Biomedical Engineering Reference
In-Depth Information
A well-organized means to purchase, receive, and
stock single-use supplies
Facilities and associated documentation to reprocess,
decontaminate, and sterilize multiple-use devices
Centralized storage of equipment that is not used
everyday but must be available
An area for preadmissions testing
Space for an interview and simple testing
Patients and physicians need to interact preoperatively to
assess and plan the anesthesia. This may also be done in
general-care areas if the patient has been admitted in the
hospital.
Induction (or holding) rooms offer a number of ad-
vantages and disadvantages. They require more patient
movement and additional equipment but can reduce
turnover time and can increase throughput. Primarily,
they provide a location to help set up lines and epidurals
without occupying time in the OR itself. They are no
longer true induction rooms, as anesthesia is not induced
in them, but they are helpful prep areas.
In the ORs, anesthesia machines must connect to
existing infrastructure for gas supplies. It is useful to have
standardized connections so that machines can be used in
any location with adequate infrastructure. Individual
surgical anesthetizing teams might have varying needs
and preferences for machine and monitoring layout,
depending on the surgical service that they support.
There also are specialized sites like radiation oncology
and MRI that will require the machine to be tailored to
meet their requirements.
Post-anesthesia care units (PACUs) have established
clinical personnel requirements for emerging patients
(ASA, 1994). Patients can be unstable; so immediate
critical care, airway management, and possibly anesthesia
equipment must be available. Their workload varies. At
one moment, the space could be used primarily for pre-
op holding; at other times, things can be relatively calm.
Then, suddenly, three or four cases finish at once. The
PACU is an ICU and must have similar monitoring re-
quirements with centralized alarms. It must accommo-
date varying demands for stretchers used in patient
transport.
care, particularly at large teaching hospitals. In an effort
to stay price-competitive with the entire medical
industry, procedures are being performed out of the
OR and in doctors' offices. No one should ignore the
fact that infrequent events with potentially cata-
strophic outcomes do happen. Key components can be
as simple as proper and adequate supplies, additional
personnel, and available telephones. Other components
depend on the procedure and level of anesthesia
performed. Even though some procedures appear to
be relatively simple, the requirements for anesthesia
can call for a machine to be present at all times. The
emergent need for mechanical ventilation and use of
volatile agents is quite possible. These machines might
be underutilized, but they are subject to greater
wear because they are moved more frequently than
machines based in the OR.
There are supply concerns, as well. Additional stock
is not as readily available when users are not in the main
supply area, which normally is the OR. If items stored
differently, individuals are out of their normal sur-
rounding, and this contributes to disorientation and
difficulty locating the items. Delays in supplies can have
catastrophic results, as well. If the correct endotracheal
tube is not readily available, minutes might as well be
hours when there is a problem with an airway.
Infrastructure
Smith
et al
. described facilities' infrastructural needs
(see Chapter 4.3). Much of an OR's evolution has
involved the application of anesthesia and some of its
historical limitations. Conductive flooring, other elec-
trostatic discharge protection, and explosion-proof elec-
trical connections were directly and indirectly employed
because of former anesthetic technology. Currently,
there is ongoing debate about the continued use of the
isolated power supply (IPS) in new construction. The use
of ground fault interrupts (GFIs) meets code re-
quirements for wet locations at a lower cost than isolated
power. Some facilities elect to continue with the more
expensive option because it does not shut off power to an
outlet at the first fault. If their application is poorly un-
derstood, GFIs could be hazardous when life-support
equipment such as anesthesia or cardiopulmonary bypass
machines is used. Shutting of life support equipment
when one plugs a faulty device into an outlet on the same
circuit is not a wise alternative.
Following are a number of other systems that are
needed, to support specific needs for anesthesia:
Immediate access to the hospital's pharmacy and
a means to control narcotics with potentially high
throughput for busy centers
Airway management tools
One of the most critical tasks in caring for the ventilated
patient is in securing an airway. If there is not a reliable
means of moving gases in and out of the lungs, cardiac
resuscitation follows respiratory arrest. Among the many
tools available to anesthesiologists, none is more impor-
tant for airway management than suction. Reliable and
adequate sources of oxygen and suction are vital. Anes-
thesia cannot be performed safely without both. Yankaur
