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Three-dimensional printing, by which a 3D solid material object is created from a digital image has proven to be an exciting and revolutionary technology in industries outside of medicine such as manufacturing, design, engineering and art. One method – known as fused deposition modeling, extrudes a plastic polymer filament through a heated nozzle onto a print platform. The plastic instantly cools down and solidifies. The 3D object is built up by further deposition of layer upon layer. Complex models can be created using support structures and struts. The plastic mediums vary in hardness and flexibility and can be biodegradable. Affordable, small size 3-D printers are now available for personal use. Other expensive and more complex methods utilize selective laser sintering (SLS) and stereolithography (SLA) technologies.
Medical applications are evolving as the technology has become more accessible and affordable. Rapid prototyping can be successfully used to create anatomically accurate models from imaging studies. Surgical subspecialties have embraced it before anesthesiology. 3D printing is being used for pre-operative planning in maxillofacial surgery, neurosurgery, orthopedics, plastic and reconstructive surgery, hepatobiliary resection, and cardiothoracic surgery. The use of 3D-printed anatomical models is rapidly becoming a very valuable tool for teaching, training and patient education purposes.
A literature review yielded a small number of articles describing multiple potential benefits and applications of 3D printing directly within the field of anesthesia. Anatomical models for training can be economically developed and produced. Real patients’ radiologic images are used to generate reproducible 3D prototype models. Readily available computer software programs (some are open source like Meshmaker and 3D Slicer) can convert CT, MRI and radiologic DICOM files (Digital Imaging and Communications in Medicine) to the virtual 3D model STL files (Standard Triangle Language) needed for printing.
1. Neuroaxial Needling Training:
Translucent 3D segments of thoracic and lumbar spines are useful for neuraxial procedural training and preoperative planning. Translucent medium models allow clear visualization of needle insertion site, angle and depth providing realistic training and skill development for the traditional midline and paramedian approaches and ultrasound guided techniques. A simple, low-cost 3D-printed thoracic spine phantom model was effectively used to teach thoracic epidural needle placement. This model can be rapidly fabricated (over 35-40 hours) with low cost ($ 40 /model) and is offered by its developers as open-source access with a step-by-step instruction manual. Spine phantoms with normal and pathological variants can provide a robust armamentarium of educational tools for neuroaxial anesthesia training. In patients with anticipated difficulties such as severe arthritis, previous surgery and spinal metalware, a patient specific 3D model can allow for better preparatory planning and real time guidance of difficult needle insertion.
2. Surgical Airway Training:
3D printed tracheal models based on human CT Neck scans offer a useful alternative to human cadaveric specimens or animal parts for surgical airway training. A prototype made from a flexible thermoplastic polyurethane and gelatinous medium resembles the compressibility and tactile feel of human and animal tracheas when penetrated with a needle or scalpel, enabling more realistic training. Various adult and pediatric sizes may be produced. A high-fidelity, low-cost 3D laryngotracheal model was successfully used to establish a cricothyroidotomy skills maintenance program in low resource setting. Simulation training improved knowledge, confidence and skills of anesthesia residents in performing emergency cricothyroidotomy. Educational training using 3D printed simulation models can significantly improve skills in life-saving, rarely performed, and difficult to rehearse procedures.
3. Bronchoscopy and Lung Isolation Simulation Training:
High fidelity 3D plastic models of the tracheobronchial tree are very useful to teach anatomy, bronchoscopy and lung isolation techniques. Compared to video and computer-based learning methods, 3D models offer the added advantage of enabling practical bronchoscopic navigation of the airways. All standard lung isolation devices can be used and practiced on these models. Anatomic variants and different pathologies, such as tracheal stenosis or tumors could be reproduced in the models from CT images of actual patients. This allows the clinician to obtain a realistic 3D reconstruction of the patient’s tracheobronchial pathology. Having a bank of such 3D prints, enables just-in-time simulation immediately before a case. These models can be rapidly created - in approximately 20 hours- allowing for pre-operative practice, preparation and planning on an airway that matches the specific patient. A new dynamic 3D bronchoscopic simulator was recently developed. The prototype print is obtained by assembling 3D reconstructions of different pathological chest CT scans into a single model. This efficiently provides realistic conditions for teaching and training on multiple pathologies. The accuracy of 3D airway reconstruction is still highly dependent on CT imaging quality.
4. Pediatric Applications:
A 3D-printed airway model more accurately predicted the appropriate endotracheal tube size in pediatric patients than traditional age-based formulas. This may also facilitate the selection of appropriate equipment for pediatric one-lung ventilation (OLV). For patients with complex and challenging airways, preoperative 3D modeling improved assessment, pre-planning and management. In orthopedic surgery, 3D printing is useful in preoperative planning and development of personalized implants. Novel artificial heart valves with new shapes, sizes and materials can improve, performance and biocompatibility of heart valve replacement.
For patients with an anterior mediastinal mass, 3D modeling helped predict airway and circulatory compromise and the potential need for extracorporeal membrane oxygenation (ECMO). Patients are referred for preoperative modelling either by the surgical service or the preoperative anesthesia clinic. Customizable 3D printed stents are already improving care and achieving better functional and aesthetic outcomes for patients with cleft lip and palate. Virtual reality and 3D printing were used to accurately elucidate pediatric airway anatomy, develop management plans, guide the performance of oro-maxillary and mandibular nerve blocks, thereby improving safety and procedural success.
Three-dimensional printing offers a fast, easy to use, low-cost method to manufacture customizable anesthesia equipment such as human-powered thermal laryngoscope and workspace syringe holder.
3D printing can improve the precision and personalization of clinical patient care as well as education and procedural training. Low-cost, high-fidelity 3D printed neuraxial and airway anesthesia phantoms derived from patient CT data can be locally created with modest infrastructure and reasonable speed. Such phantom models directly replicate anatomical structures from medical images and can incorporate patient-specific pathology. This can facilitate personalized clinical care and precise pre-procedural planning. The models offer realistic tactile feedback and may be customized with various levels of difficulty. The most developed applications include neuraxial and regional anesthesia, airway management and lung isolation simulation training. This innovative technology may also provide useful global training opportunities even in low resource environments.
1. Chao, Ian, et al. "The application of three‐dimensional printing technology in anaesthesia: a systematic review." Anaesthesia 72.5 (2017): 641-650.
2. Bustamante, Sergio, and MD Shravan Cheruku. "3D printing for simulation in thoracic anesthesia. " Journal of Cardiothoracic and Vascular Anesthesia 30.6 (2016): e61-e63.
3. Bustamante, Sergio, et al. "Novel application of rapid prototyping for simulation of bronchoscopic anatomy." Journal of cardiothoracic and vascular anesthesia 28.4 (2014): 1122-1125.
4. Mashari, Azad, et al. "Low-cost three-dimensional printed phantom for neuraxial anesthesia training: Development and comparison to a commercial model." PLoS One 13.6 (2018): e0191664.
5. Shaylor, Ruth, et al. "Virtual reality and 3D printing in clinical anesthesia: A case series of two years’ experience in a single tertiary medical centre." 6. Canadian Journal of Anesthesia/Journal Canadien d'anesthésie 70.9 (2023): 1433-1440.
7. Grandjean, Corinne, et al. "Innovations to improve lung isolation training for thoracic anesthesia: a narrative review." Journal of Clinical Medicine 13.7 (2024): 1848.
8. Gu, Shiyao, et al. "Application of advanced technologies—nanotechnology, genomics technology, and 3D printing technology—in precision anesthesia: a comprehensive narrative review." Pharmaceutics 15.9 (2023): 2289.
9. Fu, Rao, et al. "Dynamic three-dimensional printing: The future of Bronchoscopic Simulation Training?." Anaesthesia and Intensive Care 51.4 (2023): 274-280.
10. Han, Michelle, et al. "A do-it-yourself 3D-printed thoracic spine model for anesthesia resident simulation." PLoS One 15.3 (2020): e0228665.
11. Gauger, Virginia T., et al. "A multidisciplinary international collaborative implementing low cost, high fidelity 3D printed airway models to enhance Ethiopian anesthesia resident emergency cricothyroidotomy skills." International journal of pediatric otorhinolaryngology 114 (2018): 124-128.
12. Jundt, Jonathon S., Christopher C. Chow, and Marcus Couey. "Computed tomography-guided 3D printed patient-specific regional anesthesia." Journal of dental anesthesia and pain medicine 20.5 (2020): 325.
13. Long, Dustin R., et al. "Anesthesia workspace cleanliness and safety: implementation of a novel syringe bracket using 3D printing techniques." Anesthesiology research and practice 2019.1 (2019): 2673781.
Curated by: ASA Committee on Innovation
Date of last update: June 4, 2025
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