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An Anesthesia Machine That Keeps You Under Even When The Power Goes Out

In developing countries with unreliable electricity, an anesthesia machine that works even when the power goes out is crucial. It’s very bad when the anesthesia stops suddenly.

Conventional anesthesia machines are fallible in countries with unreliable electricity. When the power goes out, the machines stop pumping oxygen and drugs, leaving patients to suffer complications and injuries, or worse, die on the operating table.

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Gradian Health Systems‘s Universal Anesthesia Machine (UAM) is designed with a back-up plan. In addition to piping oxygen from pressurized tanks (the conventional way), it also uses an older method–called “draw over”–that strips oxygen from the open air. With a fuel cell, and hand pump if needed, this ensures the machine is always doing its job, whatever the power or oxygen supply.

“We deliver anesthesia without the need for compressed oxygen,” says Steve Rudy, Gradian’s CEO. “If the infrastructure changes around you, the machine changes the way it delivers anesthetic gas, so it should never fail.”

In fact, compressed oxygen is frequently the bigger problem, Rudy says. For distribution reasons, the canisters are often not available, especially in remote regions. Or, monopolies control the business and jack up prices to unreasonable levels. “In many countries, the supply does not exist,” he says. “They have a broken chain.”

The UAM, which stands about five foot tall, takes in air through a hole and passes it through an oxygen concentrator, where it reaches up to 95% potency. It then pushes the nearly-pure oxygen through a drug canister, where it’s mixed and fed to the patient through a mouth-and-nosepiece. There’s a dial to control the dose, and a display to check on the oxygen measurement (anesthesiologists need to ensure the gas always contains at least 20% oxygen). The hand-pump keeps the air moving if the fuel cell in the concentrator stops working.

I saw the UAM firsthand at Gradian’s office in Manhattan, and was impressed with the quality of the engineering and the simplicity of the design. The UAM looks easy to operate and relatively simple to fix. For example, it uses several off-the-shelf parts, including a car filter that cleans air as it first enters. And yet, the UAM doesn’t come across as a “charity product.” It looks perfectly functional–“appropriate” in development parlance–despite costing far less than conventional machines. Rudy says several are in use in the UK, where the product has regulatory approval.


Since opening for business three years ago, Gradian has delivered 95 machines to 17 countries, most of them in Sub-Saharan Africa. It sells the UAM for $16,400–which is what it costs to make and ship–and then provides free training and maintenance. Gradian itself is a hybrid. Though it charges for the hardware, it otherwise acts like a charity, with funding coming from the Nick Simons Foundation.

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Rudy says the training is almost as important as the machine itself. Too often, he says, people make donations of medical devices only to provide no after-care. The result is “graveyards” of non-functional equipment rotting in hospital basements. Gradian spends a couple of days with staff when they deliver the machine, helping medics brush up on their skills, and teaching technicians how to take care of the UAM should it break down. It also has people on hand who can fly in, if needed.

The cost of the machines is normally met by local NGOs or government agencies, with the hospitals encouraged to chip in what they can. Rudy says it’s important they actually want the machine and commit to take care of it.


The UAM dates back to the mid-1980s and a British anesthesiologist named Paul Fenton. Fenton worked for 15 years at a hospital in Malawi, where he saw how OR equipment would go wrong. A tinkerer by nature, he set about designing a safer machine by cobbling together old ideas and components. He hawked the design to manufacturers for more than a decade, before the Nick Simons Foundation stepped in and Gradian was formed to bring the UAM into production.

Rudy says standard anesthesiology machines cost $23,000 to $40,000, come with expensive warranty contracts, and still go wrong when the power goes out or compressed oxygen isn’t available.

The alternatives to anesthesia are terrible. Doctors often prescribe ketamine, which only dulls the pain and comes with horrific (or not, if you’re into it) hallucinations. Or, they might try and move patients, gaping guts and all, mid-surgery. Listening to Rudy and vice president Erica Frenkel, I was glad I wasn’t on an operating table in a poor developing country, waiting for the power to go down. But I was glad too, there was something like UAM that could finally help.

About the author

Ben Schiller is a New York staff writer for Fast Company. Previously, he edited a European management magazine and was a reporter in San Francisco, Prague, and Brussels.

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