'No volatile agent' as a standard alarm on anaesthetic workstations - a reply.

Abstract

BAREMA (the Association for Anaesthetic and Respiratory Device Suppliers) would like to thank Anaesthesia for the opportunity to respond to Dr. Liban regarding his questions about introducing a mechanism to advise users that the vaporiser has been turned on. BAREMA is a UK-based trade association representing the anaesthesia and respiratory device manufacturers and has among its members a number of global anaesthesia system manufacturers; it does not, however, represent every manufacturer. Manufacturers of modern anaesthesia machines have integrated gas monitoring and patient monitoring into their anaesthesia machines. All anaesthesia equipment is subject to internationally recognised standards when it comes to alarm management of their devices. The technology and monitoring systems now used in anaesthesia machines and monitoring are designed to help users treat patients safely. Manufacturers of anaesthesia machines have built-in gas and agent monitoring which enable them use low agent and high agent alarms to advise users that anaesthetic agent is being delivered to the patient via the low agent alarm and that it is being titrated at the correct setting without over delivery of agent by use of the high agent alarm. As anaesthesia technology has evolved, users have also requested a minimum alveolar concentration (MAC) alarm to be included in their anaesthesia machines. This alarm design is more precise and tailors the agent concentration to the patient. The MAC alarm helps the anaesthetist ensure the agent delivery is correct to their individual patient needs. This now gives the user the ability to set low and high agent alarms as well as a MAC alarm. Draeger and GE Healthcare use these alarms on their anaesthesia machines. Getinge, with the Maquet Flow-I, will shortly introduce a dedicated alarm advising the user that the vaporiser has not been turned on once therapy commences. This anaesthesia machine is fully electronic including the vaporisers and as such allows the manufacturer to add a software feature to their device. Anaesthesia machine manufacturers can incorporate new software features on fully electronic anaesthesia systems more easily. However, on conventional or traditional anaesthesia machines, this will not usually be possible. The addition of a new alarm would result in thorough testing and validation for manufacturers to ensure this meets the users’ demands of increasing patient safety while delivering a safe anaesthetic. All manufacturers are fully aware of alarm fatigue experienced by users, which can lead to patient safety being compromised in the event of an alarm not being acted on a when the user is alerted. Manufacturers are also trying to mitigate excessive alarms, which can lead to confusion by the user, as to the root cause of the alarm condition. It is therefore extremely important to ensure alarms are clear and not misleading for the user. It would be for a Hospital or Anaesthesia Lead to advise all anaesthesia machine users what the default alarms are set to for all devices and to ensure that all users receive training on the devices they are using.