Pediatric Anesthesia Mask flavor Organizer (3D Printed)

In order to ease the fear and discomfort of an anesthetic mask induction, we often use essential oils (we refer to as “mask flavors”) to add a pleasant smell to the oxygen mask which helps to, at least partially, cover the unpleasant smells of the plastic mask and sevoflurane anesthesia. One problem with our work flow is that the flavor vials are typically held in the equipment carts like so:

undefined

This method of storage is suboptimal. The vials often tip over and spill, they must be picked up in order to read the label, and the anesthesia techs can not easily tell which vials need to be replaced. Inserting a simple 3D printed organizer would be an easy and cheap solution in order to improve the organization and delivery of this tool. 

I conceived the following design in my CAD software:

undefined

The model was designed to fit nicely into the existing space. Two rows are positioned to display the vials in an orderly and easy to read manner while the back portion would allow for the storage of a few extra vials.

I printed 2 prototypes on a Prusa i3 MK3S in PLA with 0.2 mm Layer height.

undefined
undefined

Here is the model in use. It serves its purpose as designed and my anesthesia group was pleased with the upgrade.

undefined

Along with one of my colleagues, I continued to print these organizers for the remainder of the anesthesia carts.

Further Reading:
Use of essential oil to promote induction of anaesthesia in children (A brief research article on the benefits of essential oils for inhalational anesthetic induction in children)

3D Printed Emergency Drug Tray for Endoscopy Suite

Due to the popularity of my OB 3D Printed Emergency Drug Tray, members of my department asked if I could help standardize an emergency drug tray for the endoscopy suite. I polled the CRNAs and attendings that frequently work in endoscopy and made a layout that would include all the important and frequently used drugs to have on hand. Since I had previously measured the sizes and created layouts for all of the drugs in my previous emergency drug tray, creating the new model was straightforward.

3D Model Design:undefined
I Printed the Components in 2 parts so that I could have 2 distinct colors: 1 for paralytics (Succinylcholine in this case) and 1 for the other emergency medications. The halves were simply glued together with some standard cyanoacrylate glue. I added non-slip feet to the bottom so the tray can be removed from the drawer and placed on top of the cart if desired.

Final implemented product:undefined

Why Your Anesthetic Gas Analyzer Detects Halothane When You Administer Albuterol

Have you ever administered albuterol (aka salbutamol) to a ventilated patient and witnessed the anesthetic gas analyzer detect halothane even though there hasn’t been a bottle of halothane in your hospital in decades? How can a machine so advanced make such an error?

The gas analyzer on your anesthetic machine is an underappreciated technological marvel found in every operating room in every industrialized country in the world. It consists of a paramagnetic analyzer to detect oxygen and a gas phase infrared spectrometer for all other gases. Because oxygen does not absorb infrared light, it can not be analyzed by infrared spectroscopy and requires its own analyzer. All companies that produce anesthetic gas analyzers use Paramagnetic and IR technology.

In a chemistry lab, when we try to identify a molecule with IR spectroscopy we may be trying to identify an unknown molecule from a possible list of millions of molecules. In the operating room, we are only concerned with around 5 molecules. Instead of scanning the whole spectrum and identifying all possible peaks; an anesthetic gas analyzer only scans 2 limited areas of the spectrum and instead of searching for hundreds of possible peaks in these areas, the analyzer will only search for a few specific peaks in those ranges. By limiting the scanning spectrum and recognizing only a handful of absorption peaks This allows for a rapid response time on the order of milliseconds.

undefined

Albuterol and halothane have very little structural similarities. Most importantly Albuterol’s structure contains double bonds and hydroxyl groups that will produce unique infrared absorption peaks not found in halothane.

undefined

And if we look at the IR spectrums we continue to see little similarity
undefined

So if the machine isn’t detecting albuterol, what is it detecting? One clue lies in the fact that albuterol administration via metered dose inhaler will result in halothane detection by the gas analyzer but albuterol administration via nebulized solution will not. Perhaps the inhaler contains an extra ingredient that is similar to halothane. That ingredient is HFA. HFA, the propellant in most albuterol inhalers, stands for hydro fluoro alkane.

undefined

 Interestingly, halothane contains the components of a hydro flouro alkane. If we reference the albuterol HFA package insert, we see that the specific HFA used, is HFA 134a. Now this molecule looks quite similar to halothane. Interestingly, HFA 134a is an anesthetic of moderate potency, and was investigated for use as an inhaled anesthetic in humans in the 1960s.

Loooking at the IR spectra, we can clearly see that it is HFA-134a and not Albuterol that is responsible for your anesthetic gas analyzer reading Halothane.
undefined

3D Printed Multi-Patient Ventilator Adapter

The 3D printing of an adapter to connect multiple patients to single ventilator is a concept that has been floating around in the news over the past few weeks. Conceptually, the setup is simple, use two 4-way splitters to connect the inspiratory and expiratory limbs of a ventilator to 4 intubated patients. Although the implementation and management of patients ventilated in this manner is not as simple. The first mention of this concept comes from a 2006 article from the Journal of Academic Emergency Medicine entitled “A single ventilator for multiple simulated patients to meet disaster surge.” The first reported implementation occurred in 2017 when Emergency Physicians at Sunrise medical center in Las Vegas successfully placed two patients on a single ventilator after an influx of intubated patients overwhelmed their ED during the Las Vegas Shootings.

Currently, at least one hospital in New York is attempting to place multiple patients on single ventilators during the COVID-19 crisis. It seems unlikely that this technique will be successful in patient with severe lung disease; however, there are groups that are working on more complex valve systems to make the process function better.

Here is my video discussing the 3D printing of a simple Multi-Patient Ventilator adapter:

Here is a great article from PulmCrit discussing the mechanics of performing multi-patient ventilation:
PulmCrit

The General Public Does Not Understand How Surgical Gloves Work.

A large pet peeve of mine is seeing the general public use surgical gloves incorrectly as a means of infection control and protection. I most commonly see gloves being worn by grocery checkout attendants and by law enforcement. Gloves offer little direct protection from day to day interactions and provide a false sense of security that prevents the wearer from performing hand hygiene as frequently as they should.

In order to protect oneself and prevent the spread of infection, an individual needs to clean their hands between each interaction with a new individual. The typical use of gloves by non-medical individuals involves continuing to wear the same gloves for hours or even days at a time. Every time the wearer touches a new surface, object, or person, their gloves pick up whatever was there; when they touch the next surface, object, or person with those gloves, they transfer it and facilitate the spread of disease.

In addition to spreading the disease to others, most people subconsciously touch their clothing and face constantly throughout the day and since they have interacted with hundreds of people with their gloves, its like hundreds of people have touched them.

When I care for a patient in the operating room I use hand sanitizer, don gloves, interact with my patient or dirty equipment, remove my gloves, then use hand sanitizer again before I can interact with a clean environment again. Although we seem pretentious when we do it, we should constantly be reminding the people that wear gloves in public, to change their practice. Grocery workers and law enforcement such as the TSA are facilitating the spread of disease to countless people every day though ignorance of basic hand hygiene techniques.

Here’s a video I made addressing similar concerns over every day, seeing dozens of people wearing surgical gloves in public during the COVID-19 crisis:

3D Printed HEPA Filter Adapter for 3M 6000 Series Respirators

**Disclaimer: Personal protective equipment (PPE) for use in the medical field is extensively tested and FDA approved; any non-FDA approved PPE should be used only in emergency situations when no FDA approved device is available. The information provided here should be considered educational in nature and not medical advice.

The spread of COVID-19 in the US has revealed a severely inadequate supply of personal protective equipment, especially N95 masks. The dwindling supply has lead some healthcare providers to search for creative solutions for respiratory protection. One emerging method is to purchase a reusable 3M 6000 series respirator for use in the hospital environment, however, the cost of replacement filters is high and availability of all N95 filter types is low. With the CDC currently recommending that masks be disposed of after every COVID patient interaction, the cost and availability of replacement filters makes use of these masks impractical.

Small HEPA filters are inexpensive, in high availability, and filter 0.3 micron particles with greater efficiency (> 99.9 %) than N95 masks (95%), making them at least as safe as CDC recommended masks. To utilize these filters I designed and 3D printed an adapter cassette to use inexpensive Roomba vacuum HEPA filters with a 3M 6000 series respirator. With the filter, PLA Filament, and silicone sealant, the final product comes to a total of about $3 each. I also propose that one mask port be capped with a 3D printed cover so only one filter needs to be used with each patient interaction.

In this video I discuss the design, assembly, and testing of a 3D printed cassette to adapt inexpensive HEPA filters to a reusable respirator:

If you would like to replicate this project here are the items that you will need:
1. Filter Cassette 3D Models
2. 3M 6000 Series Respirator
2. HEPA Filters
3. Silicone Sealant
4. Quick drying adhesive

List of tools that you will need:
1. 3D Printer
2. Clamp

3D Printed Emergency Drug Tray

In order to provide immediate access to emergency medications in our Obstetric ORs, we have a medication drawer that is easily accessible to all anesthesia personnel by badge access. Although there have been multiple ideas for organizing the drawer with easy access and safety in mind, the current state or the drawer leaves much to be desired:

undefined

Considerations for a new design included clear grouping of medication classes, sturdy construction, easy to clean surface, and modular design for easy revision in the future. I designed a new drawer inlay and discussed the design with the our residents. With some input from them, I clearly separated emergent GA drugs and emergent epidural medications to draw their eyes quickly to drugs that should be grabbed for each situation. Here is the first iteration of the design:

undefined

After printing out an example syringe inlay, feedback was that the finger wells were too small to grab the syringe quickly, so the wells were increased in size. Feedback was positive and the design was accepted readily by the department. After a few months of use the pharmacy began stocking rocuronium syringes instead of rocuronium vials. Due to the modular design, it was straightforward to revise the inlays and replace only one section of the inlay. After a couple weeks of use, it became apparent that the succinycholine and rocuronium syringes were being swapped when restocked, so I reprinted the rocuronium inlay in a different color to draw the eyes to the difference.

Here are the inlays currently in use in our all of our Obstetric ORs:

undefined

undefined

3D Printed Epidural Cart Organizer

The epidural cart that we roll into labor and delivery rooms had a poor organizational system for commonly used items during epidural placement. The tegaderms, tape, and other items were stored in an “organizer” that was essentially a cardboard box sitting on top of the cart;

undefined

This system was not straightforward to inventory and it was often discovered, once already in the patient’s room, that items needed to be restocked. As it was a just box resting on top of the cart it was also occasionally knocked onto the floor.

To allow for better restocking and improved access to the individual items, I designed and 3D printed a new organizer. The design implements clear labelling, maximizes utilization of the space, and has suction cups integrated to prevent falling from the cart. The organizer was printed on a Prusa i3 MK3s with a total print time of about 20 hours, printed in 2 parts due to print ped dimension constraints.

undefined
undefined

Here is the organizer in use:

undefined
undefined

3D Printed Spinal and Epidural Needle Organizer.

There’s little worse than your patient sitting at the bedside and having to rummage through a pile of spinal and epidural needles during difficult neuraxial placement. I designed and 3D printed inserts for our existing storage bins for better organization. My goals were to reduce time searching for specific equipment, allow for better inventory/restocking of equipment, and provide a method for non-anesthesia personnel to assist anesthesia personnel that are performing a sterile procedure.

Here is the 3D Design:
undefined

The geometry and size of the inserts were not conducive to effective printing so the models were split into more appropriate shapes and sizes. This would also allow for efficient reprinting of certain components if they required adjustments:
undefined

The components were sliced in Cura 4 and printed on a modified Creality Ender 3 with a total print time of approximately 30 hours. The components were affixed to the storage bins with double sided tape producing the following product:
undefined

undefined