Anesthesiologists, Meet the Competition: McSleepy

[buckhorn]

New article on the discovery news network site.

New Machine that will deliver anesthesia thus making Anesthesiologists irrelevant.

link;

http://dsc.discovery.com/news/2008/05/13/mcsleepy-anesthesia.html


Anesthesiologists, Meet the Competition: McSleepy

Eric Bland, Discovery News



21st Century O.R.



May 13, 2008 -- The sexy doctors McDreamy and McSteamy from Grey's Anatomy make patients swoon with chiseled jaws and sultry glances. McSleepy, the world's first fully automated anesthesia machine, knocks patients out by administering drugs.
Right now McSleepy "is like a young resident who just started," said Thomas Hemmerling, an anesthesiologist at McGill University in Canada who helped design the device.
"The McSleepy you see in two years," he added, "will be as good as me on my best day."
McSleepy is a computer program hooked up to an anesthesia machine that gets information from sensors deployed across the patient's body. Those sensors monitor the three states that lead to general anesthesia: loss of pain, unconsciousness and muscle relaxation.
The anesthesiologist simply tells McSleepy what level of sedation is needed, and the computer tells the anesthesia machine which drugs, in what combination, to administer.
If a patient begins to wake up, feel pain, or overly relax, McSleepy detects the change and automatically delivers a dose of the appropriate drug to send the patient back to the predetermined level. In scientific terms it's known as a closed loop feedback system.
Shane Sheppard, President of the Canadian Association of Anesthesiologists, says McSleepy is interesting.
"The big advance is the ability to close the feedback loop," said Sheppard. Other anesthetist machines have been able to monitor drug levels in the blood, he added, but this is the first to administer drugs in response to drug levels in the patient.
In other words, it's like cruise control for anesthesiology and should ensure a less bumpy ride for patients under the knife.
Like cruise control is better for the highway than the city, McSleepy is better for long surgeries than short ones.
Some drugs used in anesthesiology are quickly metabolized by the body and have to be replaced by the anesthesiologist as often as every 30 minutes. Managing all of the different drugs required can quickly consume all of an anesthesiologist's time during long surgeries.
"In surgery you don't want to concentrate on the anesthesia, you want to concentrate on the patient," said Hemmerling.
McSleepy won't put anesthesiologists out of a job just yet. Letting McSleepy cruise along frees the anesthesiologist to monitor electrolyte levels, blood loss, patient temperature and a host of other things that need to be watched. An anesthesiologist is also needed on hand if complications arise during surgery, and to help put the patient under general anesthesia and then bring them out again.
So far, McSleepy has been used on 10 patients. Hemmerling plans to expand its use to more than 2,000 patients over the next couple of years.
Patients have been receptive, he said.
"Our initial thought was that patients would be more afraid," he said. "But technology is such an important part of our everyday lives, and patients expect us to go to the next level."

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[Planktonmd]

This thing is basically 3 pumps controlled by a laptop computer, and is being presented as the future solution to replace anesthesiologists!
It's very sad how simplistic is the lay public's understanding of what we do.
In my opinion, the chances of any computer solution to replace the human operator in the anesthesia setting are comparable to the chances of auto pilots flying airplanes without a human in the cockpit.

 

[Salt Creep]

It's very sad how simplistic is the lay public's understanding of what we do.

I agree completely, and I think this is a potential source of real monetary problems for us going forward (public ignorance, not pumps on a laptop).

I'd love to see some well-designed PR campaigns to help with the public perception of what we do, and what it takes to get there.

 

[CerebralEdema]

I agree! This is the most ******ed thing I have ever seen. We still have to do all of the work! Who's going to unobstruct the airway, who's going to start IVs and put lines in, who's going to make critical decisions on regulating hemodynamics, which pressors to use and when to use them dependent upon the case. In this case, a machine will never be able to do everything that we do.

I'm so happy our jobs are safe, ... now let me get back to my crossword puzzle.

 

[Taurus]

The machine won't replace the anesthesia team.

Although, it does possibly reduce the need for babysitters for straight-forward cases.

If CRNA's are costing > $200k after benefits for primarily sitting on stools, there is a lot of incentives to replace them with something automated. A hospital with dozens of CRNA's can easily save millions. Let's face it. It's not that complicated to develop an automated anesthesia system.

So far, McSleepy has been used on 10 patients. Hemmerling plans to expand its use to more than 2,000 patients over the next couple of years.​

Yes, very interesting indeed. CRNA's have much more to worry than anesthesiologists. Being periop doctors will be more important than ever in the future.

 

[Bougie]

Anyone else tired of all this replacement crap? Yesterday we were going to be replaced by nurses, today we're going to be replaced by Johnny 5, and tomorrow we'll be replaced by a genetically enhanced C. elegans.

I say let them replace us. All anesthesiologists should take 6 month long vacations to Aspen, Maui, or Vegas and let our minions run the show. Heck, I'll even take it without pay. When patients start dropping like flies across the country and they start begging us to put down our drinks and get back to the OR, we won't have to deal with this sh** for at least another couple decades.

<Noyac boots Bougie between the uprights and into the CRNA bashing section. The crowd goes wild.....>

 

[stewiegriffinFG]

Anyone else tired of all this replacement crap? Yesterday we were going to be replaced by nurses, today we're going to be replaced by Johnny 5, and tomorrow we'll be replaced by a genetically enhanced C. elegans.

NO, we are not tired of this replacement crap. This is our career, our future, and our livelihood. You can't just close your eyes, cover your ears, and say "lalalalala, I can't hear you" and expect the idea of replacement/efficiency to go away magically. It is the nature of an economy to seek increased efficiency. We just need to figure out how to use it to our advantage.

 

[Taurus]

We just need to figure out how to use it to our advantage.

Automated anesthesia systems are part of the solution and anesthesiologists need to take advantage of them.

It's a foregone conclusion that the days of stool sitting by anesthesiologists are gone. With these automated systems, the days of stool sitting by anyone are coming to an end as well. If the actual delivery of gas becomes a smaller portion of anesthesia, then periop medicine will be emphasized more and that is where having gone to medical school and residency will count.

Like I said, I see a whole lot of incentive to develop such a system. Manufacterers will make a killing selling these machines. Hospitals will save a bundle by getting rid of a lot of CRNA's. Even if these machines sell for $50k a piece, both sides come away smiling big. The biggest losers will be CRNA's who are overpaid stool sitters.

Even pharmacists have to contend with technology that is making some aspects of their job obsolete

 

[coprolalia]

Maybe we should be seeing this as a way to help us do our jobs better...



-copro

 

[OB1🤙]

In the model of the "virtual ICU," I can see how it would be a reasonable possibility. You could have teams consisting of an anesthesiologist and a small band of AAs running "virtual" ORs from a central location with monitors, video screens, and bed movement controls.

These machines could do their thing, but would require the MD/DO hitting a confirm key before a change went into effect.

The doc could manually direct the machines to give whatever drug he wanted.

If something physical needed to be done, an AA could be sent to do it.

If things went downhill in a room and the anesthesiologist's immediate attention was required, there could be some kind of "autopilot" these machines could go on, with a backup system set to automatically send a page for abnormal vitals on another patient. That or an AA could man the monitors and page the doc for any badness.

Or something.

 

[Taurus]

In the model of the "virtual ICU," I can see how it would be a reasonable possibility. You could have teams consisting of an anesthesiologist and a small band of AAs running "virtual" ORs from a central location with monitors, video screens, and bed movement controls.

These machines could do their thing, but would require the MD/DO hitting a confirm key before a change went into effect.

The doc could manually direct the machines to give whatever drug he wanted.

If something physical needed to be done, an AA could be sent to do it.

If things went downhill in a room and the anesthesiologist's immediate attention was required, there could be some kind of "autopilot" these machines could go on, with a backup system set to automatically send a page for abnormal vitals on another patient. That or an AA could man the monitors and page the doc for any badness.

Or something.

Bingo!

To truly take advantage of these machines, the layout of the OR's need to be modified to a hub-and-spoke design where the OR's are the spokes and the central hub is an anesthesia control room where the anesthesia team is monitoring all OR's and ready to go to any room at a moment's notice if something is amiss.

 

[TX515]

That is really cool.

 

[Taurus]

I see a serious business opportunity here. If someone can develop such a system, he'll be cruising the world in his private yacht for the rest of his life because it's easy to see that there'll be such a huge demand for this. There's just so much fat to trim when you're paying >$200k to sit on a stool. Just think of all the OR's out there.

 

[me454555]

They can't even make a machine that reads EKGs correctly, I have my doubts about this

 

[stewiegriffinFG]

They can't even make a machine that reads EKGs correctly, I have my doubts about this

Several factors for this, the most important being that there is quite a bit of interference and data variability that it is VERY easy for the analytical program to make a wrong analysis. Human brains are much more tolerable to this variability and can see patterns where that machines can not figure out quickly.

It's why radiology is very difficult for anything but a human. Too much variability and not enough quantification. Image processing, especially processing images with low consistency, by computers is a long way off.

Monitoring vital signs and amounts of drugs are different from these other things. The data are reliable and consistent for the most part. EEG and all that, understandably, might be much less consistent. I wonder if computer can analyze the rough transitions of deep sleep and REM sleep. (I think it's possible for the most obvious features of sleep...)

 

[TecmoBowl]

Wow! I noticed some of the veteran posters didn't even bother with this! Maybe speechless about this insanity? Anyways, just wanted to pose the notion that surgeons will be replaced by robots before we are replaced by robots/machines. What we do is still (and will always be) cerebral to a large extent, not just analyze numbers and act accordingly. We analyze the situation, no robot/machine can do that. What surgeons do however, can be replaced- again only the mechanical part, not the cerebral part. Contrary to popular belief, they have to think sometimes as well. Artificial intelligence and "The Jetsons" becoming a reality will happen before this even REMOTELY enters a hospital. This would be one QUICK way for any healthcare company to loooo$$$e. Man why did you post this???!!! It is cool though. I like the discovery channel myself, well the history channel and also the playboy channel if I actually ever ordered it!

 

[filter07]

Surgeons won't be replaced by robots in the near future.

Anesthesiologists are already being replaced by robots (CRNAs).

 

[Taurus]

Monitoring vital signs and amounts of drugs are different from these other things. The data are reliable and consistent for the most part.

Exactly. As someone who developed automated systems in my previous life, the most important thing is the input to the system. If you trust it, then automation is very possible. From my time in the OR watching residents and CRNA's, I don't see why such a system could not be developed to automate some tasks such as adjusting the delivery of gas/drugs and keeping the patient on a smooth path. This system that they wrote about basically shows that it is quite possible. Such a system would not replace anesthesiologists or CRNA/AA's necessarily. However, it would decrease significantly for each room to have a stool sitter, ie, CRNA mostly. One team will go from room to room setting up patients and hooking them up to machines and going to rooms that need attention. Another team will monitor all OR's remotely.

 

[Iquitos]

I agree! This is the most ******ed thing I have ever seen. We still have to do all of the work! Who's going to unobstruct the airway, who's going to start IVs and put lines in, who's going to make critical decisions on regulating hemodynamics, which pressors to use and when to use them dependent upon the case. In this case, a machine will never be able to do everything that we do.

I'm so happy our jobs are safe, ... now let me get back to my crossword puzzle.

I sure hope it won't be CRNA's

 

[Iquitos]

Surgeons won't be replaced by robots in the near future.

Anesthesiologists are already being replaced by robots (CRNAs).

I know, It's disgusting.

 

[Iquitos]

Automated anesthesia systems are part of the solution and anesthesiologists need to take advantage of them.

It's a foregone conclusion that the days of stool sitting by anesthesiologists are gone. With these automated systems, the days of stool sitting by anyone are coming to an end as well. If the actual delivery of gas becomes a smaller portion of anesthesia, then periop medicine will be emphasized more and that is where having gone to medical school and residency will count.

Like I said, I see a whole lot of incentive to develop such a system. Manufacterers will make a killing selling these machines. Hospitals will save a bundle by getting rid of a lot of CRNA's. Even if these machines sell for $50k a piece, both sides come away smiling big. The biggest losers will be CRNA's who are overpaid stool sitters.

Even pharmacists have to contend with technology that is making some aspects of their job obsolete

Priceless! I sure hope this will be the trend. The sooner the better.

 

[LostTommyGuns]

Where does Skynet and it's minions the Terminators fit in...?

Personally I think this is a great step - replace Anesthesiologists with computers connected to pumps, possibly computers based in India (for cost's sake) and replace Surgeons with 6-7y children who have proven their adeptness at surgery through a Nintendo Wii surgery game. Indian children. Obviously. (I presume given their age they will be equally as competent at throwing temper tantrums as their older, more experienced counterparts)

 

[toughlife]

Exactly. As someone who developed automated systems in my previous life, the most important thing is the input to the system. If you trust it, then automation is very possible. From my time in the OR watching residents and CRNA's, I don't see why such a system could not be developed to automate some tasks such as adjusting the delivery of gas/drugs and keeping the patient on a smooth path. This system that they wrote about basically shows that it is quite possible. Such a system would not replace anesthesiologists or CRNA/AA's necessarily. However, it would decrease significantly for each room to have a stool sitter, ie, CRNA mostly. One team will go from room to room setting up patients and hooking them up to machines and going to rooms that need attention. Another team will monitor all OR's remotely.

I like it.

 

[Taurus]

you are not far off and I agree with your ideas about making this a reality.

The first who capitalizes on this and mass-produces these machines will make hundreds of millions of dollars. Just imagine how many OR's in this country and around the world that you can put these machines in. If that ain't incentive, then I don't know what is.

Bottom line, the concept of periop medicine is even more important in the future.

 

[toughlife]

The first who capitalizes on this and mass-produces these machines will make hundreds of millions of dollars. Just imagine how many OR's in this country and around the world that you can put these machines in. If that ain't incentive, then I don't know what is.

Bottom line, the concept of periop medicine is even more important in the future.

Absolutely! Whoever thinks sitting in the OR is the future is banking on a dream. Hospitals may own hundreds of these machines someday and they won't need an anesthesia dept. except for a few dudes to run these machines. The key in being successful will be to sell the idea of the perioperative physician who can manage any medical issue that arises with surgical patients. These is where the skills that MMD talked about would come in handy..regional, TEE, bronch, critical care, etc. The new OR stool sitter will be MCsleepy.

 

[Apollyon]

http://www.msnbc.msn.com/id/22509081/

From an outsider's perspective, I totally see what other anesthesiologists are saying. People in the ivory tower that "reinvent the wheel" on every case, or who say that it's "trade secrets" or "knowledge specific to specialists" are overstating their case. How many cases in anesthesia - or in medicine itself - need a doctor - specifically and urgently? 5%? 10% maybe - max?

The link posted is about a seaplane that can autonomously take off, fly, and land in the ocean, in moderate seas. This is today, and this is unclassified stuff.

You have to have your head deeply in the sand if you really think that an intubating robot won't be doing most of the cases - algorithm-driven sensor looking at the airway and a CO2 sniffer? Done. Some MDA (or, to really stick some peoples' craws, a doctor who is NOT an anesthesiologist, or maybe even just a PhD) will work with an engineer, make this happen, and become a gazillionaire, while the people saying "You can't do that!" won't have their contracts renewed (or at reduced remunaration rates).

Be on the bus, or be under it. Think about 150 years ago, when general anesthesia wasn't even thought of.

 

[FireCloud9]

delete

 

[Apollyon]

remuneration

I can't believe it took me 20 months to see and correct that spelling goof.

edit: and I see Firecloud deleted his post in the time it took me to post that. I have a copy of his post; there's nothing offensive or challenging in it, and it's actually rather perceptive.

 

[Monty Python]

This thing is basically 3 pumps controlled by a laptop computer, and is being presented as the future solution to replace anesthesiologists!
It's very sad how simplistic is the lay public's understanding of what we do.
In my opinion, the chances of any computer solution to replace the human operator in the anesthesia setting are comparable to the chances of auto pilots flying airplanes without a human in the cockpit.

Speaking as a licensed pilot, the time cruising at altitude is generally robotic. The excitement, and time of most incidents, is either takeoff or landing.

Same with anesthesia ... most issues rear their ugly heads at induction or emergence.

Before you know it, these anesthesia machines will be pushing for their own independent practice rights, led by their association president HAL 9000. They believe IT managers are unnecessary.

I have a huge personal bias against more things in the OR which require an electrical outlet. When I started years ago we had a simple red cart with our anesthesia supplies and drugs. Now everything is in the pyxis (one in each OR), which twice in the last month gave me the blue screen of death in the middle of trauma cases. The master pyxis in our workroom (programmed, stocked, and maintained by pharmacy) tries to dispense vials from drawers which are empty if pharmacy isn't careful when re-stocking and re-inventorying. It's a royal pain in the a@@ working with this crap, and I see these automated anesthesia gizmos falling into the same category. Wonderful technology, cutting-edge engineering .... just like the Space Shuttles Challenger and Columbia. Fallible, potential for becoming unreliable, and requiring constant human oversight.






.

 

[cfdavid]

Speaking as a licensed pilot, the time cruising at altitude is generally robotic. The excitement, and time of most incidents, is either takeoff or landing.

Same with anesthesia ... most issues rear their ugly heads at induction or emergence.

Before you know it, these anesthesia machines will be pushing for their own independent practice rights, led by their association president HAL 9000. They believe IT managers are unnecessary.

I have a huge personal bias against more things in the OR which require an electrical outlet. When I started years ago we had a simple red cart with our anesthesia supplies and drugs. Now everything is in the pyxis (one in each OR), which twice in the last month gave me the blue screen of death in the middle of trauma cases. The master pyxis in our workroom (programmed, stocked, and maintained by pharmacy) tries to dispense vials from drawers which are empty if pharmacy isn't careful when re-stocking and re-inventorying. It's a royal pain in the a@@ working with this crap, and I see these automated anesthesia gizmos falling into the same category. Wonderful technology, cutting-edge engineering .... just like the Space Shuttles Challenger and Columbia. Fallible, potential for becoming unreliable, and requiring constant human oversight.






.

I used to be in the industrial automation industry. I can say from first hand experience that just because something is technologically feasible, doesn't mean it's ever going to be implemented. Often, the more complicated a system becomes, the more problems (and troubleshooting) there become.

In many instances of advanced technology, customers would often prefer (with a cost justification) to revert back to KISS.

 

[Narcotized]

.

 

[jwk]

Anything that might replace CRNA's I'm in favor of. We will still be needed to put the tube in, sign the chart, and give the machines morning and afternoon breaks, so I'm not worried about it replacing docs. But when I say don't give anymore narcotics and keep the blood pressure, heart rate, and ventilatory pressure at such and such levels, it's actually going to listen to me and do as asked!! Can I get a few fed-exed to where I work?

If you program the machine to do nothing without asking, which is apparently what you want your CRNA's to do, then what good is it?

 

[Narcotized]

.

 

[jwk]

You are putting words in my mouth that were neither spoken nor implied.

Ah c'mon - sure you did.

As far as the machine - it simply responds to input from monitors. BFD. It can't intubate, start IV's or place A-lines, position the patient, pad the pressure points, put a bair-hugger on, etc., etc. That's one of the reason automated record-keeping systems haven't taken off - they still require LOTS of input over an above what the system can pull from the various monitors.

 

[Monty Python]

New article on the discovery news network site.

New Machine that will deliver anesthesia thus making Anesthesiologists irrelevant.

link;

http://dsc.discovery.com/news/2008/05/13/mcsleepy-anesthesia.html

I wonder what sort of new malpractice / liability issues this will create? I see an ambulance-chasing plaintiff attorney sending subpoenas to software writers, laptop computer manufacturers, etc etc. This could open up an entirely new chapter in medical jurisprudence.

 

[Narcotized]

.

 

[Taurus]

Ah c'mon - sure you did.

As far as the machine - it simply responds to input from monitors. BFD. It can't intubate, start IV's or place A-lines, position the patient, pad the pressure points, put a bair-hugger on, etc., etc. That's one of the reason automated record-keeping systems haven't taken off - they still require LOTS of input over an above what the system can pull from the various monitors.

Of course automation won't replace intubation, starting IV's or A-lines, etc. But what percentage of the total OR time do you spend doing those tasks? Not much. Think of the airplane analogy. You need the pilot for take-off and landing. The rest of the time you can put it on cruise control. If automation is implemented, you'll need two teams. One to put pt to sleep and then wake-up. Another to monitor, which can be centralized so that you don't need a stool-sitter in each room. I still believe my hub and spoke model makes most sense because it allows quick access to any of the rooms from a central point.

 

[Apollyon]

Think of the airplane analogy. You need the pilot for take-off and landing.

Your analogy is failing, because technology is advancing. The RQ-4 Global Hawk is FAA-certified for fully autonomous flight: the program is entered, and it is then hands-off, from takeoff to landing. As for something with humans on board, there is a fellow with whom I work this evening who was in Army aviation in his prior life. We had broached this in the recent past, and he said that one of the Airbus models now will apply the brakes.

As to my prior statement posted above, a "tubing machine" is in the future: a device attached at the mouth (or just set on the mouth) with a CCD/chemical seeker/sniffer - looks for a "typical" airway - as most tubes are straightforward, especially if the patient has been NPO and premedicated, and places a bougie-type element, and a tube passed over it. The chemical sniffer smells for CO2, and pressure volumes are measured, along with a pH probe, and monitoring SaO2. In one unit, ventilation is measured, it can check for puke, a suction catheter can be right there, and the airway doesn't get mashed/ground up.

The number one thing has to be reliability; the machine will be a dud once it kills a patient or makes the patient brain-dead from tubing the goose. However, everyone has heard stories of 30 years ago, with anesthesiologists gauging SaO2 by the color of the blood, and an African-American boy ending up hypoxic.

What I'm saying is that it will happen. When, I cannot say. If I had the tubing machine for the 320lb asthmatic edentulous lady in my outpost-like standalone ED (where I don't believe an anesthesiologist has ever set foot) several days ago, the tube may have gotten in more quickly. As it was, I did set out a plan, and we went right down the chain. Mac4, to Miller 3, to bougie, which failed me, to my colleague, who had two methods, and, finally, to the visiting EM3, who, in good resident fashion, was polite, deferential, and courteous (and a bit mousy), and ended up getting the tube in place. We ventilated the patient well in between attempts, and didn't spaz.

She was alive when we transferred her. I don't yet have an update.

 

[Substance]

I don't think anaesthesia has anything to worry about.

If machines start being used, the malpractice liability will fall directly on the hospital and on the company that makes the machines, not on the physician.

Hospitals will not like this. One screw-up would cost the hospital multiple millions.

So, hospitals will still use MD and CRNA anesthetists to absorb the liability.

 

[Licoricestick]

I don't think anaesthesia has anything to worry about.

If machines start being used, the malpractice liability will fall directly on the hospital and on the company that makes the machines, not on the physician.

Hospitals will not like this. One screw-up would cost the hospital multiple millions.

So, hospitals will still use MD and CRNA anesthetists to absorb the liability.

But how many will they need to employ? 1 CRNA to 4 machines and 1 anesthesiologist to 4 CRNAs?

Obviously the machines will all have remote display capabilities... the 5 humans can all sit on stools in a windowless little room and watch monitors...that's a novel idea isn't it?

Apollyon - well done on getting the tube in, but would an intubating machine a) even be bought for that sort of location and b) actually be useful, seeing as the woman probably had an abnormal airway?

As for the airline analogies, all analogies fall down somewhere, but I still think we have a lot to learn from the airline industry, just not in relation to automation. As a profession we would do very well to learn from their safety processes that are designed to minimise the chance of human error occuring and maximise error detection. We would also benefit from the same sort of simulation training as pilots do. I know I'd much rather treat my (hopefully never eventuating for real) first MH in a dummy in a reasonably high fidelity simulator, than in a real person. I certainly benefited from sim training as an intern in terms of assessment and treatment of life threatening ward issues (VF, resp arrest, massive post op haemorrhage...).

 

[jwk]

As for the airline analogies, all analogies fall down somewhere, but I still think we have a lot to learn from the airline industry, just not in relation to automation. As a profession we would do very well to learn from their safety processes that are designed to minimise the chance of human error occuring and maximise error detection. We would also benefit from the same sort of simulation training as pilots do. I know I'd much rather treat my (hopefully never eventuating for real) first MH in a dummy in a reasonably high fidelity simulator, than in a real person. I certainly benefited from sim training as an intern in terms of assessment and treatment of life threatening ward issues (VF, resp arrest, massive post op haemorrhage...).

A lot of programs have introduced sim training into their curriculum, or are planning to do so.

Although there are many similarities with the airline industry, it's not like anesthesiology hasn't made light-year jumps in the last 30-40 years ago. The overall mortality for anesthesia is now somewhere in the 1 in 250k range. 50 years ago, the mortality rate for tonsillectomies was 3% !!! When I started in anesthesia, there was no pulse ox, no EtCO2 monitoring, and I had plenty of experience with copper kettles and sidearm vaporizers, red-rubber Carlen's endobronchial tubes, and had to get each individual item needed to insert a PA catheter out of it's own sterile pack because nothing was pre-packaged.

And let's remember that the airline industry certainly has it's own issues. In-flight near-misses and runway incursions are daily occurrences, and apparently so are bird strikes and sloppy maintenance practices as a way of saving money - all of which are under-reported.

 

[Apollyon]

Apollyon - well done on getting the tube in, but would an intubating machine a) even be bought for that sort of location and b) actually be useful, seeing as the woman probably had an abnormal airway?

You don't know our boss.

 

[Taurus]

All it takes is one hospital to show that automation works and saves money by decreasing staffing needs and it would be become the standard across the nation in a few years. At first, it will be the simple cases. As the technology improves and people are more comfortable, more complex cases will be added. People are right when they say that anesthesia is so different today than it was 30-40 years ago. Well, anesthesia will also be different in 30-40 years from now too.

 

[cfdavid]

Like the old cliche goes, the only constant is change. With technology, it's really hard to predict how things will pan out, or what will take shape. Too many variables to reliably predict specific scenarios. Things will change, but professions will adapt in kind.

Maybe we start seeing more electronics, software training in anesthesiology?? Who knows.

 

[Dogdaze]

Since it's past 1999 we're all driving air cars, using personal jet packs, and have personal valet robots a la "Lost in Space" (Danger Will Robinson!).

... or not.

As someone posted, the more advanced an automated ("expert") system is, the more chance for error (e.g., Space Shuttles). They are pretty high tech, and they have at least two qualified pilots on each flight. Also, their catastrophes happend during "automated" time, not pilot time.

As someone posted just because it's technically feasible does not mean it will be mass produced.

Just don't see happening anytime soon, maybe off in some Buck Rodgers future...

 

[Taurus]

A step closer to automation in anesthesia and the realization of my prediction.

McGill doctors administer anesthesia from Montreal — all the way to Italy

By Glenn Johnson, Postmedia News September 10, 2010

A team from Montreal's McGill University has pioneered a medical first by administering anesthesia via remote teleconferencing for surgery that was taking place in Pisa, Italy.

On Aug. 30, Dr. Thomas Hemmerling and his team from McGill's anesthesia department treated patients undergoing thyroid gland surgery in Italy, putting them to sleep remotely from a control room in Montreal.

"The practice has obvious applications in countries with a significant number of people living in remote areas, like Canada, where specialists may not be available on site," Hemmerling told Postmedia News in an interview Friday.

"Up North, you might have a GP (General Practitioner) or anesthesiologist all on his own. Now, if you have the video you can have an expert team."

Hemmerling said the ability of local medical professionals to use a team of experts from another centre has implications for the military and for countries such as Rwanda, where there are fewer than 10 anesthesiologists serving the entire country.

"The idea is if they have difficult cases, they definitely benefit to have some kind of remote control and monitoring."

The approach is part of technological advancements, known as 'Teleanesthesia,' and involves a team of engineers, researchers and anesthesiologists. Medical staff on-site start an intravenous line and then the dosage is controlled remotely through an automated system.

The procedure followed ongoing scientific collaboration between Hemmerling's team and Dr. Cedrick Zaouter and Prof. Francesco Giuntathe of Pisa University's anesthesia department.

Using four video cameras, the medical team in Montreal was able to monitor every aspect of patient care in Italy in real time.

Live images of the surgery, along with the patient's breathing rate and vital signs are monitored by each camera.

In Montreal, a remote computer station known as the 'anesthesia cockpit' is used in conjunction with a workstation that handles the audio-video link between the two centres.

Prior to the operation, an assessment of the patient's airway and medical history is also performed via video-conferencing.

Hemmerling said at one time, invasive blood tests or other tests were required in preparation for many surgeries, but that's no longer the case. Many patients take long journeys and often wait hours to see an anesthesiologist who will ask them specific questions. Video-conferencing, however, could eliminate that and reduce the stress of in-patients, prior to surgery.

"The next steps will be to confirm the results of this pilot experience with further studies," Hemmerling said.

He said the project has received funding for three years to develop standards and protocols for remote anesthesia.

"This is just a proof of concept," he said. "The second step is to standardize all the different parts of what we are doing, lighting, camera placement, to compare the performance of remote anesthesia to local anesthesia."

"It could also be used for teaching purposes, allowing the resident to perform tasks without the physical presence of a tutor, thus increasing his or her confidence level," Hemmerling said.

The Montreal-Pisa experiment furthers the knowledge learned from telemedicine, which uses interactive audiovisuals for diagnosing, examining and consulting with patients in remote areas.

The idea of remote medicine goes back at least to the early 1900s when radios were used to help people communicate with the Royal Flying Doctor Service, an emergency and primary health-care service for those living in rural, far-flung areas of Australia.​

 

[CrazyJake]

Today...when my pt coded on the table during surgery...I'm not sure McSleepy would have known what to do.

I like my chances.

CJ

PS - she lived..Mcsleepy would still be analyzing.

 

[Bertelman]

Today...when my pt coded on the table during surgery...I'm not sure McSleepy would have known what to do.

I like my chances.

CJ

PS - she lived..Mcsleepy would still be analyzing.

I wouldn't be so confident. McSleepy would have pushed a couple amps of epi, maybe shocked her. What more do you need?

Of course, all of that would have happened after the humans in the room started the code. Hope they heard McSleepy yell "CLEAR!"

 

[Taurus]

What's that sound? It's 40k CRNA's gasping in horror.

FDA Reconsiders Approval of Personalized Sedation System
By Rachel Fields | December 06, 2010

The Federal Drug Administration has granted an appeal by Ethicon Endo-Surgery to reconsider approval of the Sedasys System, a computer-assisted personalized sedation system, according to a Gastroenterology & Endoscopy News report.

The FDA has granted such an appeal only once before, more than 20 years ago, according to the report.

The system would provide automated, minimal-to-moderate propofol sedation for patients undergoing colonoscopy and upper GI procedures. The device would also allow gastroenterologists and nurses to administer propofol without the supervision of an anesthesiologist.

Some experts have expressed concern about the safety of the device, saying the Sedasys system administers propofol in doses known to produce general anesthesia, not "minimal to moderate sedation" as advertised. Proponents say the device could cut costs associated with colonoscopies and upper GI procedures and that propofol is becoming the anesthesia of choice.

Read the Gastroenterology & Endoscopy News report on the Sedasys System.
​

 

[JaggerPlate]

Does anyone else want to live in a world where a BC DO/MD and not a nurse or an effin robot provides anesthesia for friends, family, and self???