Just as surgical procedures and instrumentation continue to evolve and shape the way patient care is delivered in the operating room, the same can be says for the anesthesia equipment segment.

It’s a thriving market, to be sure. While most recent research on the global and U.S.-based anesthesia technology market has not yet been made available to the public, (Frost & Sullivan is currently working on its updated market report.) data has consistently pointed to a growing, opportunity-rich segment. Newport Beach, Calif.-based Medtech Insight LLC, a provider of medical technology business intelligence and market insight, for example, forecasted the total U.S. anesthesia and ventilation products market to reach $3.6 billion in 2012. (As a comparison, the market totaled $1.9 billion in 2002.)

Specifically, the market-research firm predicted that sales of anesthesia-delivery products, such as integrated anesthesia systems – which combine anesthesia delivery and anesthesia monitoring – will experience the most growth through 2012, followed by anesthesia and respiratory accessories, blood gas monitoring products, pulmonary-function testing products, and ventilators.

In addition, Medtech Insight notes that innovative anesthesia-monitoring technologies, such as electroencephalogram sedation-level monitors and sensors to precisely monitor patients’ level of sedation during surgery, would lead the growth in this market.

Growing Demand

Demand has also spiked for anesthesia agent-monitoring equipment, analyses show. A November 2007 report from Palo Alto, Calif.-based Frost & Sullivan revealed that the North American anesthesia-agent monitoring equipment market earned revenues of $228.3 million in 2006. What’s more, the firm estimated that this figure will climb to $297.8 million in 2013. Specifically, the mature North American capnography monitoring equipment market is expected to reach $108.4 million in 2013, representing a dramatic increase over the 2006 total of $71.2 million.

Not surprisingly, the hospital segment accounted for the largest portion of the revenue in the capnography and anesthesia agent-monitoring equipment market – demand that Frost & Sullivan partially attributed to regulations issued by the American Society of Anesthesiologists and the increasing need for monitoring equipment. “These regulations necessitate continuous evaluation of the patient’s oxygenation, ventilation, circulation and temperature, driving demand for capnography monitoring equipment,” Frost and Sullivan state.

But hospitals aren’t the only settings driving the demand. As Frost & Sullivan report, both capnography and anesthesia-monitoring markets are witnessing higher adoption in new segments within and outside of hospitals, due to the increasing need for monitoring equipment. Although primarily developed for operating rooms, other hospital settings – such as emergency rooms, critical-care units, post-anesthesia care units, recovery rooms, intensive-care units, and labor and delivery rooms – are beginning to use these devices, as well.

An Eye on Safety

Industry experts point to some significant improvements in anesthesia technology in recent years – including the evolution of equipment with integrated functionalities and enhanced ventilation capabilities.

Pressure support ventilation (PSV) – a process in which the ventilator automatically completes the breath in a spontaneously breathing patient – is a particularly noteworthy advancement in some modern-day anesthesia systems, according to Tom Green, president of Paragon Service in Saline, Mich. “I believe new ventilation modes, such as PSV, are some of the most exciting improvements to hit the anesthesia-system [segment],” he says.

Because patient conditions are more acute as the population ages and more lives can be saved with better healthcare, anesthesia equipment has to cover a broader range of patients, including neonates, and has to provide ICU-quality ventilation in the OR, notes Clemens Blümel, an anesthesiology-market specialist at Lübeck, Germany-based Dräger. According to Blümel, improvements are found in the use of extremely precise piston-ventilator technology (not only in the ICU, but also in the OR), the application of low-flow anesthesia where applicable, and the availability of most data in electronic format.

“Piston ventilators and low-flow anesthesia both support the reduction of gases,” Blümel says. Plus, piston motors don’t require drive gas, and low-flow applications require less medical gases and reduce anesthetic-drug consumption, while also maintaining warm and moist breathing air. “Both effects may help to reduce environmental burden and hospitals’ costs,” he says.

For instance, the econometer on the display of Draeger’s Apollo anesthesia device provides the caregiver with direct visual feedback information if the fresh gas flow may be higher than required by leakage losses and patient uptake. Further, Draeger’s current product portfolio in the U.S. market enables fresh gas application, volatile agent availability, and manual ventilation, even in the event of total power loss.

Sensor integration has lent itself to further equipment enhancements and has made it possible to log and track financial calculations, adds Blümel. “Flow-measurement data, as well as most other ventilation and monitoring data, are available for export to the hospital’s IT solutions as an anesthesia record keeping system.” Complete anesthesia workplace solutions (anesthesia device, gas monitoring, vaporizers, patient monitoring, and even point-of-case specific IT solutions) provided by one supplier are becoming more common to ensure seamless data transfer between different components of the anesthesia workplace, he continues.

While the integration of different functionalities into one system is a growing trend – and one that, when used properly, can drive efficiencies and ease of use by using one interface and allowing users to focus on only one screen – one anesthesia-equipment expert stresses that ongoing training and due diligence is essential to maximize safety and prevent user error.

“New, advanced anesthesia systems with integrated patient monitoring [and other functionalities] are more complex, and that can create a safety issue if they’re not used properly,” says Green. “Training is essential.” To promote safe, consistent use, Green stresses that any professional who operates the equipment should have undergone thorough training and be able to provide proof of such training to the facility in which they’re working.

Replacement Business to Boom

Despite these newer technologies, many facilities are still relying on their older anesthesia systems. In fact, more than half of the anesthesia systems in use today will lose their factory service support within the next several years, according to Green.

“There’s no doubt that the replacement business is going to be huge,” he confirms. Still, an anesthesia system doesn’t necessarily need to be sent out to pasture once it loses factory support.

To determine obsolescence, Green says facilities should consider the following four criteria:

1. Does the system meet current criteria for safe operation?
2. Are staff members properly trained to operate the system?
3. Are parts available for the system?
4. Is technical support available?

“If you can’t answer ‘yes’ to all of these questions, then the system should be considered obsolete. For safety reasons, it won’t be prudent to continue using it,” Green says.

For facilities with limited budgets that need to replace their outdated anesthesia systems, quality, used systems and low-cost manufacturers can be a good alternative, according to Frost & Sullivan. “In order to facilitate the purchase of their products, companies need to offer flexible equipment financing and maintenance options,” says Frost & Sullivan Consulting Analyst Diego Levitin.

“Flexible-monitoring solutions are likely to be considered a wise and necessary investment.”

A Focus on the Future

In the years ahead, the market may see a growing acceptance of automated anesthesia workstations, such as those offered by Pyxis and Omnicell. So far, widespread adoption of automated systems by hospitals has not been rapid. However, surgery centers, which have less overhead and a greater interest in modernizing and automating the OR, have been more eager to embrace the technology, according to consultants.

Further, the fact that the purchase of these systems is sometimes included in the price of automated dispensing cabinets has made it difficult to gain an accurate picture of the automated-workstation market. Another challenge regarding penetration is that many hospitals, particularly smaller ones, don’t have ADCs, which can mean they’re also less likely to have automated anesthesia workstations. “At this point, penetration rates are relatively low. But, there is a lot of potential,” says Arun Ravi of Frost & Sullivan’s Heathcare and Life Science Consulting Group.

Ronald Kwok, another Frost & Sullivan consultant in the Healthcare and Life Services Consulting Group, adds that patient-safety features, such as integrated lights that guide users to the proper drawer and the fact that automated anesthesia is patient-specific, will likely help drive more widespread acceptance in the future.

Blümel predicts that feedback-control systems will be more prominent in the future because they will simultaneously ease the use of the devices and the administration of drugs. “Target-controlled anesthesia might be named as a synonym for this kind of application, which moves into a future where expert systems support the anesthesiologist” and allow him/her to focus more on the status of the patient than on the device functions, Blümel reasons. He also points out that the feedback-control system will need some time to gain approval and acceptance in the U.S. market, but will arrive in U.S. hospitals as it proves its undeniable value.

Additionally, Blümel predicts software applications that visualize drug interactions in regard to the anesthesia level will arrive in the U.S. market before any closed-loop system will be released. These tools, he says, will display the dosage and the effects of drugs, based on pharmacokinetic models, and drug interaction models based on pharmacodynamic models. “The underlying algorithms are already published and known in the anesthesia community.”