Posted on Leave a comment

Xavant Technology Announces First Dual-Sensor Neuromuscular Patient Monitor

The Stimpod NMS450X NMT monitor for Anesthesia first to feature both AMG and EMG modalities in one single, portable patient monitoring system.  

Pretoria, South Africa, October. 15, 2019 – Xavant Technology, a pioneer in neuromuscular monitoring and innovative neuromodulation modalities, announced an addition to the company’s newest generation of Stimpod neuromuscular transmission monitor – the capability of utilizing either of the two most industry prominent types of monitoring sensors, AMG and EMG. The new Stimpod system and EMG sensor accessory will be exhibited at the American Society of Anesthesia (ASA) Annual Meeting, October 19-21 in Orlando, Florida alongside the company’s entire Stimpod portfolio for anesthesia.

“We are excited to announce the EMG modality to our Stimpod line of monitors,” stated Corlius Birkill, CEO of Xavant Technology. “By offering, for the first time, anesthesiologists and clinicians a choice in using either AMG or EMG, we can give them unparalleled clinical and budgetary benefits.” Mr. Birkill continued, “We believe quantitative or objective monitoring of patients who are undergoing neuromuscular block for surgery should be the standard of care. Our goal is to provide physicians with the most optimal and efficient tools to achieve that standard.”

The latest update to the AMG-based Stimpod NMS450X monitor series will enable the use for the first time ever, a dual sensor objective neuromuscular transmission monitor that enables anesthesiologists the choice of using either acceleromyography (AMG) with a reusable sensor or electromyography (EMG) with a disposable sensor to manage patients undergoing neuromuscular block during surgery or while being cared for in the intensive care unit.

By adding an EMG sensor accessory to the Stimpod, clinician opportunities in monitoring will be maximized. Being able to choose either AMG or EMG at site of service, hospitals can perform cost-effective entire-surgery monitoring with the platform that is optimal for that specific case. While AMG is a proven, accurate and cost-effective technology, the EMG sensor will simplify how clinicians monitor patients in more restrictive surgical cases, such as robotic surgery where restricting the hands is common. The EMG accessory is pending FDA clearance.

“The Stimpod NMT monitor is simple and economical way for hospitals to drive patient safety, Operating room, PACU, and ICU efficiency, and manage their very expensive paralytic and recovery drug budgets,” stated Xavant Chairman Roche van Rensburg. “We believe the data is fairly conclusive that hospitals can enhance safety outcomes related to residual neuromuscular block by utilizing objective NMT monitoring. But also important is the power to more effectively manage the time and cost-of-care efficacy for the hospital – we believe the Stimpod system can make a tremendous positive difference on both fronts,” added Mr. van Rensburg.

About Xavant Technology

By Xavant Technology October 17, 2019

Posted on Leave a comment

The Cost of Postoperative Respiratory Adverse Events

Respiratory impairment following general anaesthesia can pose a significant problem. Adverse and critical respiratory events (AREs and CREs) have been responsible for increased morbidity and mortality. The main cause of AREs after surgery is related to the use of neuromuscular blockers (NMBAs) during general anaesthesia. The action of NMBAs might not cease completely at the end of the procedure, leading to residual muscle paralysis. Postoperative residual neuromuscular blockade, aka postoperative residual curarization (PORC), ranks among the top three critical events in the post-anesthesia care unit (PACU) that require emergency intervention.1 It has been estimated that approximately 40% of the patients brought to the PACU have residual blockages.2 Apart from the obvious effects on patients’ life and health, AREs can have other consequences. Caregivers have to undergo increased physical and emotional stress, which can affect delivery of care to other patients in the PACU. Financial costs can increase for both patients and hospitals as substantial critical care resources are devoted to solving such problems.

How big is the problem of residual neuromuscular blockade?

Muscle paralysis is estimated using a clinical tool called train-of-four ratio (TOFR). Residual neuromuscular blockade is believed to have significant clinical effects if the TOFR goes below 0.9.3 With just a single dose of intermediate acting NMBAs, it has been shown that up to 45% of patients can have residual blockade (TOFR < 0.9).4 Lower TOFRs have been associated with increased risk of CREs. This was demonstrated by Murphy et al, who collected data of over 7400 patients who had received general anaesthesia.5 They found that the incidence of critical respiratory events in this group of patients due to residual blockade was 0.8%. Based on these statistics, Brull et al estimated that each year about 81,000 people in the United States and almost 0.5 million people worldwide experience CREs after general anaesthesia.2

What is the main cause of CRE after surgery?

It was shown that the incidence of CREs was higher by 50% in patients who had TOFR less than 0.76

While there can be several causes of CRE, a large proportion of cases have been associated with residual neuromuscular blockade. In one study by Bissenger et al, it was shown that the incidence of CREs was higher by 50% in patients who had TOFR less than 0.7.6 In a separate case-control study, Murphy et al compared TOFRs in patients who had developed CREs and controls who did not have CREs. They showed that while patients in the control group had TOFRs above 0.7, 78.3% of patients who had CREs had TOFRs that were below 0.7.3 Xara et al also investigated the determinants of AREs in 340 patients who underwent surgery. They found that patients who were administered NMBAs during the surgical procedure had increased incidence of AREs (79%) as compared to those who did not receive them (55%).7 They also noted that the incidence of ARE was increased in patients who had received neostigmine. Grosse-Sundrup et al showed that the use of intermediate NMBAs increased the risk of postoperative desaturation and re-intubation.8

What are the costs involved?

Residual neuromuscular blockade can cause upper airway obstruction, aspiration and pharyngeal dysfunction. These situations may require emergency intervention in the form of re-intubation and positive pressure ventilation. The costs associated with these interventions can be considerable. Patients who develop respiratory complications after surgery generally often have to be hospitalised for longer, which increases costs.

The cost of treatment for patients with respiratory complications was $62,000, compared to $5000 without complications, with an additional 92,000 more ICU admissions per year10

Zhan et al found that postoperative respiratory failure (that did not include pulmonary embolism) increased hospital stay by nine additional days, and translated to an additional $53,000 in healthcare costs.9

A report developed by the National Surgical Quality improvement program showed that patients with respiratory complications stayed at the hospital for at least 14 days longer vs. those who did not have these complications.10 The same report estimated the cost of treatment for patients with respiratory complications was around $62,000, while those without such complications were set back by a mere $5,000 in comparison. On a national level, pulmonary complications after surgery lead to 92,000 more ICU admissions per year, which alone imposes a burden of $3.42 billion annually.

What is the best way to deal with the situation?

Residual neuromuscular blockade can be avoided by monitoring neuromuscular status during the surgical procedure. If neuromuscular function is allowed to return to optimal levels prior to extubating the patient, chances of residual blockade in the PACU decrease. Ideally, the anaesthetist should be able to monitor the TOFR, so that it may be allowed to reach the critical threshold of 0.9 prior to extubation.

What kind of monitoring works best?

Severe hypoxaemia occurred in 21.1% of patients in the conventional group but in none of the patients in the acceleromyography group11

There are three methods to monitor neuromuscular function—clinical, qualitative monitoring and quantitative monitoring. Clinical methods (such as head-lift and grip-strength tests) have low sensitivity and specificity, and are not really suited for patients prior to extubation. Qualitative evaluation using peripheral nerve stimulators is a common practice. However, it involves subjective assessment of TOFR and studies have shown that TOFRs above 0.4 may not be effectively detected by this method. Quantitative (or objective) methods of calculating TOFR, using techniques such as mechanomyography, electromyography and acceleromyography, have proven more effective. Murphy et al assessed the risk of residual neuromuscular blockade and AREs in patients who were monitored by both qualitative and quantitative means.11 Patients were randomised for NMB monitoring using either conventional peripheral nerve stimulators or acceleromyography. Residual NMBs in the PACU were documented in 30% of patients in the conventional group and only 4.5% of patients in the acceleromyography group. More significantly, severe hypoxaemia occurred in 21.1% of patients in the conventional group but in none of the patients in the acceleromyography group.

The bottom line is this: quantitative neuromuscular transmission monitoring has the potential to reduce residual blockades, decrease CRE risk, and reduce costs.

Stimpod NMS450X Neuromuscular Transmission Monitor

The Stimpod NMS450X Neuromuscular Transmission Monitor

The Stimpod NMS450X is a standalone neuromuscular transmission monitor that can easily be integrated into the anaesthetic setup. During reversal of neuromuscular blockade, the monitor automatically initiates TOFR monitoring, which continues until recovery is complete. Its portable design makes it easy to shift between the OR and PACU, and it can easily be attached to the IV pole. Its economical pricing and proven efficacy make it a sensible investment for hospitals who wish to make optimum use of resources and cut costs in the long term. For more details, visit xavant.com or request a quotation.

References

  1. Strauss P, Lewis M. Identifying and Treating Postanesthesia Emergencies. Or Nurse. 2015 Nov 1;9(6):24-30.
  2. Brull, S. J., & Kopman, A. F. Current Status of Neuromuscular Reversal and Monitoring: Challenges and Opportunities. Anesthesiology 2017; 126(1): 173-90.
  3. Murphy GS, Szokol JW, Avram MJ, et al. Postoperative Residual Neuromuscular Blockade is Associated with Impaired Clinical Recovery. Anesth Analg. 2013;117(1):133–141
  4. Debaene B, Plaud B, Dilly MP, Donati F. Residual Paralysis in the PACU After a Single Intubating Dose of Nondepolarizing Muscle Relaxant with an Intermediate Duration of Action. Anesthesiology 2003;98: 1042–8
  5. Murphy GS, Szokol JW, Marymont JH, Greenberg SB, Avram MJ, Vender JS: Residual Neuromuscular Blockade and Critical Respiratory Events in the Postanesthesia Care Unit. Anesth Analg 2008; 107:130–7
  6. Bissinger U, Schimek F, Lenz G. Postoperative Residual Paralysis and Respiratory Status: A Comparative Study of Pancuronium and Vecuronium. Physiol Res/Acad Sci Bohemoslovaca. 2000; 49(4):455–462
  7. Xará D, Santos A, Abelha F. Adverse Respiratory Events in a Post-anesthesia Care Unit. Archivos de Bronconeumología (English Edition). 2015 Feb 1;51(2):69-75.
  8. Grosse-Sundrup M, Henneman JP, Sandberg WS, et al. Intermediate Acting Non-depolarizing Neuromuscular Blocking Agents and Risk of Postoperative Respiratory Complications: Prospective Propensity Score Matched Cohort Study. BMJ. 2012;345:6329.
  9. Zhan C, Miller MR: Excess Length of Stay, Charges, and Mortality Attributable to Medical Injuries During Hospitalization. JAMA 2003; 290: 1868–1874
  10. Dimick JB, Chen SL, Taheri PA, Henderson WG, Khuri SF, Campbell DA. Hospital Costs Associated with Surgical Complications: A Report from the Private-sector National Surgical Quality Improvement Program. J Am Coll Surg. 2004;199(4):531–537
  11. Murphy GS, Szokol JW, Marymont JH, Greenberg SB, Avram MJ, Vender JS, Nisman M. Intraoperative Acceleromyographic Monitoring Reduces the Risk of Residual Meeting Abstracts and Adverse Respiratory Events in the Postanesthesia Care Unit. Anesthesiology: The Journal of the American Society of Anesthesiologists. 2008 Sep 1;109(3):389-98.
Posted on Leave a comment

Increased PACU Length of Stay – A Costly Matter

Postoperative residual curarization (PORC), also known as residual neuromuscular blockade, refers to the residual muscle paralysis that occurs after emergence from general anesthesia. PORC stems from the use of neuromuscular blocking agents (NMBAs). It is defined as a Train-of-Four (TOF) ratio of <0.9 and may occur in around 41% of patients who receive intermediate-acting neuromuscular blockers.1 PORC has been associated with critical respiratory events and impaired postoperative respiratory functions.2 It is also independently associated with an increased length of stay (LOS) in the post-anesthesia care unit (PACU). The increased PACU length of stay in turn impacts operating room throughput and results in prolonged waiting time for new PACU admissions.3

The Use of Quantitative NMT Monitoring to Avoid PORC

Subjective tests of NMT monitoring are not sensitive enough to detect residual weakness

Quantitative neuromuscular transmission (NMT) monitoring can help reduce the incidence of PORC. Neuromuscular monitoring is recommended when neuromuscular blockers have been administered as a part of general anesthesia. It can be carried out through subjective techniques, such as clinical assessment or peripheral nerve stimulation (qualitative monitoring), or with the help of objective or quantitative NMT monitors that provide a numeric value representing the depth of neuromuscular blockade. There is mounting evidence that clinical or subjective tests of NMT monitoring are not sensitive enough to detect residual weakness and do not predict adequate neuromuscular recovery. Quantitative or objective neuromuscular monitors should therefore be used whenever non-depolarizing NMBAs are administered.4,5,6

The Stimpod NMS 450X is a quantitative neuromuscular monitor that uses a 3D acceleromyography (AMG) transducer which is effective in detecting the full force of muscle contraction. It minimizes the risk of residual neuromuscular blockade and associated adverse respiratory events.7 As discussed below, this leads to a decrease in the average length of stay in the PACU and substantial cost savings for the hospital.

Reduction in the PACU Length of Stay as a Cost-reducing Measure

The economic structure of the PACU determines whether a cost-saving measure such as reducing the PACU length of stay is likely to reduce hospital costs. Hospital costs can be divided into fixed and variable components. Fixed costs are one-time costs that do not change in relation to the number of surgical cases. These include capital expenditures, such as gurneys, monitors, and the physical plant of the PACU. On the other hand, variable costs are directly related to the number of surgical cases, and include X-ray films, pharmaceuticals, dressings, and laundry.

The only real way of reducing PACU costs is to increase the productivity of the PACU and the staff

It is important to bear in mind that reducing the PACU length of stay will only affect variable costs. Small reductions in the length of time that patients stay in a PACU are unlikely to impact fixed costs at ambulatory surgery centers, which include the labor costs of staffing the PACU with full-time nurses.8 This means that reducing the length of stay of a patient in the PACU by one minute is not equivalent to saving one minute of PACU costs. Therefore, the only real way of reducing PACU costs is increasing the productivity of the PACU and the staff working in it.

Reduction in the Peak Number of Patients Improves Productivity and Reduces Costs

A reduction in the peak number of patients in the PACU is the most effective way to increase the productivity of the PACU and its staff. One way of doing this is to use anesthetic agents that permit a quicker discharge of patients from the PACU. However, if for example the average total time a patient stays in the PACU is 120 minutes, then for a modern anesthetic drug to reduce the peak number of PACU patients by 25%, the drug would have to reduce the mean time to discharge from a total of 120 minutes to just 34 minutes. Such a drastic change is unrealistic and therefore this method is limited in its effectiveness to achieve a substantial increase in PACU productivity.8

Optimization of the time of arrival of patients into the PACU is the single most important measure

For a PACU with salaried or full-time hourly employees, optimization of the time of arrival of patients into the PACU is the single most important measure that can reduce the peak number of patients in the PACU and decrease the peak requirements of nursing staff. This increases PACU productivity and results in PACU cost savings.8 According to a study conducted by Butterly et al., the mean length of stay in the PACU for patients with PORC was found to be 323 minutes whereas the length of stay for patients without PORC was 243 minutes.3 This shows that using the Stimpod NMT monitor for performing objective monitoring and avoiding residual neuromuscular blockade can save up to 80 minutes of the PACU time per patient. The Stimpod thus makes possible the “unrealistic” change that results in a significant reduction in peak patient numbers in the PACU.

Decrease in Operating Room Holding Time Results in Cost Reduction

Postoperative residual curarization results in delayed discharge of the patient from the PACU. If the PACU gets filled up with patients, the next patient has to wait before leaving the operating room resulting in operating room holds. The operating room/PACU system becomes congested. This has debilitating financial fallout as it increases the operating room costs. For instance, if all the operating rooms are filled up with patients waiting for PACU beds, some surgical cases may be delayed or cancelled. Also, in some situations, incentive salaries may have to be paid to the nurses and anesthetists for the extra time that they monitor patients in the operating rooms.3,9,10

The Stimpod quantitative NMT monitor provides an excellent solution to this problem—it minimizes the incidence of PORC and with it PORC-induced delay in PACU discharge. The increased availability of beds in the PACU allows for a quicker release of patients from the operating room. This cuts down operating room costs.

Stimpod NMS 450X—The Ultimate Cost-Saving Option

Stimpod NMS450X Neuromuscular Monitor

The Stimpod NMS450X Neuromuscular Monitor reduces the incidence of residual paralysis in 97% of patients

The Stimpod NMS 450X is a fully-automated neuromuscular monitor that supports Train-of-Four (TOF), Double Burst (DB), Post-Tetanic Count (PTC), Tetanus and Twitch Stimulation modes to perform accurate, real-time neuromuscular monitoring. It uses OneTouchTM technology that allows an entire case to be monitored—starting from automatic electrode placement to extubation—with the press of a single button. The Stimpod begins TOF monitoring and moves to PTC when a deep block is achieved. It detects the depth of neuromuscular blockade throughout the procedure and automatically reinitiates TOF monitoring when the patient begins the reversal process. The monitoring continues until the patient is more than 90% recovered.

The Stimpod NMS 450X is an all-in-one solution for quantitative NMT monitoring that can

  • minimize the incidence of PORC
  • reduce the length of stay in the PACU
  • increase the PACU productivity by decreasing the peak number of patients
  • decrease the operating room hold time

In short, it’s the perfect cost-saving measure for any PACU.

References

  1. Naguib M, Brull SJ, Johnson KB. Conceptual and technical insights into the basis of neuromuscular monitoring. Anaesthesia 2017; 72: 16–37.
  2. Boon M, Martini C, Dahan A. Recent advances in neuromuscular block during anesthesia. F1000Res. 2018;7:167. Published 2018 Feb 9. doi:10.12688/f1000research.13169.1
  3. Butterly A, Bittner EA, George E, Sandberg WS, Eikermann M, Schmidt U. Postoperative residual curarization from intermediate-acting neuromuscular blocking agents delays recovery room discharge. Br J Anaesth 2010; 105: 304–9.
  4. Duţu M, Ivaşcu R, Tudorache O, et al. Neuromuscular monitoring: an update. Rom J Anaesth Intensive Care. 2018;25(1):55–60. doi:10.21454/rjaic.7518.251.nrm
  5. Abdulatif M. Neuromuscular transmission monitoring: Beyond the electric shocks and the shaking hands. Saudi J Anaesth. 2013;7(2):115–117. doi:10.4103/1658-354X.114045
  6. Naguib M, Brull SJ, Kopman AF, et al. Consensus statement on perioperative use of neuromuscular monitoring. Anesth Analg 2018; 127: 71–80.
  7. Murphy GS, Szokol JW, Marymont JH, Greenberg SB, Avram MJ, Vender JS, Nisman M. Intraoperative acceleromyographic monitoring reduces the risk of residual neuromuscular blockade and adverse respiratory events in the postanesthesia care unit. Anesthesiology 2008;109:389–98.
  8. Macario A., D. Glenn and F. Dexter, 1999, What can the postanesthesia care unit manager do to decrease costs in the postanesthesia care unit?, J Perianesth, vol 14, pp. 248-93.
  9. McLaren JM, Reynolds JA, Cox MM, et al. Decreasing the length of stay in phase I postanesthesia care unit: an evidence-based approach. J Perianesth Nurs. 2015;30:116-123.
  10. Cammu G. Sugammadex: Appropriate Use in the Context of Budgetary Constraints. Curr Anesthesiol Rep. 2018;8(2):178–185. doi:10.1007/s40140-018-0265-6
Posted on Leave a comment

Bell Medical 2018 Anesthesia Meetings Schedule

Rubber Flex Connector

Bell Medical’s mission is to introduce innovative technology to anesthesia providers in hospitals and surgery centers.  We show our commitment to this mission by supporting anesthesia societies such as the American Association of Anesthesiologist or ASA, the American Association of Nurse Anesthetist or AANA and the American Society of Technicians and Technologists or the ASATT.  We also attend numerous state anesthesia meetings for both MDs and CRNAs.  We invest over $50,000 annually to attend both national, regional and state association meetings.  The listing below is some of the anesthesia meetings we attend to exhibit our innovative technologies.  Please visit our booth!

ASATT at Bally’s Las Vegas, NV August 23-25
AANA in Boston, MA September 23-25
MOANA in St. Louis, MO October 19-21
WANA in Spokane, WA October 7-9
VANA in Norfolk, VA October 13
ASA in San Francisco, CA October 13-15
FANA in Tampa, FL October 19-21
EMS Worldwide in Nashville, FL October 31-November 2
NCANA in Cherokee, NC November 2-4
PGA in New York City, NY December 8-10

Posted on Leave a comment

Amsorb Plus Review

When choosing a type of CO2 absorbent, it is important to understand the absorbents environmental impact, effect on patient safety, ease of use and the effect on the consumption of volatile anesthetics. Today we are going to review Amsorb vs. soda limes that contain traces of Sodium Hydroxide, NaOH, such as Medisorb, Sodasorb, Dragersorb and others.

Environmental Impact

Soda limes can have a pH of up to 14 and may require disposal as a hazardous waste according to U.S. Federal Code of Regulations. Soda limes contain sodium hydroxide and are considered corrosive.

Amsorb Plus has a pH of less than 12.5 and is safe for our water table and landfills where it will break down into harmless organic compounds. Amsorb Plus comes with certification of such (see Amsorb Plus disposal document). Kaiser Permanente independently tested all the types of CO2 absorbents readily available on the market and determined Amsorb Plus to be the only one that was safe for disposal in regular landfills. Other types of CO2 absorbents had higher pH and needed to be red bagged and incinerated at greater expense. Amsorb Plus is not harmful in disposal to the environment which translates into a cost savings for hospitals and surgery centers since red bagging is expensive and time consuming.

Patient Safety

Soda limes are known to degrade volatile anesthetics to Carbon Monoxide, Compounds A – F, and Formaldehyde.

Amsorb Plus has no strong alkali and is incapable of producing any of these toxins. Clinical Anesthesia by Barash, 2012, recommends using Amsorb Plus by name and states doing so: (Amsorb Plus)

eliminates all of the potential complications related to anesthetic breakdown and therefore minimizes the possibility of additional costs from those complications, including additional laboratory tests, hospital days, and medical/legal expenses. Adoption of [Amsorb Plus] into routine clinical practice is consistent with the patient safety goals of our anesthesia society.

Ease of Use & Consumption of Volatile Anesthetic

Soda Lime users generally change absorbent based on color change and never know for sure when to change product. Users usually error on the side of caution and change soda lime more often (a wasteful and confusing practice) because if they don’t change soda lime it is possible to endanger the patient by producing toxins such as Compound A, Formaldehyde and Carbon Monoxide. Soda Lime includes a dye that changes color to indicate exhaustion. However, it does not retain color change for long before reverting back to looking fresh. The user can never be sure when product should be changed. Ask any clinician that has used a soda lime and they will verify it is not uncommon to begin a case with what they think is fresh absorbent only to immediately find out they have high levels of FiCO2 and rapid color change of their absorbent.

Soda Limes “adsorbs” (significant amounts of volatile anesthetic which means clinicians wait longer periods of time for their machines and vaporizers to equilibriate. They are less able to reach desired drug percentages without increasing vaporizer settings.

Amsorb Plus has permanent, consistent, and reliable color change. Thus allowing the user to easily tell the state of the absorbent at a glance. Amsorb Plus also adsorbs far less anesthetic vapor than soda limes so machines and vaporizers reach equilibriation faster and accurately reach desired drug percentages without needing to increase vaporizer settings above what is desired for patient inspiration. This saves time and money (utilizing less anesthetic vapor).

Amsorb vs. Soda Lime Review Summary

Soda Lime Amsorb Plus
Environmental Impact
Patient Safety
Ease of Use & Consumption of Volatile Anesthetic

Posted on Leave a comment

CO2 Absorbent Study Shows CO w Fresh Medisorb!

Pediatric Circuit with Gas Sampling Elbow, Fixed Wye, 1 Liter Bag, Filter

Key findings from 2010 study on CO2 absorbent surprisingly ignored!

Detection of Carbon Monoxide During Routine in Infants and Children

Richard J. Levy, MD,* Viviane G. Nasr, MD,* Ozzie Rivera, BS,† Renee Roberts, MD,* Michael Slack, MD,‡ Joshua P. Kanter, MD,‡ Kanishka Ratnayaka, MD,‡ Richard F. Kaplan, MD,*and Francis X. McGowan, Jr., MD§ (Anesth Analg 2010;110:747–53)

Excerpts and quotes from the study:

Carbon Monoxide was detected routinely during general anesthesia in infants and children when using fresh GE Medisorb, a soda lime. (It has long been known that CO is produced in desiccated soda lime yet surprising to be found when using fresh soda lime.)

Carbon Monoxide is a known neurotoxin. Exposure to low concentrations of CO (12.5ppm) can cause neurotoxicity in the developing brain and may lead to neuro developmental impairment. Peak CO levels measured in the anesthesia breathing circuit were in the range thought to impair the developing brain.

The study suggests that use of carbon dioxide adsorbents that lack strong metal hydroxide (ie. the Amsorb Plus CO2 absorbent) could limit inspired CO if detection was attributed to degradation of volatile anesthetic. …findings suggest the use of carbon dioxide absorbents that lack strong metal hydroxide (the Amsorb Plus CO2 absorbent does not use strong metal hydroxides).
Young children exposed to inhaled anesthetics were twice as likely to develop behavioral or developmental disorders after exposure.

The study measured CO levels in the circuit and in the blood stream via COHb.

CO binds 240 times more avidly to hemoglobin than oxygen.

The APSF recommends using adsorbents that do not use strong metal hydroxides(sodium hydroxide), (the Amsorb Plus CO2 absorbent does not use strong metal hydroxides or sodium hydroxide).

The APSF recommended not using absorbents based on strong alkali or metal hydroxides. The Amsorb Plus CO2 absorbent does not contain strong alkali or metal hydroxides and is thus recommended by the APSF.

For more information on Amsorb Plus CO2 absorbent contact Bell Medical at 314-772-5600.

Posted on Leave a comment

Amsorb Plus CO2 Absorbent

Amsorb Plus CO2 Absorbent improves patient safety by eliminating potential toxins plus it provides permanent color change so you always know the status of your absorbent. Your health organization is currently using GE Medisorb which is a traditional sodalime that can produce toxins when desiccated or fully spent. Since your facility does not change your absorbent until you have a reading of over 5 mmHg inspired CO2 the risk of exposure to toxins such as Compound A, Carbon Monoxide and Formaldehyde is increased. With Amsorb Plus you can continue to push your absorbent to complete exhaustion with no worry of toxins. Because Amsorb Plus CO2 Absorbent produces no toxins ever, your clinicians may also deliver lower flows while administering Sevoflurane and thus save the hospital system thousands. Amsorb Plus CO2 Absorbent is part of many health systems “green initiative” because Amsorb Plus has a lower pH than sodalimes such as GE Medisorb when spent. Amsorb Plus is NOT a sodalime. Amsorb Plus CO2 Absorbent is safe for the environment and safe for landfills. GE Medisorb and sodalime are often required to be “red bagged” for incineration at great expense due to spent sodalime’s high pH (see attached Kaiser Permanente disposal document).

Amsorb Plus CO2 Absorbent

Amsorb Plus offers numerous benefits at no additional cost for the actual absorbent. We offer Amsorb Plus CO2 Absorbent under our price matching program that guarantees savings since you save on anesthetic agent and on product disposal.

Bell Medical would be happy to provide you with product to conduct your own evaluation and trial with the hopes that your positive experience would allow Amsorb Plus to be considered as a product of choice. Please review the attachments and let us know how best to proceed with a local or corporate evaluation. Thank you for your interest and support.