The technology available for pressure relieve works on the principle of pressure redistribution however, every technology creates its own pressure as its nature of counter reaction to any surface based on Newton’s third law. However, if the cushioning is supreme the pressure will immerse into the surface like Memory foam and will be release slowly back when the limb is removed. In such cases, due to lack of elastomeric distribution is gentle and might not be effective for positioning devices. On the other hand, only elastomerism will equalise the pressure without cushioning might cause damage to other nearby sites. An optimum of both such cushioning and elastomerism is essential for right pressure distribution with comfort to the site under stress. There are numerous grades of gel technology i.e. Medigel (generic name: Viscoelastic Gel), upgraded with anti-microbial coating Covid Coat+ in 2020 by DRDO referred as Viscoelastic Gel with Covid Coat+ (or Medigel coated with anti-microbial coating). Thus, the following table describes how this present technology is different from other technologies making it useful for OT Positioning Devices:

No, both types of Operation Theatre Positioning Devices are developed using Medigel (aka Viscoelastic Gel), however, in 2020, during COVID-19 spread, under DRDO's initiative of Ultraswachh Technology, the technology is upgraded with anti-microbial coating referred as Covid Coat+. The solution is tested against numerous hospital pathogens as well as COVID-19. Such technological upgradation is specific and mandatory for all government supplies as being approved by Quality Control of India for its acceptance of availability of Government e-Marketing (GeM) portal of Government of India. Thus, the blue color variants are provided with such coating as well as 50 ml of Anti-microbial coating solution in each pack. As per norms laid down by QCI, India, the packaging standards require labeling of brand name, product name stickers on the wooden box. Each item is packed with Enshield (ensuring microbe free internal environment) and Air clean pouch. Bi-lingual User manual describing its maintenance or instructions of usage as well as their digital copy related QR code is provided on each box. To ensure quality tracing, batch certification is released for every such sale and loaded on our website. The digital QR code is also provided on each item box containing blue variant. All these aspects are optional for Green variants thus cost-effective, yet both technologies are equivalent though latter (green ones) are not compatible with Hot OTs unless coated with Anti-microbial solution. Please visit the following link to understand packaging standards: https://www.otcare.co.in/services-9

Gel Craft Healthcare (P) Limited, a technology partner of DRDO in Ultraswachh technology, is an original manufacturer of Viscoelastic Gel technology. Viscoelastic Gel is material brand with high elastomeric potential with softness/ shore OO value limits to zero, an extreme cushioning & comforting gel. This possesses ideal properties for utilizing it in Operation Theatre Positioning Devices for preventing any pressure or illicit physiological response. In 2020, DRDO has taken initiative in development of Ultraswachh technologies using ozone as primary sterilant and to ensure prevention of its leakage in cabinet or portable unit design assembly, viscoelastic gel was found to be effective being inert with enhanced elastomerism. DRDO has integrated another technology referred as Covid Coat by evolving it to Covid Coat+ by upgrading its formulation using an adhesive binder such that it can be coated into Viscoelastic Gel aka C3I Gel (Medigel) so that no biofouling is feasible as expected in high infectious zones in hospitals or Isolated Wards. The resultant technology is referred as Viscoelastic Gel with Covid Coat+ (VeGCC+). The same provides an exclusive and unique series of Operation Theatre Positioning Devices that can be used in standard OTs as well as during management of contaminated or infected patients. It is available with and without film in Sapphire Blue color. Features of VeGCC+ Technology Elastomeric cushioning works on principle of counter reaction to pressure on bony prominences of body such that it is distributed equally in all directions Unlike memory foam, it releases back faster thus effective for positioning devices preventing neuromuscular injuries Unlike rubber, latex, foam, silicone and any other product, it induces no pressure on any aligned or relieved body parts Ideally designed and contoured for multiple positions including Prone Positions Product’s design and comforting positioning complies with SOPs laid down by Association of Surgical Technologists (AST-SOPs) OT Gel Sheet can be cut into desired shapes and no gel product leaks Product’s touch perception is natural skin like yet completely inert Tested for contamination removal being extremely hydrophobic layers Covid Coat+ coating ensures no microbial growth for 90 days or 365 days based on variant used Products are cured using Ultraswachh technology during production and can be disinfected using same, if need be. VeCC+ = C3I Gel + CC+ Now Both VeCC+ and C3I Gel are referred commonly as Medigel (brand name) with one difference that former has anti-microbial coating while latter don't have. To bring clarity for our customers, in general practice former is sold as supreme category in Sapphire Blue color while latter sold in Green color in Indian Market. Based on requirement of clients, specific shades of natural colors can even be derived.

A process in which a surgical team access to the surgical site with least physiological compromise to the patient while simultaneously protecting its joints and skin is referred as Surgical Positioning. Surgical positioning especially during prolonged surgery is an important task preventing any pressure or illicit physiological response. For example, prone positions post anaesthesia for longer durations is linked with pressure applied and its applied time (it is advisable to provide intermediate release of pressure); body physiology and age compatibility along with damage incurred by pressure, shear and frictional impact also make patient vulnerable. It cause multiple pressure sores at various sites.

Prolonged Surgeries refer to surgeries that are extended for long time and during that period patient’s positioning is dependent on Surgical Team. Proper patient positioning on the operating table padded with organogel padding is essential to allow optimal surgical exposure and to prevent neuromuscular injuries. Dependent portions at risk for compression injury on body parts i.e., eyes/ ears; penis/ scortum; breasts; fingers and; pendulous injury (table related injury).It is essential as per law for human ethics and responsibility towards anaesthetised patient who is unable to communicate his / her pain to the surgical team. It is their responsibility to ensure safety of patient's and preservation of integumentary, musculoskeletal, respiratory and circulatory system functions while prolonged surgeries. As per SOPs laid down by Association of Surgical Technologists, all OT Positioning Devices should remain effective for surgeries of 3 hours or more. This is in relation to basic time frame related to Prolonged Surgery.

There are numerous surgical positions and their relative impact differs in terms of body part affected. Some of these are: A prolonged operation in the lithotomy position can put pressure on the lower leg and lead to neuromuscular dysfunction especially extremities. Benign paroxysmal positional vertigo (BPPV) is the most common disorder of the inner ear’s vestibular system, which is a vital part of maintaining balance. BPPV follows surgery as a result of the trauma on the inner ear during the procedure combined with a prolonged supine (laying down face-up) position. Positioning is even more critical in robotic surgery because it must provide access to the surgical field and also accommodate the robotic camera system and working arms. Trendelenburg position (normal or reverse i.e., head is 15deg down / raise the bed level) cause cardiac and pulmonary issues. Sitting on beach chair (semi-flower) position effects all three i.e., cardiac, pulmonary and nerve tissues. Pressure points in the sitting position include the occipit; scapula; elbow; sacrum and heels. Jack Knife position in which buttocks are raised may cause reduction in cardiac output; functional residual capacity of lungs could be reduced by 20% and affect nerve tissue too. Lateral Decubitus position (side lying) requires specific bean bags; special hip pads; pillows and overhead armboard for upper arm and auxiliary rolls (blanket or foam). Flexed Lateral Decubitus position (here side lying with head and feet are lower than its mid-section) is prone to positional impact too. Patients positioned on fracture table (in supine position) require positional care during operative surgery. Supine position refers to a dorsal state i.e., lying on his / her back; knees are flexed with positional products.

Imagine a person who is not allowed to turn or change his / her position, the body parts received continuous compressions on skin and underlying tissues both from the surface on which person is lying from one side while bony part from other side. If such pressure is not relieved or removed, it leads to pressure sores due to lack of oxygen and nutrients in this area. The bony prominences are prone to significant damage like head, shoulders, elbows, sacrum, hips, buttocks, knees and heels. To redistribute the pressure evenly a cushioned surface with extreme elastomerism is essential to manage the elements of shear, friction and pressure on the site. It may starts building up with in less than two hours, however age and health status of the patient is a determining factor. An estimate revealed that in more than 20% of prolonged surgery cases, the probability of such pressure sores is inevitable. Such occurrence is both cost intensive in terms of longer recovery time and in some cases, it is a medico-legal issue too. Thus, this is priority area to have skills to manage such unwanted stress and the measure is only prevention of occurrence of such ulcers by artificially cushioned them with contoured organic C3I gel technology based Medigel® positioning devices.

During various operative states, numerous positions are required and such immobilised body parts require positional devices with no negative pressure induction wherein Medigel® C3I Gel Technology plays a critical role. As compared to rubber, latex, foam, silicone and any other product line, C3I Gel offers complete elastomerism along with cushioning and comfort, such that no pressure is induced on any aligned or relieved body parts supported during such prone positions. The various positions are given below: * Complete stabilization of patient requires all the positional devices to be available in OT as periodic shifting requires various combinations. Position Positional structure*