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Kayla Freudenthal

Revisions to the Universal Anesthesia Machine and Improvement of Surgeries in

Underdeveloped Countries

Normal anesthesia machines can cost up to hundreds of thousands of dollars, require

$50,000 a piece to repair if broken, and still not be 100% safe or effective in surgery. Anesthesia

medicine is already one of the most dangerous and daring careers out there, so why make it that

much harder to have a successful surgical outcome?

The Universal Anesthesia Machine (UAM) was developed to solve all the problems and

challenges associated with the normal anesthesia machines in first world countries, but is also

beneficial and easier to use for those in third world countries. Still, after the invention, there

remain minor improvements to the machine that are needed to safely and effectively make this

machine successful in any surgery, regardless of location (​Frenkel, 2011)

So why is it so important? Anesthesia is an excellent tool that can be used to save lives. It

is desperately needed to safely perform life saving surgeries. Also, in underdeveloped countries,

people are rarely trained in anesthesia and it is hard to obtain access to hospitals that can

properly use an anesthetic. Most surgeries in underdeveloped countries are done while the patient

is awake, or when the patient is given too much or too little medication (​Petronzio, Mashable,

2017)​. Small improvements to the UAM will be a game changer in surgery, that could bring

prosperity to all hospitals and clinics around the world.

I chose this topic because in my future, I want to pursue a career in anesthesia medicine

and be able to save lives everyday. Research such as this will improve my career and make it

easier to give patients the best outcome. This is important to me because I truly believe in the
importance of anesthesia and the capabilities it holds in medicine. Making such a powerful tool

safe and accessible is key to furthering the field of medicine.

In underdeveloped countries, most surgeries are administered anesthesia by untrained

professionals. Most times the patient is awake and can feel the surgery being performed on them.

Normal anesthesia machines also take up lots of power and energy that small hospitals cannot

support, causing blackouts and the surgeries to be finished in the dark. Access to a machine is

hard to come by and dosage of the medications are not always accurate (Petronzio, et al., 2017).

The UAM was developed to solve these issues (Frenkel, 2011). It includes features that

make anesthesia more safe and effective. The machine is built with a self-filtering oxygen

system that takes room air, filters it, and separates the CO2 and O2. It also includes a battery that

can last up to six hours without taking up energy from the hospital, so it will not cause blackouts

during procedures. Other features include ventilation stations and a monitor that shows vital

signs. Above all those wonderful things, the machine is much more affordable and portable than

the clunky machines used in most hospitals (Petronzio, M. & et al, 2017) (Frenkel, 2011).

As amazing as this machine sounds, there are still a few missing pieces to the UAM. If

we are going to solve these underlying issues, we need to think of the people and how we can

improve this machine to make it flawless. Having accessibility, training, and proper dosage of

medications, are little things that can easily be improved and make the biggest impact on the

change that could improve healthcare.

Repeated training and practice are the proper ways to gain experience and learn how be

the best at your job. It is rare to run across a properly trained and educated anesthesiologist in a

rural underdeveloped country. Those who are trained to use new technological devices that
require new gadgets and techniques. Being able to understand the machine and know it

inside-out is key to making the machine successful. What is the point of giving a child a remote

if they do not know how to turn a television on, it is the same for the machine. What good will it

do to give an untrained professional a new device with someone's life on the line?

There are many techniques that have been developed to give effective training and proper

education for medicine and techniques (​Vafaee Najar, et al.2016). ​One system for improving

training methods is Failure Mode and Effects Analysis (FMEA), which was developed to engage

staff to identify issues within their work processes and to collaborate to come up with strategies

to reduce risk. In an experiment hosted in Sierra Leone, nurse anesthesiologists monitored a

group that tried using the FMEA method to identify problems with the UAM and how to fix it.

This worked because the collaborations from all the medical professionals allowed concerns to

be heard and a search to be conducted on how to fix the issue (Rosen, et al., 2015).This same

technique can be applied in many ways, such as identifying what needs to be done, because it

uses the resources that the team has around them. It is free and engages minds to find a solution.

Controlled and accurate dosage is the next, but equally important step to improving the

UAM. If a few simple changes occured, this machine could be powered by anesthesia

technicians, be a much faster process, and would require less schooling for those operating it,

saving them many years of schooling and thousands of dollars in student loans.

One of these simple changes would be to use a infusion pump, which stated by Dr. Alyse

Rymer, (Rymer, A. Personal communication, October 24, 2017) of Providence Portland, “is a

great and amazing tool that slowly gives medications to patients through an IV, determining the

speed and amount of dosage based on the age and weight of a patient”. For example, after giving
the patient an IV and some oxygen, the doctor would attach propofol or another anesthetic to the

infusion pump and turn the dials to match the patient's age and weight. The medication would

now be inserted into the patient, keeping them asleep throughout the whole surgery and at a

dosage rate that does not harm the patient. It is also battery charged meaning it will not take up

energy from the hospital, causing blackouts, and can last throughout long complicated surgeries

(Frenkel, E. 2011).

An infusion pump is also helpful for surgeries on people who range in age because it can

be set to make sure each person gets the correct dosage. A young child or an older patient need

less anesthetic to knock them out, compared to a person in their mid 20s who has a higher

tolerance rate and will require more of the drug. It covers the age gap that will occur during

surgery and allows each patient to receive a safe dosage.

In a recent study, a surgery that used an infusion pump to dose a patient showed the

success rate and impact of using an infusion pump versus the placebo effect.(Zhang, Lu, Chang,

& Pubmed.,2017, January 23). The experiment tested pain management with the infusion pump

for patients after joint repair surgeries. The results concluded that the infusion pump does work

more accurately and relieves more pain during and after the surgery. This technique can be used

in the operating room to give accurate doses to patients and manage pain for surgeries that are

not general anesthesia (Zhang, Lu, Chang, & Pubmed.,2017, January 23).

Accessibility, the last but most important part to the revision process. If nobody can

access the machine, it defeats the whole purpose of why it was made. The UAM is already way

more affordable than the normal machine, but it needs to be more available so any hospital

around the world can have the opportunity to purchase what they desperately need to save the
lives of their patients. Geographic location plays a role in the accessibility of the UAM because

of transportation, and the process of obtaining one. It is much more challenging for a hospital in

Sierra Leone to get access to the machine than it would be for someone working at a hospital in

the United States.

It is also important for staff to have access to proper training and practice on the

machines, to the point where they know them inside out and can fix the machine themselves.

Physicians need to be fully and properly trained in order to make the machine as safe as it can be

and, depending on the number of UAMs in the hospital, how to safely transport it from room to

room and how to monitor the vital signs of the patient.

The Universal Anesthetic Machine is very beneficial, desperately needed around the

world, and is the future of anesthetic medicine. It has the ability to impact everyone who lives in

underdeveloped countries as well as first world countries. From the rich to the poor, and the

young and the old, the UAM has the power to save lives and reduce risks during surgeries no

matter the person.

This research is important to me because in my future career as a physician it is my

purpose to save lives, and develop new, more successful rates in anesthesia so the future of

medicine will be better. I want each of my patients to have the best surgical outcome and

recovery they can, and by making these simple improvements, medicine can get there.

This research taught me about how thankful I am to live where I do and to have access to

great quality healthcare. I learned about the huge risks and techniques of surgery in

underdeveloped countries because they have no other choice to save someone’s life. The

Universal Anesthesia Machine has brought promise and hope to the medical community and
given us the opportunity to be able to improve in the future. I hope to see even simpler, safer

techniques and tools being developed to save a patient's life and increase life expectancy as the

world grows older. Anesthesia is one of the most important tools of surgery, and reducing risks

only improves the chances of a patient’s survival.

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