The Anaesthesia Machine: Questioning a Design Evolution

<p>An underlying fear for many in using new digital systems is not the 'digital' but the struggle to trust and see reality; this may represent the loss of an art or aesthetic judgement, over an empirical measurement.(1) Why do we have what we have - and what could we have? Since the acceptance of the "Boyle's" configuration as a design standard, the evolution of anaesthesia equipment has predominantly remained tethered to this design icon.(2) Increasingly governed by historical habits and industrial ideologies, significant gains in technology have denied anaesthetists ergonomic advantage, due in part, to a design stagnation of physical composition. In doing so, it has become a legend of origin and a convention of machine use, a situation that is traced back to the evolution of rag and bottle, portable inhaler, and the asymmetric layout of anaesthetic apparatus. One of the key difficulties or questions for design is how to implement new technologies to retain and strengthen the established product-person trust.(3) The past reveals two methods; first the traditional addition of technology to historical brands and established formats; and second, the innovative embodiment of task and technology in a search for better systems.(4) Within the evolution of the anaesthesia machine, design methodologies have colluded to satisfy safety, ignoring a profession's habits, resulting in a complex lamination of engineering (technology), interaction (ergonomics) and aesthetics (path dependence and manufactured style). The application of new digital technology demands a physical design response that can satisfy clinician needs, patient safety and the commercial goals of industry in balancing technology and safety to clinical outputs and user satisfaction.(5) The study presents an informative and investigative methodology to construct a proactive design base, cumulating in active involvement, an informed critical analysis and a prospective methodological vision. The concluding experiment focuses on information and ideals from anaesthetists, to firstly test the established composition; secondly to inform us of how anaesthetists envisage their equipment; and thirdly, how simulation and industrial design may partner in unlocking the transfer of creative knowledge. In applying this partnership as a strategic design confidant, a new understanding of design process and concomitant design within an elite profession is established. Altogether this thesis seeks to explore the anaesthesia machine, to investigate the past, create closer relationships with anaesthetists and act together prospectively towards questioning the established. It may be 'it is not a solution we are looking for but the right way (or process) to ask the questions’ to manifest a new answer. (1) B Guy, "The anaesthesia machine: questioning a design evolution" (Thesis., Victoria University of Wellington, 2010), vii (2) K Bryn Thomas, The development of anaesthetic apparatus ( London UK: Blackwell Scientific Publications, 1975), viii (3) M B. Weinger, "Anesthesia equipment and human error," Journal Clinical Monitoring and Computing 15 (Jul 1999): 319-323. (4) O M. Watt, "The evolution of the Boyle apparatus, 1917-67," Anaesthesia 23 (1968): 103-118. ; G Boquet. J A. Bushman. H T. Davenport, "The anaesthesia machine: a study of function and design," British Journal of Anaesthesia 52 (1980): 61-67. ; Jeffrey B. Cooper. Ronald S. Newbower. Jeffrey W. Moore. Edwin D. Trautman, "A new anesthesia delivery system," Anesthesiology Vol 49 No 5 (1978): 310-318. (5) B Moggridge, Designing interactions (Cambridge, Mass: MIT Press, 2007), 579.</p>

The Anaesthesia Machine: Questioning a Design Evolution

<p>An underlying fear for many in using new digital systems is not the 'digital' but the struggle to trust and see reality; this may represent the loss of an art or aesthetic judgement, over an empirical measurement.(1) Why do we have what we have - and what could we have? Since the acceptance of the "Boyle's" configuration as a design standard, the evolution of anaesthesia equipment has predominantly remained tethered to this design icon.(2) Increasingly governed by historical habits and industrial ideologies, significant gains in technology have denied anaesthetists ergonomic advantage, due in part, to a design stagnation of physical composition. In doing so, it has become a legend of origin and a convention of machine use, a situation that is traced back to the evolution of rag and bottle, portable inhaler, and the asymmetric layout of anaesthetic apparatus. One of the key difficulties or questions for design is how to implement new technologies to retain and strengthen the established product-person trust.(3) The past reveals two methods; first the traditional addition of technology to historical brands and established formats; and second, the innovative embodiment of task and technology in a search for better systems.(4) Within the evolution of the anaesthesia machine, design methodologies have colluded to satisfy safety, ignoring a profession's habits, resulting in a complex lamination of engineering (technology), interaction (ergonomics) and aesthetics (path dependence and manufactured style). The application of new digital technology demands a physical design response that can satisfy clinician needs, patient safety and the commercial goals of industry in balancing technology and safety to clinical outputs and user satisfaction.(5) The study presents an informative and investigative methodology to construct a proactive design base, cumulating in active involvement, an informed critical analysis and a prospective methodological vision. The concluding experiment focuses on information and ideals from anaesthetists, to firstly test the established composition; secondly to inform us of how anaesthetists envisage their equipment; and thirdly, how simulation and industrial design may partner in unlocking the transfer of creative knowledge. In applying this partnership as a strategic design confidant, a new understanding of design process and concomitant design within an elite profession is established. Altogether this thesis seeks to explore the anaesthesia machine, to investigate the past, create closer relationships with anaesthetists and act together prospectively towards questioning the established. It may be 'it is not a solution we are looking for but the right way (or process) to ask the questions’ to manifest a new answer. (1) B Guy, "The anaesthesia machine: questioning a design evolution" (Thesis., Victoria University of Wellington, 2010), vii (2) K Bryn Thomas, The development of anaesthetic apparatus ( London UK: Blackwell Scientific Publications, 1975), viii (3) M B. Weinger, "Anesthesia equipment and human error," Journal Clinical Monitoring and Computing 15 (Jul 1999): 319-323. (4) O M. Watt, "The evolution of the Boyle apparatus, 1917-67," Anaesthesia 23 (1968): 103-118. ; G Boquet. J A. Bushman. H T. Davenport, "The anaesthesia machine: a study of function and design," British Journal of Anaesthesia 52 (1980): 61-67. ; Jeffrey B. Cooper. Ronald S. Newbower. Jeffrey W. Moore. Edwin D. Trautman, "A new anesthesia delivery system," Anesthesiology Vol 49 No 5 (1978): 310-318. (5) B Moggridge, Designing interactions (Cambridge, Mass: MIT Press, 2007), 579.</p>

Technology: A Friend or Foe? Do Electronic Health Records Increase Burn Out Amongst Anaesthesiologists?

3D total laparoscopic hysterectomy in progress under general anaesthesia; steep head low, everyone delighted to see the 3D picture on screen with the goggles including the anaesthesia resident. I enter the OT (needless to say that as a senior one has to supervise more than one OT at a time). The high-end Anaesthesia machine standing tall inside the OT with all the sophisticated monitoring gadgets. I look at the ventilatory pattern on monitor: etCO2 graph upsloping with a value of 42mm of Hg, airway pressure 26mm of Hg and rising! I ask a rhetoric question to my resident as to where his attention is and to my dismay, he expresses his dissatisfaction that the monitors neither give us alarms against rising etCO2 or airway pressure nor do they warn us about changing capnograph slopes!! I am appalled. THROWBACK- Not long time ago when we were residents, we used our ‘educated hands’ to monitor the airway pressure with manual ventilation. Differential diagnosis of tight bag used to be one of the favourite questions seniors used to ask us during on-table teaching. We had no etCO2 monitor then (the mandatory minimum monitoring standard); leave alone the hi-tech ventilatory gadgets and associated airway gas monitoring. Sooner the educated hand was replaced by ventilator and arguments will continue whether to declare this as a loss of clinical skill; an unresolved riddle due to paucity of evidence. The least that I can say is with the hand on pulse and bag in hand, we used to ‘stay connected’ to the patient; with the technical advances this connection got lost. Does this make the ventilator and the advances in monitoring evil?? Obviously not. The advances in science and technology are not only for our comfort but they also play a pivotal role in improving patient’s safety and offering better patient care. Over years surgery has advanced enormously and most of these developments are attributed to advances in the field of anaesthesia which has evolved itself from the Stone Age t

The East–Freeman Automatic Vent: An interesting footnote in the history of mechanical ventilation

An example of the East–Freeman Automatic Vent from Oxford was found in the early anaesthesia equipment collection at St George Hospital, Sydney. It weighs less than 200 g and is representative of a group of miniature ventilators that were described in the 1960s, including the Minivent from South Africa and the Microvent from Canada. All relied on a pressure-operated inflating valve that was described in 1966 by Mitchell and Epstein from Oxford. The ventilators were compact, portable and were powered by the gas supply from the anaesthesia machine or other driving source that distended a reservoir bag. The main problem was that they could stick in the inspiratory phase. This led to pressure in the lungs rising towards the driving pressure. There was a risk of barotrauma to the patient if the system was not promptly disconnected. While theyhad provided an alternative to hand bagging, they were superseded, as more sophisticated and safer ventilators became widely available.

A modification to the Maquet Flow-i anaesthesia machine for ICU ventilation

The authors present an easily manufactured modification of Getinge Group’s Maquet Flow-i anaesthesia machine that gives it potential to be used long-term as an Intensive Care ventilator for emergency circumstances. There are some 7000 such machines in use worldwide, which could assist in increasing ICU ventilated bed capacity in a number of nations. The authors believe this modification has potential as a solution to increasing ventilator numbers for the COVID-19 pandemic, in hospitals where the Flow-i is underutilised for its designed purpose during this emergency. The technical drawing files are downloadable on the GrabCAD website and are Creative Commons (CC-BY 4.0) licensed to allow local manufacture of the modification. We welcome other Flow-i users and engineers to join us in troubleshooting this project on the associated GrabCAD discussion group during this ‘pre-print’ phase of research.