Proper Service Procedures Are Essential to the Safe Use of Anesthesia Workstations

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In a recent letters to the editor article titled “Early Detection of Anesthesia Workstation High-Pressure Oxygen Line Leak,” the authors report an unusual cause of a leak in the high-pressure oxygen supply internal to the anesthesia machine that cannot be detected by the recommended preanesthesia machine checkout process.1 The clinicians involved with caring for the patient made the appropriate decision to replace the anesthesia workstation since they were unsure that it would be reliable. Fortunately, they were able to take that action without concern for immediate patient safety as the patient had a spinal anesthetic. The report does not mention the importance of proper service procedures, and it is likely that proper maintenance would have avoided the problem.
The Narkomed GS workstation (Draeger Medical, Telford, PA) that was involved with this case report is an older design. The exact age of the device was not disclosed in the report but that model was no longer manufactured after 2007. The manufacturer continued to supply parts and factory repair until December 2014 and continued preventive maintenance until December 2016. One of the absolute criteria for machine obsolescence is when adequate maintenance is no longer possible.2 The Narkomed GS mentioned in this report may well be obsolete by this criteria since the availability of parts for repair was not guaranteed after December 2014. There is no mention in the letter about the service history of the machine. It is not uncommon for institutions to relegate older equipment to settings like an obstetric operating room, in part because general anesthesia is much less commonly used. However, proper service of these machines is essential especially because they are not often used for general anesthesia. When the device is needed for general anesthesia, the risk to the patient and the fetus are high if the device fails unexpectedly.
The authors do not mention anything in the letter about how the machine was serviced, when it was last serviced, and who was responsible. Service contracts and providers are of varying quality and not uncommonly a focus of cost control by hospital administration. Furthermore, it seems the authors were misinformed by the Draeger representative they queried. In 2006, Draeger released a Technical Service Bulletin specifically for the Narkomed GS addressing the potential for hoses to become brittle and leak with aging. Specifically, the bulletin states that “Initial tubing inspection is recommended at year 10, whenever the device is opened (for repair), and at the latest performed in conjunction with Periodic Maintenance Certification (PMC), then at 1-year PMC service intervals there after.”3 It would be useful for the authors to determine how the institution is servicing the machines and whether or not the service provider followed the service recommendations.
It is important to perform a preanesthesia checkout of the anesthesia workstation but not all internal problems can be identified by this process. Anesthesia workstations require regular, high-quality service to ensure reliability. Service providers must be trained, and service contracts need to include regular preventive maintenance in accord with manufacturer recommendations.
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