Biomedical Engineering Reference
In-Depth Information
critically ill patients. Patient care during surgery is, in
many ways, similar to that of other critical care areas, but
changes happen in terms of minutes or hours, versus days
or weeks. Because of their specialty and experience,
anesthesiologists must understand intravenous adminis-
tration of rapidly acting drugs, fluids, and volume control.
Critical care calls for in-depth knowledge of mechanical
ventilation, airway management, and cardiovascular
monitoring, including invasive pressure lines of hemo-
dynamically unstable patients. Anesthesiologists are also
responsible for cardiac and pulmonary resuscitation
(code response) in the ORs and ICUs.
negate further discussion. If facility requirements are
met, but physical space is an issue, the anesthesiologist,
machine, and supplies are often crowded into an un-
comfortable corner. From a user's perspective, they are
away from the space to which they have grown accus-
tomed. People must be extra vigilant when they are out
of their normal element, as supplies and other things are
not where they are expected to be. More importantly,
support personnel are not immediately available to help
in emergencies, as in they are in the OR. One example is
the need of imaging pediatric patients. Small children
tend not to stay still enough for adequate results, and
therefore need sedation. Unless properly planned, pedi-
atric supplies are not commonly found throughout the
hospital. Delays in procuring critical care items could
lead to disastrous results.
The special needs of magnetic resonance imaging
(MRI) and radiation oncology (e.g., proton beam accel-
erators) present unique challenges to all involved in their
use. The most significant are magnets and invisible forces.
Both technologies involve strong forces that cannot be
seen, and catastrophic events can result if mistakes occur.
Specialized equipment is needed, to detect the energy
field generated by both types of devices.
MRI requires highly specialized equipment: Non-
ferrous magnetic materials can be used, CRTs are
a problem, radio frequency (RF) sensitive environment,
physiological monitors are less than optimum, the same
level of monitoring is simply not available, application of
MRI is expanding and it is being used more frequently
during surgery. Radiation oncology requires leaving anes-
thetized patients by themselves, which is not something
that people take lightly. Anesthesiologists still need to be
able to monitor the patient and machine while they are
out of the room.
Pain management
Anesthesia departments are also responsible for pain
management during diagnostic, therapeutic, and obstet-
ric procedures. Pain units that are staffed by anesthesi-
ologists diagnose and treat painful syndromes when
patients suffer from chronic issues. Obstetric floors often
have anesthesiologists present, to help reduce the pain
involved with labor and delivery.
Considering all of this, do not overestimate anesthe-
siologists. They are not superhuman. No individual will
master all of these subspecialties. As a CE or biomedical
equipment technician (BMET) supporting the needs of
the department and its staff, it helps to understand the
breadth of responsibilities and expectations of
the
physicians as a whole.
Where is anesthesia performed?
ORs, treatment rooms, and intervention radiology suites
are beginning to look more similar than ever. Historical
functions of the different areas and physician specialties
are blending, making formerly clear lines quite hazy. Pa-
tient flow through the hospital's multifaceted care units
must be carefully planned. Preparing and recovering
a surgical day-care patient (rather than one from general
surgery) will put significantly different demands on
support systems and staffing. The hospital cannot afford
bottlenecks that result with unnecessary delays in surgi-
cal, imaging, or other expensive care areas.
For various reasons, doctors and patients alike ex-
press interest in providing anesthesia at remote locations
(out of the OR) of the hospital. This poses significant
risks and unique challenges in planning, supporting, and
actually meeting the demand. These remote sites most
often were not designed with anesthetizing-location-fa-
cility requirements in mind. Details of facility criteria are
discussed in Chapter 4.3. Reliable supplies of oxygen and
suction, along with adequate electrical power and light-
ing, are key components. The lack of any of these can
Safety concerns
The single most significant difference in supporting
anesthesia technology, as distinguished from any other
clinical engineering function, is that there is a susceptible
patient connected to life-support equipment, and they
are given medications that bring them relatively close to
death. Anesthesiologists are keenly aware of this. As
a whole, stress levels of people in ORs are exacerbated
because the patient has undergone two forms of injury
when on an OR table. They have suffered the initial ill-
ness or trauma that has brought them to the OR, and
they must undergo the trauma of the surgical procedure
itself. It can be difficult to believe that the patient often
must experience additional trauma in order to get better.
Patient safety is a team effort. No single department
bears the responsibility for overall patient safety. Every-
one must evaluate their individual responsibilities and
