Automated "Robotic" Anesthesia Closed Loop System RCT - Thoughts?

[unkemptmiso]

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Recently came across this is the ASA's publication, front page. Any preliminary thoughts? Any glaring deficiencies in the study? Looks interesting, but the technology is definitely way too immature. Thinking sedasys

Anesthesiology

anesthesiology.pubs.asahq.org

 

[IlDestriero]

This technology is available overseas but is DOA in the US 2/2 the FDA.
They don’t want to know that the anesthetic will get to x based on algorithms eventually, they want a dial that says 2% or 200mcg/kg/min.

 

[T-burglar]

I love the concept of robust closed loop systems for anesthetic depth and even hemodynamics like automated pressors and vasodilators. I especially love the idea for a continuous paralytic infusion controlled by a quantitative paralysis monitor. That would be great.

Fluid administration I would personally never automate even if there was a system available. These devices that claim to monitor cardiac output or fluid responsiveness based on a waveform analysis are such garbage.

 

[aneftp]

What happen to mcsleepy robot propofol gi sedation? That died as well. Didn’t it even with fda approval.

 

[deleted875186]

I read the article last week. A lot of assumptions made when deciding the outcome measured. We are assuming depth of prop/Remi intraoperative will have a measurable outcome on date of postop cognitive disorders. Assuming that using an art line with flowtrac and colloid boluses will somehow affect post of neuro status. Assuming making more ventilator changes will somehow affect the outcome as well. I don’t think any of these assumptions are really a slam dunk, and so the trial doesn’t make much sense to me. Perhaps this was the only measurable outcome they could find that was any different between the groups.

 

[dhb]

Takes 30min to set up, the more loops you have the more room for error/ malfunction.
Just set the propofol and paralytics at x ml/mg per hour and call it a day

 

[deleted162650]

Cue @Newtwo in 5, 4, 3, 2 . . .

 

[deleted697535]

Cue @Newtwo in 5, 4, 3, 2 . . .

Well the control group used Schneider/minto TCI algorithms. Since y'all have declared these algorithms are buffoonery and beneath you there is nothing to discuss about this paper.😉

 

[GA8314]

It would be very easy to have a closed loop feedback system whereby you take analog input to a controller from, say, a twitch monitor. Output could easily drive an infusion of a paralytic. Issue is that it's just too easy to do it manually. Automation simply does not lend very well to certain tasks. Others, it does exceptionally well.

 

[dhb]

Well the control group used Schneider/minto TCI algorithms. Since y'all have declared these algorithms are buffoonery and beneath you there is nothing to discuss about this paper.😉

There was no difference in outcome in the 2 groups so the algorithms aren't very important 😉

 

[nimbus]

It would be very easy to have a closed loop feedback system whereby you take analog input to a controller from, say, a twitch monitor. Output could easily drive an infusion of a paralytic. Issue is that it's just too easy to do it manually. Automation simply does not lend very well to certain tasks. Others, it does exceptionally well.

We used that system in residency during the 1990s. The computer was better at maintaining a constant level of NMB when monitoring MMEPs.

https://www.jcvaonline.com/article/1053-0770(94)90010-8/fulltext?mobileUi=0

 

[T-burglar]

I love the idea of a computer controlled level of NMB, I hate having to think about Redosing paralytics

 

[MoMoGesiologist]

I love the idea of a computer controlled level of NMB, I hate having to think about Redosing paralytics

Really? It’s not that hard...?

 

[kidthor]

And yet, they can't seem to invent an infusion pump that doesn't alarm randomly due to "air"...

 

[deleted697535]

There was no difference in outcome in the 2 groups so the algorithms aren't very important 😉

Sorry what? Did we read the same study?
I mean maybe you or anyone else really doesnt care about the outcomes but there definitely was a difference.

 

[nimbus]

The study group got arterial lines and the control group didn’t. My takeaway is that alines prevent cognitive decline but the difference is minor.

 

[dhb]

Sorry what? Did we read the same study?
I mean maybe you or anyone else really doesnt care about the outcomes but there definitely was a difference.

"Whether a 1-point decrease in the 30-item cognition score is meaningful remains an open question. "...

Reading the link i couldn't find out how the points were distributed: did one patient have a big cognitive decline or where all of the patients in the control group lower.

 

[woopedazz]

I just want pulse oximetry that comes with a propofol concentration addon. We could call it "Pro-ximetry"