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Book & New Media Review |
Cleveland, Ohio
http://www.anest.ufl.edu/vam
Anesthesia machines have evolved from simple, non-electronic pneumatic systems to fully integrated anesthesia delivery systems based on sophisticated computer technology using advanced electronic sensors. While three decades ago, a rudimentary background in pneumatics and fluidics sufficed to understand how anesthesia machines function, this is no longer the case. Today an understanding of pneumatics, analogue and digital electronics, computer software technology, and human factors engineering is necessary to fully understand the operations of latest generation integrated anesthesia delivery systems. Since an understanding of modern anesthesia machines has become essential to the safe practice of modern clinical anesthesia, anesthesiologists must tackle the often-painful process of learning about the inner workings of anesthesia machines if they are to practice safely. (For instance, anesthesiologists should be aware of the various design differences among manufacturers that impact on how preoperative machine checks are carried out). Traditionally, students learn how anesthesia machines work by attending lectures and looking at static illustrations in textbooks and journal articles. However, the important dimensions of time and interactivity are necessarily missing in such settings, impairing the learning experience.
Fortunately, there is help. The Virtual Anesthesia Machine (VAM) is a Web-based, interactive, computer simulation of an anesthesia machine aimed at educating medical students, residents and others on the inner complexities of the anesthesia machine. Available on the Web at http://www.anest.ufl.edu/vam, VAM simulates the inner operations of a typical anesthesia machine and ventilator using the (free) Shockwave Web player. The result is a "transparent mental model" of a typical modern anesthesia machine that is accurate, easy to understand, readily accessible, and free to use. Users of the package can interactively experiment to learn (for instance) how adjustments of anesthesia machine controls affect (animated) gas flow throughout the machine or how various anesthesia machine failure modes affect performance. Thus users can observe the effects of flow of gas through the CO2 absorber or the operation of safety features like the O2 failsafe system. The result is that students obtain a complete understanding of the patterns of gas flow within the system and thus understand the consequences of user actions or machine malfunctions on gas pressures, flows, and composition.
The VAM project is coordinated by Sem Lampotang, Ph.D., and involves a team of biomedical/software engineers and advising clinicians at the Anesthesiology Department of the University of Florida at Gainesville. The system was developed using macromedia director 8.0 to perform the animation and SoundForge XP 4.0d for the sound effects. To view the animation, the shockwave Web player specific to the user’s PC platform (Windows or Macintosh) must first be obtained via a free download. Although the intent is that the package will be used via the Web, instructions are also provided for users who wish to use the package for teaching but do not have a live internet connection. Also included at the Web site is a detailed excellent "Virtual Anesthesia Machine Tutorial" as well as a comprehensive list of learning objectives.
Adjustable user controls provided in the animation include: gas supply and scavenging connectors; flowmeter knobs; oxygen flush valve; vaporizer; selector switch (manual vs mechanical); breathing bag; ventilator on/off switch and ventilation settings; APL valve; vacuum adjustment valve. Also included in the animation are the following components: pressure gauges; pressure regulators; check valves; flowmeter bobbins; fail-safe mechanism; low pressure alarm; inspiratory and expiratory valves; ventilator spill valve; proportional flow control valve; ventilator exhaust valve; negative and positive pressure relief valves.
I had no problems downloading and running the simulation using Microsoft Internet Explorer 5.5 under Windows 95. I found the user interface to be intuitive and easy-to-use without reading the tutorial; readers who take the trouble to read the supplied materials should find the system particularly easy to use.
New features in the latest release of VAM include a link to a newly created bulletin board dedicated to discussion of anesthesia machines and equipment, a fault algorithms section, and a placeholder link to the first chapter of a VAM workbook that is being developed by the Anesthesia Patient Safety Foundation, a sponsor of the VAM project. The VAM workbook is designed to "provide step-by-step, structured and self-paced exercises to explicitly reinforce the sometimes not too obvious learning objectives imbedded in the VAM animation" and will be made available free of charge as a read-only PDF file in November 2002. Finally, the latest release of VAM offers the option of Arabic, Chinese, Korean and Russian notations in addition to labels in English, Spanish, French, German, Italian and Dutch.
VAM has appropriately received considerable recognition for its excellence, including "Outstanding Abstract for Application of Technology in Education" at the 2000 Society for Technology in Anesthesia meeting, first place "Outstanding Scientific and Educational Exhibit" at the 2001 American Society of Anesthesiologists (ASA) annual meeting, and the Anesthesia Patient Safety Foundation Ellison C. Pierce Award for "Best Scientific Exhibit in Patient Safety" at that same meeting.
I expect the VAM project to live long and prosper. Indeed, the "revision history" section of the VAM Web page is ample testimony to the efforts that the VAM group has undertaken in order to continue development on this important project. Highly recommended.
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