Anesthesia Units

(1)



Anesthesia Units

Scope of this Product Comparison

This Product Comparison covers complete anesthesia systems capable of delivering anesthetic agents,

ventilating the patient, and monitoring ventilation variables (and possibly gas and physiologic variables).

Excluded are separate analyzers designed to measure concentrations of halogenated anesthetics and gases

supplied to the unit or to detect levels present in the operating room; also excluded are separate stand-alone

physiologic monitoring systems. For information on these devices, see the following Product Comparisons:



Multiple Medical Gas Monitors, Respired/Anesthetic



Oxygen Monitors



Physiologic Monitoring Systems, Acute Care; Neonatal; ECG Monitors; Monitors, Central Station

These units are also called: anesthesia machines.

Purpose

Anesthesia units dispense a mixture of gases and vapors and vary the

proportions to control a patient’s level of consciousness and/or analgesia

during surgical procedures. Anesthesia units primarily perform the following

four functions:



Provide oxygen (O

2

) to the patient



Blend gas mixtures, in addition to O

2

, that can include an

anesthetic vapor, nitrous oxide (N

2

O), other medical gases, and air



Facilitate spontaneous, controlled, or assisted ventilation with

these gas mixtures



Reduce, if not eliminate, anesthesia-related risks to the patient and

clinical staff

(2)

patient safety. To meet the minimum standard of care in the United States, the American Society of

Anesthesiologists (ASA) states that anesthesia systems must continually monitor the patient’s oxygenation,

ventilation, circulation, expired CO

2

levels, and temperature. Integrated or stand-alone monitors may be used.

Gas supply and control

Because O

2

and N

2

O are used in large quantities, they are

usually drawn from the hospital’s central gas supplies. Cylinders

containing compressed O

2

, N

2

O, and sometimes other gases are

mounted on yokes attached to the anesthesia machine and can

serve as an emergency gas supply in case central supplies fail.

Cylinder connections should include indexing systems (e.g.,

specific pattern of pins), which are intended to prevent accidental

mounting of a gas cylinder on the incorrect yoke. Each gas

entering the system from a cylinder flows through a filter, a

one-way check valve, and a regulator that lowers the pressure to

approximately 45 pounds per square inch (psi). There is no need

for a separate regulator when the central gas supply is used

because the pressure is already at about 50 psi.

Anesthesia machines have an O

2

-supply-failure device and an

alarm that protect the patient from inadequate O

2

supply. If the O

2

supply pressure drops below about 25 to 30 psi, the unit decreases

or shuts off the flow of the other gases and activates an alarm.

The flow of each gas in a continuous-flow unit is controlled by

a valve and indicated by a flowmeter. The flowmeter can be a purely mechanical arrangement, with a flow tube

in which a bobbin moves up and down depending on the flow, or it can be an electronic sensor with an LCD

(liquid crystal display). After the gases pass through the control valve and flowmeter, enter the low-pressure

system, and, if required, pass through a vaporizer, they are administered to the patient. The N

2

O and O

2

flow

controls are interlocked so that the proportion of O

2

to N

2

O can never fall below a minimum value (generally 0.25)

to produce a hypoxic breathing mixture. An O

2

monitor that is located on the inspiratory side of the breathing

circuit analyzes gas sampled the patient’s breathing circuit and displays O

2

concentration in volume percent. O

2

monitors should sound an alarm if the O

2

concentration falls below the preset limit.

(3)

Variable bypass and heated blender vaporizers are concentration calibrated and thus can deliver a preselected

concentration of vapor under varying conditions. In a variable bypass vaporizer, such as one used for enflurane,

isoflurane, halothane, or sevoflurane, a shunt valve divides the gas mixture entering the vaporizer into two

streams; the larger stream passes directly to the outlet of the vaporizer, while the smaller stream is diverted

through an internal chamber in which vapor fills the space over the relatively volatile liquid anesthetic. The vapor

mixes with the gas of the smaller stream, which then rejoins the larger stream as it exits the vaporizer. In a

mechanically-controlled variable-bypass vaporizer, a bimetallic thermal sensor that regulates the shunt valve to

divert more or less gas through the chamber compensates for temperature changes that affect the equilibrium

vapor pressure above the liquid. Each variable bypass vaporizer is specifically designed and calibrated for a

particular liquid anesthetic.

The heated blender vaporizer was introduced for use with the anesthetic agent desflurane. In this type of

vaporizer, desflurane is heated in a sump chamber. A stream of vapor under pressure flows out of the sump and

blends with the background gas stream flowing through the vaporizer. Desflurane concentration is controlled by

an adjustable, feedback-controlled metering valve in the vapor stream.

Measured-flow vaporizers (also known as copper kettle or flowmeter-controlled) are considered largely

obsolete but may still be in limited use in some developing countries. These vaporizers are not concentration

calibrated; instead, a measured flow of carrier gas is used to pick up anesthetic gas.

Draw-over vaporizers are sometimes used by the military in the field, as well as in situations or countries in

which pressurized gas sources are unavailable. Such units offer low resistance to gas flow and are relatively

(4)

system (e.g., leaks in the breathing circuit). The expired tidal volume can be measured with a flowmeter, with a

spirometer, or (most commonly) with a sensor placed in the expiratory circuit. Most ventilators are capable of

providing controlled ventilation and can maintain a positive airway pressure during the expiratory phase of the

breath (positive end-expiratory pressure [PEEP]). Many ventilators can be equipped with modes that permit

spontaneous breathing during mechanical ventilation.

Breathing circuits

Most anesthesia systems are continuous-flow systems (see Figure 1), that provide a continuous supply of O

2

and anesthetic gases. There are two basic types of breathing circuits used in these systems: the circle system and

the T-piece system (see Figure 2), each of which can assume various configurations. (A common configuration of

the T-piece system is the Bain modification of the Mapleson D system.) A higher proportion of anesthetic gases is

rebreathed in the circle system, which uses check valves to force gas to flow in a loop and returns expired gases

(minus the CO

2

), plus fresh gas, to the patient. In the T-piece circuit, most of the exhaled gas is vented out of the

system, and the portion rebreathed depends on the fresh-gas flow rate.

In the circle system, fresh gas from the anesthesia

machine enters the inspiratory limb of the breathing

circuit and mixes with gas in the system before the

resulting mixture flows through a one-way valve to the

patient. Expired gas flows from the patient through a

second (expiratory) limb of the circuit, passing another

one-way valve, into either a reservoir bag or a ventilator.

When positive pressure is generated in the system,

either by a manual squeeze of the reservoir bag or by

compression of the bellows or piston by a mechanical

ventilator, collected gas that does not escape via an

adjustable pressure-limiting (APL) valve to the

scavenging system is driven through a CO

2

absorption

canister where CO

2

is removed from the gas before it is

returned to the patient. In circle breathing systems, a

fresh-gas flow of 1 L/min or less is typically considered

low-flow anesthesia (4 to 10 L/min is typically

considered the usual fresh-gas flow rate). A fresh-gas

flow of 0.5 L/min is generally considered minimal-flow

(5)

Because excess pressure imposed on the patient’s lungs can cause serious lung damage, either an APL valve

(during manual ventilation) or a valve in the ventilator (during automatic ventilation) allows excess gas to escape

when a preset pressure is exceeded. There are two types of APL valves: spring-loaded and needle valves. The

spring tension in spring-loaded APL valves can be adjusted to control the pressure at which the valve will open.

At lower pressures, the valve is closed. The pressure in the breathing system maintained by the needle valve

depends on the flow through the valve. Therefore, when the valve is not fully closed, gas will always leak from

the system. The minimum exhaust pressure required to refill a ventilator bellows is usually 1 to 2 cm H

2

O; for

maximum pressure, both types of valve are fully closed. Because many APL valves do not have calibrated

markings, the anesthetist must adjust them empirically to give a desired peak inspired pressure. Circle systems

and T-piece systems also include a pressure gauge for monitoring circuit pressure and setting the APL valve. An

electronically controlled, settable, and calibrated APL valve is available on some anesthesia machines.

Scavenging system

A scavenging system captures and exhausts waste gases to minimize the exposure of the operating room staff

to harmful anesthetic agents. Scavenging systems remove gas by a vacuum, a passive exhaust system, or both.

Vacuum scavengers use the suction from an operating room vacuum wall outlet or a dedicated vacuum system.

To prevent positive or negative pressure in the vacuum system from affecting the pressure in the patient circuit,

manifold-type vacuum scavengers use one or more positive or negative pressure-relief valves in an interface with

the anesthesia system. In contrast, open-type vacuum scavengers have vacuum ports that are open to the

atmosphere through some type of reservoir; such units do not require valves for pressure relief.

Passive-exhaust scavengers can vent into a hospital ventilation system (if the system is the nonrecirculating

type) or, preferably, into a dedicated exhaust system. The slight pressure of the waste-gas discharge from the

anesthesia machine forces gas through large-bore tubing and into the disposal system or directly into the

atmosphere.

Monitors and alarms

Anesthesia systems incorporate a set of equipment-related monitors, including those for airway pressure,

expiratory volume, and inspired O

2

concentration. They can also include exhaled gas monitors, such as those for

CO

2

concentration, N

2

O concentration, and agent concentration, or physiologic monitors such as those for blood

O

2

saturation by pulse oximetry, electrocardiogram, invasive and noninvasive blood pressure, and temperature.

Anesthesia systems are typically configured with respect to their monitors in one of two ways: as modular

systems or as preconfigured systems. In the modular approach, an anesthesia machine with a basic set of

equipment monitors (usually airway pressure, inspired O

concentration, and expired volume) is used as a

(6)

status of all alarms, plus explanatory messages.

Several models exist to predict the level of wakefulness in anesthetized patients, such as the Ramsay Scale and

the Modified Observer’s Assessment of Alertness/Sedation Scale. However, in lieu of a direct method of

monitoring brain activity during surgery, users may rely on indirect means of assessing consciousness, such as

blood pressure and vital signs. According to proponents, one indirect method, level-of-consciousness monitoring

(e.g., Bispectral Index [BIS], Physiometrix’s Patient State Index), measures the effectiveness of painkilling agents

while ignoring the sedative and paralytic elements that constitute a significant portion of anesthetic agents. Some

anesthesia units may incorporate this technology as an additional tool to monitor the patient.

Level-of-consciousness monitors use a metered scale (0 to 100) to indicate the degree of patient wakefulness based on

collected and processed data. A digital meter indicates the number on the scale that corresponds to the patient’s

degree of wakefulness, with a higher number representing a higher degree of consciousness and awareness of

sensation despite the presence of anesthetic agents. One supplier offers an Entropy module that provides

information on the central nervous system during general anesthesia. The information is acquired based on the

acquisition and processing of raw electroencephalogram (EEG) and frontalis electromyography (FEMG) signals

using a proprietary algorithm. The Entropy module is designed to assist clinicians in delivering the appropriate

amount of anesthetic agents. ASA states that there is not enough evidence to warrant mandatory use of these

technologies for patients under general anesthesia. However, ASA states that it may be useful for at-risk patients

to be monitored for intraoperative awareness. For additional information, visit ASA’s Website at

http://www.asahq.org/publicationsAndServices/AwareAdvisoryFinalOct05.pdf.

Automated anesthesia record keepers/anesthesia information management systems

Automated anesthesia record keepers (AARKs) are available either as an option on some anesthesia units or

from third-party suppliers. They are used for collecting data from electronic ventilation and monitoring

equipment that has appropriate outputs. Vital signs such as blood pressure, heart rate, end-tidal CO

2

, and

oximeter values are recorded at specific intervals and plotted in graph form. Drug dosages, lab data,

intraoperative events, and gas delivery rates are entered into the system either manually or by some

semiautomated means; comments can also be entered directly onto the record. An AARK produces a formatted

hard copy of the anesthesia record for the patient’s files. Gathering and storing such data can expedite individual

patient management and billing, quality assurance, critical incident analysis, and teaching. However, automated

record keeping has not achieved wide acceptance, in part because of many clinicians’ concerns about misleading

artifacts being entered into the record, hospital personnel’s resistance to change, and the cost of implementing an

automated record keeper.

(7)

One of the greatest dangers of general anesthesia is a lack of O

delivered to the patient (hypoxia), which can

result in brain damage or death. Conversely, the administration of O

2

in a concentration of 100%, even for a short

duration, may be toxic. Inhalation of 100% O

2

may cause resorption atelectasis. The danger of inhaling 100% O

2

,

even for a short duration, is particularly acute in neonatal anesthesia, potentially causing retrolental fibroplasia

and bronchopulmonary dysplasia. Inadequate O

2

delivery can be caused by any number of conditions, including

disconnection of the patient from the breathing circuit; accidental movement of the O

2

, N

2

O, or other gas flow

control setting knobs; changes in the patient’s lung compliance; and gas leaks. One common safety measure is the

inclusion of an O

2

monitor and a CO

2

monitor or an expired volume alarm (in an anesthesia unit with an

ascending bellows) in the anesthesia system. An O

2

monitor warns of inadequate O

2

concentration in the

inspiratory limb. A CO

2

monitor or a spirometer alarm (in an anesthesia unit with an ascending bellows) in the

breathing circuit can alert the anesthetist to inadequate ventilation such as that caused by a disconnection.

ECRI Institute has investigated incidents of patient exposure to carbon monoxide (CO) during the

administration of inhaled anesthetics through semiclosed circle anesthesia systems. Once in the blood, CO binds

tightly with hemoglobin, forming carboxyhemoglobin and diminishing the ability of hemoglobin to transport and

release O

2

. A reaction between halogenated anesthetic agents and commonly used CO

2

absorbents can produce

CO if the CO

2

absorbent is excessively dry. Excessive dryness can occur when (1) an anesthesia machine has been

idle (e.g., over a weekend) and (2) there is a continuous flow of medical gas (which is very dry) through the CO

2

absorber. When dry, the absorbent becomes highly reactive in the presence of certain halogenated agents,

resulting in the production of CO as the agent flows through the machine’s CO

2

absorber. ECRI Institute

recommends that the absorbent material in both canisters of an absorber be replaced whenever there is reason to

believe that a machine has been left idle with gas flowing for an undetermined time. Fresh absorbent materials

are sufficiently hydrated and normally remain hydrated by exhaled water vapor in the circle system, thereby

preventing reaction with halogenated agents. For more information, see the Health Devices citation in this report.

Some anesthesia system malfunctions can cause delivery of gas with excessive CO

2

concentration, an

inadequate or excessive amount of anesthetic agent, or dangerously high pressure. Hypoventilation,

compromised cardiac output, air in the pleural cavity (pneumothorax), and asphyxiation are possible

consequences of such problems.

Improperly calibrated vaporizers can result in the delivery of the wrong concentration of anesthetic agent to

the patient. Removing some vaporizers from the anesthesia machine and transporting them can disturb their

calibration and could eventually cause delivery of too much or too little anesthetic. However, many “tip-proof”

vaporizers have been released to reduce calibration errors. The output of an anesthesia vaporizer should be tested

each time the vaporizer is removed from a system and each time it is returned to service. Each vaporizer should

be inspected and the calibration verified at least twice a year.

(8)

solid particulate, and microorganism contamination after installation or repair and periodically thereafter.

In many countries, a diameter index safety system (DISS) is used to prevent the connection of gas hoses from

the machine to the wrong wall outlet, and a pin index safety system is used to prevent the connection of the

wrong cylinders to the yokes in the anesthesia machine. The pin index safety system employs pins protruding

from the yoke that correspond to holes in a specific type of gas cylinder post. Only a cylinder post with the

corresponding holes can fit properly onto the yoke. ECRI Institute has seen instances of improper connections in

which damaged pins allowed users to force the wrong cylinder into place. ECRI Institute recommends that

damaged indexing components should never be used.

Faulty or inoperative scavenging systems are responsible for most anesthetic gas pollution in the operating

room; other causes include improper anesthesia administration technique and leaks in anesthesia equipment.

Common sources of leaks include hose connectors, the CO

2

absorber, the APL valve, and the endotracheal tube or

mask. Current scientific and epidemiologic studies have shown that exposure to trace levels of anesthetic gases

continually present in the operating room can cause adverse health effects in operating room personnel, such as

an increased incidence of spontaneous abortion and congenital anomalies in offspring. In addition, trace gas

levels in the air may have a slight anesthetizing effect on the anesthetist and surgeon.

Inadequate evacuation of some scavenging systems can cause pressure to build up in the breathing circuit,

with the potential for pneumothorax.

Another common problem is circuit obstruction due to the presence of a foreign object (e.g., needle caps) or a

manufacturing defect. This problem occurs most often when a pre-use check is omitted.

As mentioned previously, anesthesia units that lack integrated monitors and alarms can cause confusion by

sounding numerous alarms simultaneously. While integrated monitors and alarms are becoming more

widespread, both modular and integrated systems are subject to the confusion caused by false alarms. A false

alarm, caused by accidental patient movement or other nonphysiologic reasons, can confuse operating room staff

and possibly draw attention away from other alarms that may truly indicate a change in the patient’s physiologic

condition. Ensuring that the alarm limits are properly set and positioning sensors and electrodes in such a way as

to minimize artifacts can reduce the incidence of false alarms. ECRI Institute recommends that users do not set

physiologic alarm limits below normal values in order to reduce nuisance alarms.

The magnetic fields created by magnetic resonance imaging (MRI) equipment may interfere with the function

of conventional anesthesia units and electronic monitoring equipment when used in proximity to such

equipment. Conversely, magnetic materials and electronic monitors may interfere with MRI scanner function and

degrade image quality. Many MRI-compatible anesthesia machines have restrictions or limitations to their use in

the MRI environment. If they are not used in accordance with these restrictions/limitations, MRI-compatible

(9)

Included in the accompanying comparison chart are ECRI Institute’s recommendations for minimum

performance requirements for anesthesia units. The recommendations are listed in two categories: basic and high

performance.

ECRI Institute considers certain minimum safety measures necessary for all anesthesia units. Among these

measures are O

2

fail-safe and hypoxic mixture fail-safe systems, gas cylinder yokes for O

2

if central supplies fail,

and an internal battery (for units with automatic ventilators) capable of powering the unit for at least 30 minutes.

The unit must be able to measure O

2

concentration, airway pressure, and either the volume of expired gas or

the concentration of expired CO

2

(ETCO

2

). (Note: ASA recommends monitoring of ETCO

2

in all intubated

patients; this can be accomplished by the anesthesia unit or by a separate device [e.g., capnograph, multigas

monitor].)

Gas cylinders should be attached through hanger yokes with the proper pin index safety system and check

valves. Each pipeline gas cylinder supply should have a pressure gauge with scale numbers large enough to be

easily read. Gas hoses and machine receptacles should use DISS fittings to prevent misconnection.

It is advantageous if the anesthesia unit accepts medical-air input to allow delivery of either air and/or N

2

O as

the gas carrier. In the event of a partial or complete loss of O

2

supply, an undefeatable audible alarm should

activate and the flow of N

2

O gases should automatically shut off or decrease proportionately to the flow of O

2

to

prevent a hypoxic condition. Also, flows and the mixture ratios determined from flowmeter settings should be

accurate to within 10% of set values. Anesthetic vapor concentration delivered to the common gas outlet should

be accurate to within 0.2% vapor concentration of agent or 10% of the set value (whichever is greater) at any gas

flow. It is preferable that ventilation rate and PEEP values be monitored. It should not be possible to silence or

disable a ventilator monitor alarm for longer than two minutes.

Units should have a power-loss alarm, and the battery backup should have an automatic low-battery alarm.

All units should include a backup battery to guard against power loss. The anesthesia unit should automatically

switch to the internal battery if line power is interrupted; also, the loss of line power should be accompanied by

an alarm. The battery should also operate the anesthesia unit and integral monitors for at least 30 minutes. A

low-battery alarm should visually and audibly indicate when the low-battery voltage falls to a level below which the unit

may fail to perform satisfactorily. The battery should not require more than 16 hours to recharge completely after

depletion.

High-performance systems are distinguished largely by their ability to serve a wide range of patients and to

operate with little or no supplemental equipment. Features that make this possible include ventilator modes and

tidal volume ranges suitable for neonates and adults, as well as integrated gas and sometimes physiologic

monitoring. (Although most models tend to include only a small number of standard ventilation modes,

(10)

monitors, while others have integrated monitors (preconfigured approach). The advantages of preconfigured

monitoring include convenience and electronically integrated displays and prioritized alarms. Modular systems

can be less expensive than preconfigured systems, especially if the facility already owns the monitors.

Hospitals can purchase customized modular systems assembled from standard components, or they can

assemble their own modular systems. These systems must meet all national and regional safety standards.

Advantages of the modular approach include flexibility in choosing and upgrading monitors and ease of service;

drawbacks include assembling a system that may not be successfully integrated and thus has multiple alarms

and/or displays.

Anesthesia units and patient monitoring systems should be carefully chosen to ensure that all essential

monitoring functions recommended by the American Society of Anesthesiologists are obtained and to ensure

optimal integration and an adequate standard of care. For legal reasons, the level-of-monitoring and

anesthesia-delivery capabilities for each anesthesia station should be uniform so that all patients receive the same standard

of care for the same surgical procedures.

Integrated anesthesia workstations, along with the gas/vapor dispensing subsystem and individual

physiologic and equipment monitors, may also include a device for automatically dispensing injectable drugs.

Consequently, the anesthesia workstation can be viewed as an integrated monitoring system that dispenses

anesthetic drugs.

Hospitals should also consider the standardization of anesthesia equipment; that is, purchasing systems that

are compatible with equipment already in operating rooms or other areas of the hospital (e.g., intensive care

units). The purpose of standardization is to allow a reduced parts inventory, minimize the number of suppliers

and service personnel, and reduce confusion among the staff.

Pulse oximetry is considered a standard of care for monitoring arterial O

2

saturation in the operating room

during procedures requiring anesthesia and in intensive care units and recovery.

Pulse oximeters noninvasively measure O

2

saturation of blood hemoglobin (SpO

2

) and, along with O

2

monitors

and CO

2

monitors, are increasingly being required for anesthesia units by state law. Some U.S. states have

specified their own requirements for anesthesia units. Hospitals should check with their state’s department of

health for any regulations that may apply to their area. Pulse oximeters provide a spectrophotometric assessment

of hemoglobin oxygenation by measuring light transmitted through a capillary bed, synchronized with the pulse.

The detection system consists of single-wavelength LEDs (light-emitting diodes) and microprocessors located

within a sensor. For more information on pulse oximeters, see the Product Comparison titled Oximeters, Pulse.

CO

2

monitors measure end-tidal CO

2

and can help identify leaks and misconnections as well as indicate when

the trachea has not been properly intubated.

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Maintenance, service, and inspection



Accessories, such as monitoring equipment, necessary to comply with standards



Optional accessories



Vaporizers (some have been offered at discounted prices or at no cost upon the introduction of a

new anesthetic agent)



Gases, including O

2

, N

2

O, and anesthetic agents



Anesthesia circuits



Recording and storage of anesthesia-related data



Disposables



Utilities

Hospitals can purchase service contracts or service on a time-and-materials basis from the supplier. Service

may also be available from a third-party organization. The decision to purchase a service contract should be

carefully considered. Most suppliers should provide routine software updates, which enhance the system’s

performance, at no charge to service contract customers. Purchasing a service contract also ensures that

preventive maintenance will be performed at regular intervals, thereby eliminating the possibility of unexpected

maintenance costs. Also, many suppliers do not extend system performance and uptime guarantees beyond the

length of the warranty unless the system is covered by a service contract. Hospitals that plan to service their

anesthesia units in-house should inquire about the availability and cost of service training and the availability

and cost of replacement parts.

ECRI Institute recommends that, to maximize bargaining leverage, hospitals negotiate pricing for service

contracts before the system is purchased. Additional service contract discounts may be negotiable for

multiple-year agreements or for service contracts that are bundled with contracts on other similar equipment in the

department or hospital. Discounts will depend on the hospital’s negotiating skills and knowledge of discounts

offered to other customers, the system configuration and model to be purchased, previous experience with the

supplier, and the extent of concessions granted by the supplier, such as extended warranties, fixed prices for

annual service contracts, and guaranteed on-site service response. Buyers should make sure that applications

training and service manuals are included in the purchase price of the system. Some suppliers offer more

extensive on- or off-site training programs for an additional cost. For customized analyses and purchase decision

support, readers should contact ECRI Institute’s SELECTplus™ Group.

Stage of development

Efforts to improve the design of anesthesia units center on gas supply and proportioning systems, gas

monitors, ventilators, vaporizers, and data-handling (display, processing, and reporting) software. There is also

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Centers for Disease Control and Prevention. Guidelines for prevention of nosocomial pneumonia. Hospital

Infection Control Practices Advisory Committee. MMWR Recomm Rep 1997 Jan 3;46(RR-1):1-79.

Chant K, Kociuba K, Munro R, et al. Investigation of possible patient-to-patient transmission of hepatitis C in a

hospital. New South Wales Pub Health Bull 1994 May;5(5):47-51.

Davey A, Moyle JT, Ward CS. Ward’s anaesthetic equipment. 4th ed. London: WB Saunders; 1998.

Dorsch JA, Dorsch SE. Understanding anesthesia equipment. 4th ed. Baltimore: Lippincott, Williams & Wilkins; 1998.

ECRI. Anesthesia systems [evaluation]. 1996 May-Jun;25(5-6):158-211.

Anesthesia systems [evaluation]. 2006 Jul; 35(7):242-87.

Anesthesia systems [update evaluation]. 1998 Jan;27(1):4-27.

Anesthesia systems [update evaluation]. 2002 Apr;31(4):121-49.

Anesthesia ventilators with descending bellows: the need for appropriate monitoring [hazard]. 1996

Oct;25(10):391-3.

Carbon monoxide exposures during inhalation anesthesia: the interaction between halogenated

anesthetic agents and carbon dioxide absorbents [hazard report]. 2000 Nov;27(11):402-4.

Anesthesia systems [evaluation]. 2006 Jul;35(7):242-87.

Ehrenwerth J, Eisenkraft JB, eds. Anesthesia equipment: principles and applications. St. Louis: Mosby-Year Book; 1993.

Eisenkraft JB, Leibowitz AB. Ventilators in the operating room. Int Anesthesiol Clin 1997 Winter;35(1):87-108.

Elliot B, Chestnut J. Dangers of alarms [letter]. Anaesthesia 1996 Aug;51(8):799-800.

Failure to test anesthesia machine prior to surgery and to properly monitor patient during surgery. Med Malpract

Verdict Settlements 2002 Jun;18(6):4.

Heaton J, Hall AP, Fell D. The use of filters in anaesthetic breathing systems [letter]. Anaesthesia 1998

Apr;53(4):407.

Hobbhahn J, Hoerauf K, Wiesner G, et al. Waste gas exposure during desflurane and isoflurane anaesthesia. Acta

Anaesthesiol Scand 1998 Aug;42(7):864-7.

Hogarth I. Anaesthetic machine and breathing system contamination and the efficacy of bacterial/viral filters.

Anaesth Intensive Care 1996 Apr;24(2):154-63.

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pressure tests. Anaesthesia 1996 May;51(5):461-4.

Supplier information

ACOMA

Acoma Medical Industry Co Ltd [152410] 2-14-14 Hongo Bunkyo-ku Tokyo 113-0033 Japan Phone: 81 (3) 38166911 Fax: 81 (3) 38143845 Internet: http://www.acoma.com E-mail: [email protected]

AMS

AMS (Advanced Medical Systems) Ltd Div GE Healthcare UK [356053] Kazim Karabekir Cad 95/75 Iskitler

Ankara TR-06060 Turkey Phone: 90 (312) 3840520 Fax: 90 (312) 3423307 Internet: http://www.ams.com.tr E-mail: [email protected]

ANMEDIC

Anmedic AB [397996] Galgbacksvagen 6 Vallentuna S-186 30 Sweden Phone: 46 (8) 51430600 Fax: 46 (8) 51430620 Internet: http://www.anmedic.com E-mail: [email protected] Anmedic UK [398001] PO Box 114

Hayling Island PO11 9QN England

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800 MacArthur Blvd PO Box 619 Mahwah, NJ 07430-0619

Phone: (201) 995-8000, (800) 288-2121 Fax: (201) 995-8606 Internet: http://www.datascope.com

DATEX-OHMEDA/GE HEALTHCARE

GE Healthcare Technologies Clinical Systems (Finland) [452811] Kuortaneenkatu 2 Posti Loaero 300

Helsinki FIN-00031 Finland

Phone: 358 (10) 39411 Fax: 358 (10) 3945566 Internet: http://www.gehealthcare.com

Datex-Ohmeda Inc Div GE Healthcare [351254] 3030 Ohmeda Dr PO Box 7550

Madison, WI 53707-7550

Phone: (608) 221-1551, (800) 345-2700 Fax: (608) 222-9147 Internet: http://www.gehealthcare.com

GE Healthcare Clinical Systems Devices (UK) [452807] 71 Great North Road

Hatfield AL9 5EN England

Phone: 44 (1707) 263570 Fax: 44 (1707) 260065 Internet: http://www.gehealthcare.com

Datex-Ohmeda Pte Ltd (Singapore) Div GE Healthcare [351978] 152 Beach Road #12-05/07 Gateway East

Singapore 189721 Republic of Singapore Phone: 65 63918636 Fax: 65 62916618 Internet: http://www.gehealthcare.com E-mail: [email protected]

DRAEGER MEDICAL

Draeger Medical UK Ltd [157747] The Willows Mark Road

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Phone: 61 (1800) 800327 Fax: 61 (1800) 010327 Internet: http://www.draeger.com.au

E-mail: [email protected] Draeger Medical Inc [371341] 3135 Quarry Rd Telford, PA 18969 Phone: (215) 721-5400, (800) 437-2437 Fax: (215) 723-5935 Internet: http://www.draegermedical.com E-mail: [email protected]

EKU ELEKTRONIK

EKU Elektronik GmbH [306278] Am Sportplatz Leiningen D-56291 Germany Phone: 49 (6746) 1018 Fax: 49 (6746) 8484 Internet: http://www.eku-elektronik.de E-mail: [email protected]

F STEPHAN

F Stephan GmbH Medizintechnik [306280] Kirchstrasse 19 Gackenbach D-56412 Germany Phone: 49 (6439) 91250 Fax: 49 (6439) 912511 Internet: http://www.stephan-gmbh.com E-mail: [email protected] F Stephan Middle East Office [428586] Cabol Street PO Box 17304 Al Rabiya Amman 11195

Jordan

Phone: 962 (6) 5548060 Fax: 962 (6) 5548061 Internet: http://www.stephan-gmbh.com E-mail: [email protected]

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HEYER MEDICAL

Heyer Anesthesia GmbH & Co KG [152523] Carl-Heyer-Strasse 1/3 Postfach 1345 Bad Ems D-56130 Germany Phone: 49 (2603) 7910 Fax: 49 (2603) 70424 Internet: http://www.heyermedical.de E-mail: [email protected]

INTERMED

Intermed Equipamento Medico Hospitalar Ltda [174394] Avenida Cupece 1786 Cidade Ademar

Sao Paulo-SP 04366-000 Brazil Phone: 55 (11) 56701300 Fax: 55 (11) 55630008 Internet: http://www.intermed.com.br E-mail: [email protected]

KIMURA

S Kimura Medical Instrument Co Ltd [152416] 17-5 Yushima 2-chome Bunkyo-ku

Tokyo 113 Japan Phone: 81 (3) 38144061 Fax: 81 (3) 38145304 Internet: http://www.kimura-medical.co.jp E-mail: [email protected]

MEDEC

Medec Benelux nv [291305] Lion D'orweg 19 Aalst B-9300 Belgium Phone: 32 (53) 703544 Fax: 32 (53) 703533 Internet: http://www.medecbenelux.be E-mail: [email protected]

NORMECA

Normeca A/S [162653]

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Abingdon Science Park Barton Lane Abingdon OX14 3PH England Phone: 44 (1235) 547001 Fax: 44 (1235) 547021 Internet: http://www.penlon.com E-mail: [email protected] Penlon America [451484] 11515 K-Tel Dr Minnetonka, MN 55343 Phone: (952) 933-3940, (800) 328-6216 Fax: (952) 933-3375 Internet: http://www.penlonamerica.com E-mail: [email protected]

PNEUPAC

Smiths Medical International Ltd [450285] Military Road Hythe CT21 5BN England Phone: 44 (1303) 260551 Fax: 44 (1303) 266761 Internet: http://www.smiths-medical.com E-mail: [email protected]

ROYAL MEDICAL

Royal Medical Co Ltd [157039]

4/Fl Mijin Building 464-41 Seokyo-dong Mapo-ku Seoul 121-210 Republic of Korea Phone: 82 (2) 3385561 Fax: 82 (2) 3363328 Internet: http://www.royalmedical.com E-mail: [email protected]

SAMED

Samed Elettromedicali srl [187040] strada Provinciale 181 N 1/B Merlino (LO) I-26833 Italy

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Beech House Chiltern Court Asheridge Road Chesham HP5 2PX England Phone: 44 (1494) 784422 Fax: 44 (1494) 791497 Internet: http://www.blease.com E-mail: [email protected]

Spacelabs Healthcare Inc An OSI Systems Co [101758] 5150 220th Ave SE PO Box 7018

Issaquah, WA 98027-7018

Phone: (425) 657-7200, (800) 522-7025 Fax: (425) 657-7212 Internet: http://www.spacelabshealthcare.com

TAEMA

Taema Sub L'Air Liquide SA [151544] 6 rue Georges Besse CE 80

Antony Cedex F-92182 France Phone: 33 (1) 40966600 Fax: 33 (1) 40966700 Internet: http://www.taema.com E-mail: [email protected]

ULCO

Ulco Engineering Pty Ltd [157051] 25 Sloane Street

Marrickville 2204 Australia

Phone: 61 (2) 95195881 Fax: 61 (2) 95502841 Internet: http://www.ulcomedical.com

Note: The data in the charts derive from suppliers’ specifications and have not been verified through

independent testing by ECRI Institute or any other agency. Because test methods vary, different products’

specifications are not always comparable. Moreover, products and specifications are subject to frequent changes.

ECRI Institute is not responsible for the quality or validity of the information presented or for any adverse

consequences of acting on such information.

When reading the charts, keep in mind that, unless otherwise noted, the list price does not reflect supplier

discounts. And although we try to indicate which features and characteristics are standard and which are not,

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Policy Statement

The Healthcare Product Comparison System (HPCS) is published by ECRI Institute, a nonprofit organization.

HPCS provides comprehensive information to help healthcare professionals select and purchase diagnostic and

therapeutic capital equipment more effectively in support of improved patient care.

The information in Product Comparisons comes from a number of sources: medical and biomedical engineering

literature, correspondence and discussion with manufacturers and distributors, specifications from product

literature, and ECRI Institute’s Problem Reporting System. While these data are reviewed by qualified health

professionals, they have not been tested by ECRI Institute’s clinical and engineering personnel and are largely

unconfirmed. The Healthcare Product Comparison System and ECRI Institute are not responsible for the quality or

validity of information derived from outside sources or for any adverse consequences of acting on such

information.

The appearance or listing of any item, or the use of a photograph thereof, in the Healthcare Product Comparison

System does not constitute the endorsement or approval of the product’s quality, performance, or value, or of

claims made for it by the manufacturer. The information and photographs published in Product Comparisons

appear at no charge to manufacturers.

Many of the words or model descriptions appearing in the Healthcare Product Comparison System are

proprietary names (e.g., trademarks), even though no reference to this fact may be made. The appearance of any

name without designation as proprietary should not be regarded as a representation that is not the subject of

proprietary rights.

ECRI Institute respects and is impartial to all ethical medical device companies and practices. The Healthcare

Product Comparison System accepts no advertising and has no obligations to any commercial interests. ECRI

Institute and its employees accept no royalties, gifts, finder’s fees, or commissions from the medical device

industry, nor do they own stock in medical device companies. Employees engage in no private consulting work

for the medical device industry.

About ECRI Institute

ECRI Institute, a nonprofit organization, dedicates itself to bringing the discipline of applied scientific research

in healthcare to uncover the best approaches to improving patient care. As pioneers in this science for nearly 40

years, ECRI Institute marries experience and independence with the objectivity of evidence-based research.

More than 5,000 healthcare organizations worldwide rely on ECRI Institute’s expertise in patient safety

improvement, risk and quality management, healthcare processes, devices, procedures, and drug technology.

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MODEL ECRI INSTITUTE'S RECOMMENDED SPECIFICATIONS ECRI INSTITUTE'S RECOMMENDED SPECIFICATIONS ACOMA ACOMA Basic-Performance Anesthesia Units1 High-Performance Anesthesia Units1 PH-5FII PRO-55

WHERE MARKETED Not specified Not specified

FDA CLEARANCE Not specified Not specified

CE MARK (MDD) Not specified Not specified

CONFIGURATION Not specified Not specified

PIPELINE GAS INLETS All All 3 (O2, N2O, air) 3 (O2, N2O, air)

GAS CYLINDER YOKES O2 O2, N2O, air 2 (O2, N2O) 2 (O2, N2O)

VAPORIZERS, AGENTS Isoflurane, halothane, enflurane, desflurane, sevoflurane Isoflurane, halothane, enflurane, desflurane, sevoflurane Isoflurane, halothane,

enflurane, sevoflurane Isoflurane, halothane, enflurane, sevoflurane

Type Variable bypass Variable bypass

Number 1 2+ 3 3

Interlock Yes (if >1 vaporizer) Yes Yes Yes

SUCTION SYSTEM Optional Optional Optional Optional

O2 FAIL-SAFE Audible, visual, N2O shutoff Audible, visual, N2O shutoff Yes Yes

HYPOXIC MIXTURE

FAIL-SAFE Yes (methods vary) Yes (methods vary) 30% O2 30% O2 AUTOMATIC

VENTILATOR Yes Yes Optional Optional

Bellows, size Adult/pediatric Adult/pediatric

Type Not specified Ascending

Primary controls

Ventilation modes Manual, spontaneous, VCV Manual, spontaneous, VCV, PCV, SIMV or pressure support

Volume, CMV CMV, IMV, assist, CPAP

Tidal volume Yes Yes

Range, cc 50-1,200 20-1,500 200-900, 0-2,660 100-1,200, 0-2,660

Minute volume Yes Yes

Range, L/min >20 >20 1-20 1.7-20, 1-13

Frequency, bpm 5-60 5-60 5-40, 0-180 5-40, 0-180

Inspiratory flow, L/min 5-65, 3-40 5-62.8, 3-40

IE ratio 1:0.5 to 1:5, 1:0.5 to 1:9.9 1:1 to 1:3, 1:0.5 to 1:9.9

Inspiratory pause Optional Optional Not specified 20% or 30%

Pressure limit, cm H2O Adjustable, <70 preferred Adjustable, <70 preferred 40, 15-65 4-70

PEEP, cm H2O 0-20 0-20 0-20 0-20

Other controls Inspired time control Inspired time control

System checks Pre-use vent, gas supply,

ongoing system Pre-use leak, vent, compliance, gas supply, ongoing system

None specified None specified

This is the first of four pages covering the above model(s). These

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SCAVENGING SYSTEM Active or passive Active or passive Optional Optional

AUTO RECORD KEEPER No Optional No No

ANESTHESIA DATA

MANAGEMENT No Optional No Not specified

MONITORS

Airway pressure Yes Yes Yes Yes

Where measured Varies Varies Not specified Not specified

High-pressure alarm Yes Yes Not specified Yes

Subatmospheric

pressure alarm Yes Yes Yes Yes

Continuing pressure

alarm Yes Yes No Yes

Low pressure/apnea Yes Yes Not specified Yes

Other pressure alarms Optional Optional None None

Expiratory volume/flow Yes Yes No Yes

Type of sensor Varies Varies NA Not specified

Where measured Varies Varies NA Not specified

Rate alarm NA No

Apnea alarm Yes (method may vary) Yes (method may vary) NA Yes

Reverse-flow alarm NA No

High/low minute

volume NA Yes

High/low flow NA No

Other expiratory alarms NA Not specified

O2 concentration Yes Yes Yes Yes

Type of sensor Galvanic cell Galvanic cell

Response time, sec <30 <30 Not specified Not specified

CO2 concentration Optional Optional No No

Apnea alarm Required (if CO2 monitoring

is integral) Required (if CO2 monitoring is integral) Not specified Yes

N2O No Yes Not specified No

Agent monitors No Yes Optional No

Type of agents NA Isoflurane, halothane, enflurane, desflurane, sevoflurane

Isoflurane, halothane,

enflurane, sevoflurane Not specified

Auto ID No Yes No No

Agent concentration

alarm No Yes Not specified Not specified

(22)

MODEL ECRI INSTITUTE'S RECOMMENDED SPECIFICATIONS ECRI INSTITUTE'S RECOMMENDED SPECIFICATIONS ACOMA ACOMA Basic-Performance Anesthesia Units1 High-Performance Anesthesia Units1 PH-5FII PRO-55 ECG No Optional No No

Heart rate No Required (if ECG is integral) NA No

ST segment No Required (if ECG is integral) NA No

Noninvasive BP No Optional No No

Invasive BP No Optional No No

Temperature No Optional No No

Pulse oximeter No Optional Not specified No

Other monitors None Optional None specified None specified

Other features None specified None specified

DISPLAYS Yes Yes No Yes

Number 1 ≤2 NA Not specified

Type NA LED

Integrated Yes Yes NA No

Interface with others Yes Yes NA No

DATA INPUT No No

PRIORITIZED ALARMS 3 (caution, advisory, alarm) 3 (caution, advisory, alarm) No Yes

MRI COMPATIBILITY Not specified No

PHYSICAL FEATURES H x W x D, cm (in) 148 x 60 x 65 (58.3 x 23.6 x 25.6) 148 x 70 x 77 (58.3 x 27.6 x 41.2) Weight, kg (lb) 80 (176.4) 145 (319.7) Shelves, cm (in) 3 x 61 x 30 (1.2 x 24 x 11.8), 13 x 42 x 21.5 (5.1 x 16.5 x 8.5) 61 x 30 (24 x 11.8) Drawers, cm (in) 8.5 x 36 x 18 (3.3 x 14.2 x 7) 30 x 28.5 x 37 (11.8 x 11.2 x 14.6)

Writing shelf, cm (in) 88 x 49.5 x 25 (34.6 x 19.5

x 9.8) 60 x 32.5 (23.6 x 12.8)

POWER REQUIRED, VAC Not specified Not specified

Auxiliary outlets Not specified Not specified

This is the third of four pages covering the above model(s). These specifications continue onto the next page.

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BACKUP BATTERY Required Required Not specified Not specified

Type Not specified Not specified

Use per charge, hr 0.5 0.5 Not specified Not specified

PURCHASE INFORMATION

Price ¥1,990,000 (US$16,607) for

block type, ¥2,010,000 (US$16,774); does not include vaporizer

Not specified

Warranty 1 year 1 year

Service contract Not specified Not specified

Delivery time, ARO Not specified Not specified

OTHER SPECIFICATIONS Some units for use in MRI rooms may not be able to meet all "high" requirements.

Auxiliary shelves. None specified.

UMDNS CODE(S) 10134 10134 10134 10134

LAST UPDATED May 2008 May 2008

Supplier Footnotes

Model Footnotes 1_{These recommendations}

are the opinions of ECRI Institute's technology experts. ECRI Institute assumes no liability for decisions made based on this data.

1_{These recommendations}

are the opinions of ECRI Institute's technology experts. ECRI Institute assumes no liability for decisions made based on this data.

(24)

MODEL ACOMA AMS AMS AMS

PRO-INJ 100 200 300

WHERE MARKETED Not specified Worldwide, except North

America Worldwide, except North America Worldwide, except North America

FDA CLEARANCE Not specified Submitted Submitted Submitted

CE MARK (MDD) Not specified Yes Yes Yes

CONFIGURATION Not specified Mobile Mobile Mobile

PIPELINE GAS INLETS 3 (O2, N2O, air) 3 (O2, N2O, air) 3 (O2, N2O, air) 3 (O2, N2O, air)

GAS CYLINDER YOKES 2 (O2, N2O) Optional (O2, N2O, air) Optional (O2, N2O, air) Optional (O2, N2O, air)

VAPORIZERS, AGENTS Isoflurane, halothane,

enflurane, sevoflurane Isoflurane, halothane, enflurane, desflurane, sevoflurane Isoflurane, halothane, enflurane, desflurane, sevoflurane Isoflurane, halothane, enflurane, desflurane, sevoflurane

Type Variable bypass Temperature compensated Temperature compensated Temperature compensated

Number 2 1 2 3

Interlock Yes No Yes Yes

O2 FAIL-SAFE Yes Yes Yes Yes

HYPOXIC MIXTURE

FAIL-SAFE 30% O2 Yes Yes Yes

AUTOMATIC

VENTILATOR Optional (PRO-55V) 700 series 900 series 900 series Bellows, size Adult/pediatric Adult/pediatric Adult/pediatric Adult/pediatric

Type Ascending Ascending, bellows type Ascending, bellow type Ascending, bellow type

Ventilation modes CMV, IMV, assist, CPAP CMV, PCV, SIMV+PSV CMV, PCV, SIMV+PSV,

pressure support CMV, PCV, SIMV+PSV, pressure support

Tidal volume Yes Yes Yes Yes

Range, cc 0-2,660 20-1,500 20-1,500 20-1,500

Minute volume Yes Yes Yes Yes

Range, L/min 1-13 0.3-25, automatic 0.3-25, automatic 0.3-25, automatic

Frequency, bpm 0-180 2-99 2-99 2-99

Inspiratory flow, L/min 3-40 0-100, automatic Adjustable in PCV Mode Adjustable in PCV mode

IE ratio 1:0.5 to 1:9.9 2:1 to 1:5 2:1 to 1:5 2:1 to 1:5

Inspiratory pause 20% or 30% User-adjustable User-adjustable User-adjustable

Pressure limit, cm H2O 4-70 10-70, adjustable 10-70, adjustable 10-70, adjustable

PEEP, cm H2O 0-20 Off (0), 3-20 Off (0), 3-20 Off (0), 3-20

Other controls PRO-55V has inspired time

control Touchscreen, adult/pediatric modes, integrated spirometry, fresh-gas and compliance compensation

Touchscreen, adult/pediatric modes, sigh function, pressure support, integrated spirometry, fresh-gas and compliance compensation

System checks None specified Self-verification, leak test Self-verification, leak test Self-verification, leak test This is the first of four pages covering the above

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PRO-INJ 100 200 300

SCAVENGING SYSTEM Optional Active or passive Active or passive Active or passive

AUTO RECORD KEEPER No Optional Optional Optional

ANESTHESIA DATA

MANAGEMENT Not specified Optional Optional Optional MONITORS

Where measured Not specified Y-piece Y-piece Y-piece

High-pressure alarm Yes Yes Yes Yes

Subatmospheric

pressure alarm Yes No No No

alarm Yes Yes Yes Yes

Low pressure/apnea Yes Yes Yes Yes

Other pressure alarms None Peak Peak Peak

Expiratory volume/flow Yes Yes Yes Yes

Type of sensor Not specified Spirolite Spirolite Spirolite

Where measured Not specified Y-piece Y-piece Y-piece

Rate alarm No Yes Yes Yes

Apnea alarm Yes Yes Yes Yes

Reverse-flow alarm No No No No

High/low minute

volume Yes Yes Yes Yes

High/low flow No Yes Yes Yes

Other expiratory alarms Not specified Disconnection, leak,

obstruction Disconnection, leak, obstruction Disconnection, leak, obstruction

O2 concentration Yes Yes Yes Yes

Type of sensor Galvanic cell Galvanic cell Galvanic cell Galvanic cell

Response time, sec Not specified Not specified Not specified Not specified

CO2 concentration No Yes Yes Yes

Apnea alarm Yes Yes Yes Yes

N2O No Yes Yes Yes

Agent monitors No Yes Yes Yes

Type of agents Not specified Isoflurane, halothane, enflurane, desflurane, sevoflurane Isoflurane, halothane, enflurane, desflurane, sevoflurane Isoflurane, halothane, enflurane, desflurane, sevoflurane

Auto ID No Yes Yes Yes

alarm Not specified Yes Yes Yes

This is the second of four pages covering the above model(s). These specifications continue onto

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PRO-INJ 100 200 300

ECG No Yes Yes Yes

Heart rate No Yes Yes Yes

ST segment No Yes Yes Yes

Noninvasive BP No Yes Yes Yes

Invasive BP No Yes Yes Yes

Temperature No Yes Yes Yes

Pulse oximeter No Yes Yes Yes

Other monitors None specified Arrhythmia, respiration rate,

5/12 ECG, BIS, CO Arrhythmia, respiration rate, 5/12 ECG, BIS, CO Arrhythmia, respiration rate, 5/12 ECG, BIS, CO

Other features None specified Trends, printing, networking Trends, printing, networking Trends, printing, networking

DISPLAYS Yes Yes Yes Yes

Number Not specified 1 1 1

Type LED Color TFT Color TFT Color TFT

Integrated No Yes Yes Yes

Interface with others No Yes Yes Yes

DATA INPUT No Membrane switches,

ComWheel, knobs Membrane switches, ComWheel, knobs Membrane switches, ComWheel, knobs

PRIORITIZED ALARMS Yes 3 (caution, advisory,

warning) 3 (caution, advisory, warning) 3 (caution, advisory, warning)

MRI COMPATIBILITY No Not specified Not specified Not specified

PHYSICAL FEATURES

H x W x D, cm (in) 148 x 70 x 77 (58.3 x 27.6 x

41.2) 150 x 58 x 82 (59.1 x 22.8 x 32.3) 150 x 70 x 82 (59.1 x 27.6 x 32.3) 150 x 80 x 85 (59.1 x 31.5 x 33.5)

Weight, kg (lb) 145 (319.7) 69 (152.1) 86 (189.6) 110 (242.6)

Shelves, cm (in) 61 x 30 (24 x 11.8) 56 x 34 (22 x 13.4) 34 x 34 (13.4 x 13.4), top

shelf 34 x 34 (13.4 x 13.4), top shelf

Drawers, cm (in) 30 x 28.5 x 37 (11.8 x 11.2

x 14.6) 10.5 x 37 x 37 (4.1 x 14.6 x 14.6), 4 maximum 10.5 x 37 x 37 (4.1 x 14.6 x 14.6), 4 maximum 10.5 x 37 x 37 (4.1 x 14.6 x 14.6), 4 maximum

Writing shelf, cm (in) 60 x 32.5 (23.6 x 12.8) 37 x 37 (14.6 x 14.6) 37 x 37 (14.6 x 14.6) 37 x 37 (14.6 x 14.6)

POWER REQUIRED, VAC Not specified 220/240, optional 110-120 220/240, optional 110-120 220/240, optional 110-120

Auxiliary outlets Not specified 3 3 3

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PRO-INJ 100 200 300

BACKUP BATTERY Not specified Yes Yes Yes

Type Not specified Rechargeable Rechargeable Rechargeable

Use per charge, hr Not specified 0.5 0.5 0.5

Price Not specified €16,000 (US$25,065)

without monitor €19,000 ($US29,765) without monitor €21,000 (US$32,898) without monitor

Warranty 1 year 2 years 2 years 2 years

Service contract Not specified Yes Yes Yes

Delivery time, ARO Not specified 3-4 weeks 3-4 weeks 3-4 weeks

OTHER SPECIFICATIONS None specified. Alternative gas supply per end-user requirements; illuminated flowmeter.

Alternative gas supply per end-user requirements; illuminated flowmeter; air/N2O selection valve.

Alternative gas supply per end-user requirements; illuminated flowmeter.

UMDNS CODE(S) 10134 10134 10134 10134

LAST UPDATED May 2008 May 2008 May 2008 May 2008

Supplier Footnotes Model Footnotes Data Footnotes

(28)

MODEL ANMEDIC ANMEDIC ANMEDIC ANMEDIC

Falcon SE Hawk Kite Merlin

WHERE MARKETED Worldwide, except USA Worldwide Worldwide, except USA Worldwide, except USA

FDA CLEARANCE No Yes No No

CE MARK (MDD) Yes Yes Yes Yes

CONFIGURATION Mobile Mobile or wall Mobile Mobile

PIPELINE GAS INLETS 3 (O2, N2O, air) 3 (O2, N2O, air) 3 (O2, N2O, air) 3 (O2, N2O, air)

GAS CYLINDER YOKES Up to 4 (O2, N2O, air) Optional 3 optional (O2, N2O, air) Up to 4 (O2, N2O, air)

VAPORIZERS, AGENTS Isoflurane, halothane, enflurane, desflurane, sevoflurane Isoflurane, halothane, enflurane, desflurane, sevoflurane Isoflurane, halothane, enflurane, desflurane, sevoflurane Isoflurane, halothane, enflurane, desflurane, sevoflurane

Type Variable bypass Variable bypass Variable bypass Variable bypass

Number 1 or 2 1 1 or 2 1 or 2

Interlock Yes Yes Yes Yes

HYPOXIC MIXTURE

FAIL-SAFE Ratio system Ratio system Ratio system Ratio system AUTOMATIC

VENTILATOR Yes Optional Anevent Optional Anevent Yes

Bellows, size Adult Adult Adult Adult

Type Ascending, bag in bottle Ascending, bag in bottle Ascending, bag in bottle Ascending, bag in bottle

Ventilation modes Manual, CMV, PCV, SIMV Manual, CMV Manual, CMV Manual, CMV, PCV, PSV, MMV, SIMVc, SIMVp

Range, cc 20-1,500 Up to 1,500 Up to 1,500 20-1,500

Minute volume Yes No No Yes

Range, L/min Not specified NA NA Not specified

Frequency, bpm 4-60 6-60 6-60 4-60

Inspiratory flow, L/min 2-80 0-60 0-60 3-100

IE ratio 3:1 to 1:9.9 1:1, 1:2, 1:3 1:1, 1:2, 1:3 1:0.5 to 1:4

Inspiratory pause Adjustable inspiratory flow No No 0-50% of Ti

Pressure limit, cm H2O 10-65 10-60 10-60 5-80

PEEP, cm H2O 0-20 Optional 2-20 Optional 2-20 0-20

Other controls Fresh-gas and compliance

compensation None None Fresh-gas and compliance compensation

System checks Automated-instructed ventilator and breathing system check

Manual Manual Automated-instructed

ventilator and breathing system check

This is the first of four pages covering the above model(s). These specifications continue onto

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SCAVENGING SYSTEM Exhaust or passive AGSS Exhaust or passive AGSS Exhaust or passive AGSS Exhaust or passive AGSS

AUTO RECORD KEEPER No No No Optional

ANESTHESIA DATA

MANAGEMENT Serial RS232 output No No Serial RS232 output and USB

MONITORS

Where measured Expiratory limb Bellows Bellows Expiratory limb

High-pressure alarm Adjustable Adjustable Adjustable Adjustable

Subatmospheric

pressure alarm Yes No No Yes

alarm Yes No No Yes

Low pressure/apnea Yes No No Yes

Other pressure alarms System pressure None None None specified

Expiratory volume/flow Yes No No Yes

Type of sensor Differential pressure NA NA Differential pressure

Where measured Bellows inlet NA NA Bellows inlet

Rate alarm Yes NA NA Yes

Apnea alarm No NA NA Yes

Reverse-flow alarm Yes NA NA Yes

High/low minute

volume Yes NA NA Yes

High/low flow No No No Yes

Other expiratory alarms No No No Yes

O2 concentration Optional No No Optional

Type of sensor Galvanic cell NA NA Galvanic or paramagnetic

Response time, sec Not specified NA NA <0.5

CO2 concentration No No No Yes

Apnea alarm NA NA NA Yes

N2O No No No Yes

Agent monitors No No No Yes

Type of agents NA NA NA Isoflurane, halothane,

enflurane, desflurane, sevoflurane

Auto ID NA NA NA Yes

alarm NA NA NA Yes

This is the second of four pages covering the above model(s). These specifications continue onto the next two pages.

(30)

ECG No No No No Heart rate NA NA NA NA ST segment NA NA NA NA Noninvasive BP No No No No Invasive BP No No No No Temperature No No No No Pulse oximeter No No No No

Other monitors None None None None

Other features Numeric ventilator trends None None Numeric ventilator trends

DISPLAYS Yes No No Yes

Number 1 NA NA 1

Type Color TFT (16.3 cm [6.4"]) NA NA Color TFT (30.7 cm [12.1"])

Integrated Yes NA NA Yes

Interface with others Yes NA NA Yes

DATA INPUT No No No Yes

PRIORITIZED ALARMS Yes No No Yes

MRI COMPATIBILITY No Yes No No

PHYSICAL FEATURES H x W x D, cm (in) 138 x 86 (70, frame) x 75 (54.3 x 33.9 [27.6, frame] x 29.5) 148 x 75 (63, frame) x 72 (58.3 x 29.5 [24.8, frame] x 28.3) with trolley 148 x 75 (63, frame) x 72 (58.3 x 29.5 [24.8, frame] x 28.3) 138.7 x 81.3 [69.8, frame] x 71.7 (54.6 x 32 [27.5, frame] x 28.22)

Weight, kg (lb) 165 (363.8) 30 (66.2) with ventilator 90 (198.5) with ventilator 130 (286.7)

Shelves, cm (in) 67 x 36 (26.4 x 14.2) 63 x 35 (24.8 x 13.8) 63 x 35 (24.8 x 13.8) 60 x 38 (23.6 x 15)

Drawers, cm (in) 47 x 33 x 11 (18.5 x 13 x

4.3), 3 maximum 42 x 30 x 10 (16.5 x 11.8 x 3.9), 3 maximum 42 x 30 x 10 (16.5 x 11.8 x 3.9), 3 maximum 40 x 52 x 10 (15.7 x 20.5 x 3.9)

Writing shelf, cm (in) 62 x 30 (24.4 x 11.8),

tabletop None 43 x 29 (16.9 x 11.4) 41 x 33 (16 x 13)

POWER REQUIRED, VAC 110-125, 220-250 110-125, 220-250 110-125, 220-250 110-125, 220-250

Auxiliary outlets 4 4 4 4

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BACKUP BATTERY Yes No No Yes

Type Lead-acid NA NA Lead-acid

Use per charge, hr 0.5 NA NA 0.5 or 2

Price Not specified Not specified Not specified Not specified

Warranty 1 year 1 year 1 year 1 year

Service contract Not specified Not specified Not specified Not specified

Delivery time, ARO Not specified Not specified Not specified 4-8 weeks

OTHER SPECIFICATIONS Pull-out writing surface;

lamp; auxiliary gas outlets. Auxiliary gas outlets. Auxiliary gas outlets. Pull-out writing surface; lamp; auxiliary gas outlets.

UMDNS CODE(S) 10134 10134 10134 10134

LAST UPDATED May 2008 May 2008 May 2008 May 2008

Supplier Footnotes Model Footnotes Data Footnotes

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MODEL ANMEDIC DAMECA DAMECA DAMECA

Swift Siesta i BREASY SIESTA i TS Siesta i WHISPA

WHERE MARKETED Worldwide, except USA Worldwide, except North

America Worldwide, except North America Worldwide, except North America

FDA CLEARANCE No No No No

CE MARK (MDD) Yes Yes Yes Yes

CONFIGURATION Mobile Mobile Mobile Mobile

PIPELINE GAS INLETS 3 (O2, N2O, air) Yes Yes Yes

GAS CYLINDER YOKES Up to 4 (O2, N2O, air) Optional Optional Optional

VAPORIZERS, AGENTS Isoflurane, halothane, enflurane, desflurane, sevoflurane Isoflurane, halothane, enflurane, desflurane, sevoflurane Isoflurane, halothane, enflurane, desflurane, sevoflurane Isoflurane, halothane, enflurane, desflurane, sevoflurane

Type Variable bypass Temperature compensated Temperature compensated Temperature compensated

Number 1 or 2 1 or 2 1 or 2 1 or 2

Interlock Yes Yes Yes Yes

SUCTION SYSTEM Optional Yes Yes Yes

HYPOXIC MIXTURE

FAIL-SAFE Ratio system Yes Yes Yes

AUTOMATIC

VENTILATOR Yes Yes Yes Yes

Bellows, size Adult Same for adult and infants Same for adults and infants Same for adult and infants

Type Ascending, bag in bottle Ascending, bag in bottle Ascending, bag in bottle Ascending, bag in bottle

Ventilation modes Manual, CMV, PCV, SIMV Not specified Not specified Not specified

Range, cc 20-1,500 20-1,500 20-1,500 20-1,500

Minute volume Yes Yes Yes Yes

Range, L/min Not specified 2-15 2-15 2-15

Frequency, bpm 4-60 4-80 4-80 4-80

Inspiratory flow, L/min 2-80 2-15 2-80 2-80

IE ratio 3:1 to 1:9.9 3:1 to 1:9.9 3:1 to 1:9.9 3:1 to 1:9.9

Inspiratory pause Adjustable inspiratory flow 0-70% 0-70% 0-70%

Pressure limit, cm H2O 10-65 25-85 25-85 25-85

PEEP, cm H2O 0-20 4-20 4-20 4-20

Other controls Fresh-gas and compliance

compensation Fresh-gas and compliance compensated Fresh-gas and compliance compensated Fresh-gas and compliance compensated

System checks Automated-instructed ventilator and breathing system check

Self-test including leak test Self-test including leak test Self-test including leak test

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