi-Fi capabilities of the smartphone to send images remotely. Mobisante hopes to get their portable ultrasound systems into remote villages and rural hospitals where resources are limited, population density is lower, and medical assistance is not as easily accessible. Although if things continue to progress well for Mobisante and portable ultrasound technology as a whole, we may soon find expectant moms uploading fetal pictures of their bundle of joy to their Facebook newsfeeds. Thanks to Tom Cruise, only if they live outside of California, of course. Press release: World’s first smartphone-based ultrasound imaging system cleared by the FDA… (.pdf) Company page: Mobisante … Flashbacks: The Signos, Self Contained Handheld Ultrasound Gains FDA Approval; Mobile Clinical Imaging On a Smart Phone (hat tip: Engadget)…

A few years ago we wrote about the punnily named ResQPOD, pictured on top, an impedance-threshold device that prevents air from re-entering the lungs to assist with cardiac filling. The Lancet has just published a study comparing standard CPR to CPR using ResQPod combined with another assist device called the ResQPump (side below), both from Advanced Circulatory Systems, Inc (Roseville, MN). From the abstract: Findings 2470 provisionally enrolled patients were randomly allocated to treatment groups. 813 (68%) of 1201 patients assigned to the standard CPR group (controls) and 840 (66%) of 1269 assigned to intervention CPR received designated CPR and were included in the final analyses. 47 (6%) of 813 controls survived to hospital discharge with favourable neurological function compared with 75 (9%) of 840 patients in the intervention group (odds ratio 1·58, 95% CI 1·07—2·36; p=0·019]. 74 (9%) of 840 patients survived to 1 year in the intervention group compared with 48 (6%) of 813 controls (p=0·03), with equivalent cognitive skills, disability ratings, and emotional-psychological statuses in both groups. The overall major adverse event rate did not differ between groups, but more patients had pulmonary oedema in the intervention group (94 [11%] of 840) than did controls (62 [7%] of 813; p=0·015). Interpretation On the basis of our findings showing increased effectiveness and generalisability of the study intervention, active compression-decompression CPR with augmentation of negative intrathoracic pressure should be considered as an alternative to standard CPR to increase long-term survival after cardiac arrest. Full abstract in Lancet: Standard cardiopulmonary resuscitation versus active compression-decompression cardiopulmonary resuscitation with augmentation of negative intrathoracic pressure for out-of-hospital cardiac arrest: a randomised trial Good summary from Milwaukee Journal Sentinel: New CPR devices save lives, Medical College study finds… Study info and product pages: THE RESQ TRIAL……

Medgadget editor Paul Pisklak, M.D., an anesthesia resident at Baylor, is attending the annual meeting of Society for Technology in Anesthesia. Here’s his first report. The keynote speaker at this year’s Society for Technology in Anesthesia conference at The Venetian in Las Vegas was Colonel Jim Bagian, M.D., P.E., a physician and astronaut. Dr. Bagian gave a talk cleverly entitled "Patient Safety: It’s Not Rocket Science." His unique broad view of the aviation and healthcare industries gives him a special insight into the subject at hand. The main thrust of his argument is that a large percentage of adverse events that happen in hospitals are human and communication errors, i.e., misuse of the technology that we already have. One example he gave was from his former role as a VA safety official when a group of nurses came to him with an external pacemaker error. A patient was getting very bradycardic, but when they hooked up the pacemaker, it said "Error 004." The nurses brought it to the hospital’s biomedical department staff, who simply took out and reinserted the battery. This workaround had been used for 8 years! Dr. Bagian ended up calling the manufacturer and addressing the root cause of the problem and having them update a software update. The gist of this story is the importance of addressing the root cause of device problems and not just "band-aid fixes." Another interesting anecdote that he shared had to do with vigilance. A group of radar operators in the military was offered a full month’s extra pay if they could have 100% accuracy at detecting enemy ships. It turned out that despite the huge incentive, the operators’ accuracy went down considerably after an hour, demonstrating the human propensity to get distracted at routine tasks – a fact that has considerable applicability to anesthesiologists, who spend hours monitoring for what can be minuscule changes. Of note, providing electric shocks to the chairs of the radar operators every 10 minutes increased vigilance dramatically! Dr. Bagian drove this concept home with an interactive segment. To demonstrate the concepts of vigilance and "inattentional blindness," he showed the following video. When you watch this, see if you can count how many times the ball is passed between people in white shirts. Now there’s food for thought about the things that we have to think about and those that we don’t. We will keep reporting from…

Traditionally, if you need to sedate an intubated patient in the ICU, the go-to agents are midazolam or propofol. However, waking these patients up when trying to extubate can be a lengthy ordeal due to the long half-time and accumulation of these drugs. Volatile anesthetics like isofluorane or sevofluorane, usually used in the operating room, have a much quicker wake-up time, but the size and cost of an anesthesia machine make them impractical for use in the ICU. Sedana Medical (Uppsala, Sweden) seems to have overcome this limitation with the introduction of the AnaConDa (Anesthetic Conserving Device). The device features a syringe pump that delivers Isofluorane or Sevofluorane to a small carbon-fiber device which goes in-line with a traditional ICU ventilator. In many ways, this can be considered a disposable anesthetic vaporizer. This month’s Anesthesia & Analgesia features a study that validated this device in an ICU setting and found that it is quite accurate (end-tidal concentration was within 13% of target concentration). Advantages of this device, in addition to quick wake-ups, include lower cost of the equipment as compared to traditional vaporizers and an overall decreased consumption of anesthetic. Abstract in A&A: The Accuracy of the Anesthetic Conserving Device (Anaconda) as an Alternative to the Classical Vaporizer in Anesthesia Product page: The AnaConDa ……

Here’s an interesting simple technology that might come handy to anesthesiologists and others who tend to do lots of central lines. Making sure that you are not in a carotid (or subclavian or femoral arteries, etc) is not always as simple as many think. Sure, you can do a blood color comparison. You can also connect a vertical column, and see how far the blood will rise. But why to do these maneuvers, if you can have something at the end of a finder needle that does not add steps to your procedure? Meet Mirador Biomedical of Seattle, Washington that has just received FDA’s 510(k) clearance for its Compass Vascular Access pressure measurement device, as well as a similarly designed Compass Lumbar Puncture pressure monitor. From the Compass Vascular Access product page: Focus on the Procedural Site View your hands, the patient and the pressure without additional cabling, operators or connections Integrate Seamlessly with Needles and Syringes Easily incorporated into the Seldinger technique for inserting catheters Eliminate “Blind” Guidewire Insertion The port allows insertion of the guidewire while monitoring the pressure From Compass Lumbar Puncture product page: Indication of CSF Entrance: Entrance into the target space is indicated by a pressure increase. Seamless Integration with LP Needles: The CompassTM LP connects to standard Lumbar puncture needles. Immediate and Continuous Measurement of Opening Pressure: View the pressure continuously without additional cabling, operators or connections. Press release: Mirador Biomedical, developing the innovative Compass™ family of disposable medical devices, announced FDA 510(k) clearance of its two leading products… (.pdf) Product page: Compass pressure measurement devices……

We’ve reported on Masimo’s noninvasive hemoglobin monitor, part of Masimo Rainbow SET, here on Medgadget in the past. The idea of monitoring hemoglobin in real time and without the need to draw blood is very attractive in the OR and ICU settings, but does it work? According to results of a trial released at the annual meeting of the American Society of Anesthesiologists this week, the answer is a resounding yes! In the study, Masimo’s device helped reduce blood tranfusions in orthopedic surgery patients by an astounding 86 percent. Patients received either the "standard of care" (using blood draws) or the continuous hemoglobin measurement along with the blood draws to guide transfusion therapy. Of the 327 total patients, seven in the standard group and only one in the Masimo group received blood transfusions. According to lead researcher, Jesse M. Ehrenfeld, MD, MPH, recently appointed as Director, Center for Evidence Based Anesthesia at Vanderbilt University Medical Center, "Blood transfusions pose real risks to patients and are also a major contributor to the cost of surgical care. Very few monitoring technologies are subjected to the rigor of a randomized controlled trial, and even fewer are able to show a significant impact on clinician behavior and ultimate patient outcome. Our study has demonstrated that SpHb monitoring clearly changes clinician behavior and results in lower intraoperative blood transfusion rates and lower overall blood utilization. These findings have important clinical implications for hospitals around the world who are seeking to reduce surgical patient risk and reduce costs." Press release: Randomized Controlled Trial Shows Masimo Noninvasive and Continuous Hemoglobin Monitor Helps Clinicians Reduce Blood Transfusions During Surgery Product page: Masimo’s total hemoglobin (SpHb)… Flashbacks: Fluid Volume Monitoring with Pulse Ox Shows Promise; Easy Hemoglobin Monitoring Without Butterflies, Needles or Catheters; Masimo Releases Acoustic Sensor System for Continuous Respiration Rate Monitoring; Masimo Launches Hemoglobin Hand-Held Tester Pronto-7; Masimo to Release New Halo Index, Radical 7 Pulse Oximeter, Patient SafetyNet Monitoring System…

ZOLL Medical has received FDA approval for the Propaq M monitor, a monitor only version of the recently released Propaq MD. The user interface and connections are identical to the MD version, but it loses the defibrillation option, resulting in a more compact and mobile package. Like the Propaq MD, it has been designed for military and air medical use, resulting in a smaller, rugged, long-lasting model, able to withstand extremely fine sand and jets of water. From the press release: The Propaq M is a new ultra-lightweight, compact device that combines highly sophisticated, advanced capabilities with the well-accepted and proven features of the Propaq monitors. New features of the Propaq M include 12-lead monitoring, a third invasive pressure channel, extensive trending and data collection, a large high-contrast color display with 4-waveform capability, a night vision goggle (NVG) mode for military and air medical night operations, and a user-removeable battery that will operate all the physiological parameters for over 7.5 hours. These new capabilities were designed into a new small, lightweight, rugged package nearly 5 lbs. lighter than currently deployed technology. Press release: ZOLL Propaq M Monitor Granted 510(k) Clearance by U.S. Food and Drug Administration……

ZOLL Medical has received FDA approval for the Propaq M monitor, a monitor only version of the recently released Propaq MD. The user interface and connections are identical to the MD version, but it loses the defibrillation option, resulting in a more compact and mobile package. Like the Propaq MD, it has been designed for military and air medical use, resulting in a smaller, rugged, long-lasting model, able to withstand extremely fine sand and jets of water. From the press release: The Propaq M is a new ultra-lightweight, compact device that combines highly sophisticated, advanced capabilities with the well-accepted and proven features of the Propaq monitors. New features of the Propaq M include 12-lead monitoring, a third invasive pressure channel, extensive trending and data collection, a large high-contrast color display with 4-waveform capability, a night vision goggle (NVG) mode for military and air medical night operations, and a user-removeable battery that will operate all the physiological parameters for over 7.5 hours. These new capabilities were designed into a new small, lightweight, rugged package nearly 5 lbs. lighter than currently deployed technology. Press release: ZOLL Propaq M Monitor Granted 510(k) Clearance by U.S. Food and Drug Administration……

BK Medical, Analogic Corporation’s daughter firm, has released a new ultrasound in its portable Flex Focus line. The Flex Focus 700 is specifically designed for operating rooms, featuring a large 19 inch touchscreen along with touch controls on the bezel. There’s even an optional remote control to operate the unit from a distance. More from BK Medical about the new ultrasound: The system’s 19-inch screen displays sharp laparoscopic, intraoperative, and percutaneous images, with detail that is visible from virtually any angle. The Flex Focus 700 is small, lightweight, and supports a wide range of sterilizable transducers. * Remote control* — for control within the sterile area. * Touch screen — with a simplified control panel. * Touch control panel. * Completely mobile — the scanner is easy to move and maneuver * Fully adjustable screen height — move the scanner back and forth and up and down * Easy-access transducer connectors — no reaching down or bending over * Completely customizable interface — so you can get started quickly and work the way you want to * Picture-in-Picture (PiP) for simultaneous display of camera and scanner images on a single monitor. * Optimized setups and measurements for surgical ultrasound with the Surgery Pro Package * Access to all BK Medical’s specialized transducers * Clear, sharp laparoscopic, intraoperative and percutaneous images * 19" screen means image details are easy to see from any angle * Simultanous biplane image displayed like you’ve never seen it before * Sealed keyboard, no sharp corners or buttons where germs could hide * Surgical transducers from BK Medical are all sterilizable Press release: Analogic’s BK Medical Subsidiary Introduces the Flex Focus 700 Surgical Ultrasound System Product page: Flex Focus 700……