Ok, so I've been working in the field of biomedical engineering for 2.5 years now, and I have had these inquiries for some time. The problem is not with the nature of the questions but rather the conflicting answers I've been receiving from medical practitioners (with various backgrounds and years of experience).

When asking other biomedical engineering colleagues, well... most seem not to care much about the practice itself and either resort to solutions which generate more profitable sales (if employed by a company) or please the hospital board of directors (cost-effective solutions or whatever goes with their whims; a method resorted by the head of maintenance departments at hospitals).

As for reading medical journals and forums on the subject, it seems to confuse me even more.

I don't like to be kept in the dark especially when such answers could affect my performance in the field (mainly product assessment and equipment selection). So I've decided to gather as much answers as possible, see which feedbacks seem to be more favorable, and base my own judgment upon them (pending improvement as I gain more hands-on experience of course).

Before posting the first batch of questions, I would like to ask all practitioners (from medical students to attending physicians, intern nurses to head of nursing staff) to give their feedback and, if possible, feedback from fellow colleagues. Also, I would prefer if you can state your current level in the medical hierarchy (if practice is done in a university or teaching hospital) or position as well as the current/future emphasis of study. Further more, I'm dividing the questions by topic for facility of review later on, and mentioning the targets to each topic.

Topic 1: Miller /VS/ Macintosh Laryngoscope Blades
Target: All levels, all specialties

The most common type of laryngoscope blades (and which frankly seem to be dominating the local market) is the Macintosh type. Generally, I though that it was because of the curved nature which might be easier to use for intubation and get a better view of the airway. But to my surprise, some doctors seem to favor the Miller blade over the Macintosh. Here's the question: Is this related to
the familiarity of the practitioner with the blade during his/her duration of study? Or does the Miller blade have certain advantages over the Macintosh in some fields of application? If so, can you provide some examples on such situations?

Topic 2: ESU/Cautery Machines: Their Power Ratings and Coagulation Modes
Target: All levels, OR staff and surgeons

First let's tackle the power rating aspect. 75% of all ESU machines I've seen have a maximum power rating of 180-200W. However, I still come across some systems with power ratings of 300-400W. Now here's the catch in the later systems: you can only select this power rating for pure cut mode (monopolar option of course), while other modes are restricted to a maximum of 100-150W. The question is have you ever had to resort to such a high output power while cutting? Does the depth of tissue influence such selections? Do you abide by the settings recommended on the user manual or modify it as you deem necessary during the operation? Why?

As for the coagulation modes, there seems to be a new option called the "Spark" mode, so I decided to give it a try during a surgery with a friend who's a cardiologist. Let's just say we were confused as to why it was set as an option if it had the same impact as the fulguration mode. The user manual isn't much help seeing that it recommends both the spark and fulguration modes for non-contact coagulation, but describes the spark mode as "massive and rapid" as opposing to fulgurate's "effective" nature. Are we missing something or is it just one of those useless options which seem to have spread recently in modern systems? On the other hand, there's the desiccation mode. Other than polypectomy (which personally haven't seen being performed other than with
colonoscopy), in what situations do you resort to this mode of coagulation?

Topic 3: The ECG Gel: Heaven or Hell?
Target: All levels, mainly cardiologists and nursing staff

I think we've all been through this before: you use the ECG gel because it's a standard imposed by the health ministry and supposedly keeps those ECG bulbs (ventouse) on the patient while matching impedance and reducing body noise. But (surprise, surprise) the quality of the locally available gel (even high grade) seems to be pretty much useless (it's consistency is closer to water than actual gel, and it dries as fast as when using alcohol swabs). Plus, the ugly side effects include messy bulbs which need to be cleaned two or three times before being used again, and the horrid fear that is verdigris (green-blue precipitate) which seems to spread all over, destroying the bulb's integrity and severing the connectivity between patient's tissue and bulb. Even with intense cleaning, the verdigris seems to corrode the bulb over time. Some resort to using the KY gel instead, but it actually adds noise rather than reduce it (it's mostly intended for abdominal or vascular use on ultrasound probes) and, consistency wise, it's thick. I tried adding a bit of KY gel with the ECG gel to enhance consistency without compromising the matching impedance or noise reduction issues. The solution worked, but the verdigris problem resides even with the 9$ a piece, Italian, high quality bulb. Should we stick to alcohol swabs to save the bulbs and hope for the best? Or should we keep using the ECG/KY mix and change the bulbs when necessary (i.e. every 2 or 3 years)?

The next installment of questions will be posted soon (hopefully... pending schedule).