Category: Technology

Elucidating the Mechanisms of Anesthesia

The Anesthesia Blog has tended to attract a certain tech-geek type of anesthesia provider.  We have attempted to cater to our audience by highlighting anesthesia tech products, smartphone apps and advances in our field.  Like many who sit and ponder about all things anesthesia, we’ve often wondered how anesthesia actually produces its desired effect?  Meyer-Overton was a nice thought but proven too simplistic.   Last we heard it had something to do with meddling with the lipid bilayer sandwich…but nobody seems to know for sure.

In a provocatively titled article in Scientific American called “What Doctors Don’t Understand About Anesthesia” we dive deeper into an interesting revelation into the effects of anesthesia on the brain:

Highlighting these fundamental gaps in knowledge, a group of researchers recently made a surprising discovery about how we transition out of consciousness and back. The common view holds that going under (induction) and coming back up (emergence) are the same process, albeit in different directions. However, a recent study published in the journal PLoS ONE suggests that going under is not the same as coming back up.

The researchers, led by Dr. Max Kelz at the University of Pennsylvania School of Medicine, observed that less anesthetic is required to keep the brain anesthetized than to induce unconsciousness. To explain these observations, the researchers have introduced a concept they call “neural inertia,” referring to the brain’s resistance to transitions between consciousness and unconsciousness. Elucidating the mechanisms of neural inertia could be critical to the task anesthesiologists perform every day, namely preventing patients from experiencing pain or awareness during surgery and in helping those patients who exhibit delays returning to the conscious state. This line of research could also provide insights into disrupted states of consciousness like coma.

Excellent work by Dr Kelz.  Thanks for adding to our understanding.

Feb 29, 2012 | 0 comments View Post

iPhone App Review: Anesthesia Drugs Fast

Review by contributing author Tech Nick Lee:

Anesthesia Drugs Fast is an app for the iPhone, iTouch and iPad. It is designed as a point-of-care utility for calculating dosages for the most common anesthesia drugs. There is no Android version at this time.

Review:

One of the tenets of a well-designed app is simplicity and elegance. This is a single view app with only one control: the weight selection. Unlike other apps where you have to navigate through different screens to get information, everything is presented on one page.  Choose the patient’s weight from 1 to 200 kilograms, and this app will immediately give you a dosage range.

 

The drug categories are induction agents, muscle relaxants, sedatives, antiemetics and basic resuscitation medications. It gives you intravenous and intramuscular dosages for some of the medications. By touching the information button you can see the formulas used for the range calculation. With just one selection control and one page view, I found I could determine the proper dose while running down a hallway. It was that easy.

 Pros:

  1. Probably the easiest to-use app I’ve seen.
  2. Simple presentation, packed with the most common drugs on a single page.
  3. Only one selection needed to get drug dosages

 Cons:

  1. An Android version is lacking

Conclusion:

This is a well-designed app for the anesthesia provider. While those new to anesthesia will find it invaluable, seasoned clinicians will find it useful for pediatrics and bariatrics. It is so easy to use you can determine the correct dosage range while running down the hallway to a code.

Feb 13, 2012 | 0 comments View Post

Noninvasive Continuous Total Hemoglobin in the OR?

Tech-y things that should happen in the OR but don’t:

1) Electronic record accessible via touchscreen that shows a given patient’s entire medical history including every radiologic study they ever had and every encounter with any health care provider at any institution.

2) Voice recognition bed control so when the surgeons asks for the table up it happens without anesthesia intervention.

3) Wireless ASA monitors.

4) A reliable noninvasive way to monitor analgesia, CBC, lytes, Blood gases, cardiac output, cerebral/myocardial perfusion. etc etc.

It would be fairly reasonable to assume the many of these things won’t happen anytime soon.  Or will they?:

From Masimo press release:

Irvine, California – January 9, 2012 – Masimo today announced FDA 510(k) clearance and full market commercial launch of the Masimo Pronto-7®—a palm-sized handheld device designed for quick and easy noninvasive spot-checking of total hemoglobin (SpHb®), SpO2, pulse rate, and perfusion index.

This is not the first effort by our friends at Masimo to make most monitoring non-invasive.  Keep up the good work and I sincerely hope to see same papers testing the efficacy of this product in the OR.

Product info.

Jan 19, 2012 | 0 comments View Post

Optical Blood Pressure Measurement Is Here

The monitoring of physiology is an important aspect of what we do within anesthesiology. It is almost unfathomable to the new trainee that pulse oximetry has only fairly recently become the standard of care. The measurement of blood pressure has evolved as well. A finger on the radial pulse slowly gave way to the sphygmomanometer. Subsequently, the anesthesia provider soon scoffed at the idea manually auscultating the Korotokoff sounds once oscillometric devices were invented. In what could be the next step in this evolution:

TLT [Tarilian Laser Technologies] has also successfully completed the outstanding break-through development of a stand-alone CUFFLESS device that can not only deliver highly accurate blood pressure readings almost anywhere in the body — but can also deliver key information about the entire arterial tree as well as the heart.

This device is in the preemie stages of development and is not likely to appear in an OR near you anytime soon but the demo looks pretty darn compelling:

Image: jscreationzs / FreeDigitalPhotos.net

Jan 08, 2012 | 0 comments View Post

Anesthesia and Operating Room Distractions

Much has been written about distracted driving, texting while driving, etc. etc..  The fatality rate of those that text while driving has gone up every year since the cellular telephone was invented.  Just recently, the NTSB has gone so far as to recommend an all out ban on cellular phone use in the car.

Apparently the human brain cannot multi-task as well as it thinks it can.  We also see evidence of this everyday in the operating room.  I have personally witnessed a colleague text his wife in the middle of inducing a patient (!).  This type of behavior has been going on at some level behind the ether screen for as long as there have been ether screens.  The only difference now is what once looked like this:

 


….can now be hidden in your pocket.

The New York Times published an article today called “As Doctors Use More Devices, Potential for Distraction Grows” by M. Richtel.  In the article he describes the dangers inherent in “distracted doctoring” and the efforts to ban device use altogether.  The article describes the influx of technology throughout the hospital but does indeed focus on us guilty gas passers:

“I’ve seen texting among people I’m supervising in the O.R.,” said Dr. Stephen Luczycki, an anesthesiologist and medical director in one of the surgical intensive care units at Yale-New Haven Hospital. He said he had also seen young anesthesiologists using the operating room computer during surgery.

“It is not, unfortunately, uncommon to see them doing any number of things with that computer beyond patient care,” Dr. Luczycki said, including checking e-mail and studying or entering logs on a separate case. He said that when he was in training, he was admonished to not even study a textbook in surgery, so he could focus on the rhythm and subtleties of the procedures.

When he uses computers in the intensive care unit, he regularly sees what his colleagues were doing before him.

“Amazon, Gmail, I’ve seen all sorts of shopping, I’ve seen eBay,” he said. “You name it, I’ve seen it.”

Dr. Luczycki is also a huge fan of technology’s positive impact on medicine. So, too, is Dio Sumagaysay, administrative director of 24 operating rooms at Oregon Health and Science University hospitals, even though he has heard about or witnessed instances of people using devices during critical moments.

In early 2010, he heard several complaints that doctors or nurses were using their phones to check or send e-mails even though they were part of a team intubating a patient before surgery.

Mr. Sumagaysay established a policy to make operating rooms “quiet zones,” banning any activity that was not focused on patient care. He later had to reprimand a nurse he saw checking airline prices using an operating room computer during a spinal operation.

An all out ban would be silly, the peripheral brain aspect is too valuable to give up entirely.  The problem is we lose site of what we are doing and maybe whatever your significant other has to say can wait until AFTER induction…you think?

The article also goes on to describe a neurosurgeon who made 10 phone calls on his bluetooth headset during surgery.  The patient had a bad outcome, sued and won.  Can you hear me now? Not from jail, no.

Comments?  Should we ban all personal tech from the OR?

 

 

Image: Idea go / FreeDigitalPhotos.net

Dec 15, 2011 | 0 comments View Post

Moore’s Law and Anesthesia

Moore’s Law is a well-known axiom amongst the tech-geek set.  It states that your iPhone will get smaller every year until it disappears.  No really, Moore’s law describes a long-term trend in the history of computing hardware: the number of transistors that can be placed inexpensively on an integrated circuit doubles approximately every two years (or 18 months), and thus making your iPhone smaller every year.

This, of course, applies to anesthesia tech as well.  I have previously blogged about the Vein Viewer.  The VeinViewer uses near-infrared light and other technologies to detect subcutaneous blood and create a digital image of the patient’s superficial vein pattern projected directly onto the surface of the skin in real time.  It’s a pretty neat device who’s original dimensions and cost made it damn near useless on a practical level.  Thanks to Moore’s law and perhaps the desire to actually sell a few of these devices we know have the Vein Viewer Flex.

From The Christie Medical’s Website:

Ideal for alternate care facilities, such as surgery and blood/plasma centers, as well as home healthcare and EMS, VeinViewer Flex is designed for durability and maximum portability. Flex is also suited for hospital departments such as the ER and NICU where space requirements and speed of assessment demand ultra-portable and VeinViewer reliable.

See the Vein Viewer in Action

No word on availability or price.  Stay tuned.

 

Nov 25, 2011 | 0 comments View Post

Anesthesia Technology Update

Medicine is changing quickly on every front.  Tech is leading the way making anesthesiology safer, easier and less likely to cause harm.  Which in my humble opinion the ultimate goal.  Of course tech for tech’s sake is not what I am referring to:

The Canadians are at it again.  The first attempt we all know was met with fascination and a collective “so what”, McSleepy was designed to make maintenance phase of anesthesia fool-proof.  This time they’ve gone a little too far:

First there was McSleepyTM. Now it’s time to introduce the first intubation robot operated by remote control. This robotic system named The Kepler Intubation System (KIS), and developed by Dr. Thomas M. Hemmerling, McGill University Health Centre (MUHC) specialist and McGill University Professor of Anesthesia and his team, may facilitate the intubation procedure and reduce some complications associated with airway management. 

I firmly believe in necessity as the mother of invention.  I therefore see this robot going nowhere.  Really? McGill U Dept of Robot Loving Gas Passers?  Are you having that much trouble putting the tube in the right hole?   Come to the US and we’ll teach you.  Perfect McSleepy and I think you’ll be on to something.  Unless the French beat you to it.

May 07, 2011 | 1 comment View Post

The future of anesthesia and surgery

I have previously blogged about all things anesthesia tech as well as the inevitable robot-led takeover of the specialty :)

See previous posts here and here.

Contrary to what many a blog-commenter might believe, I welcome the robotic revolution and think it can only help titrate our drugs better and avoid errors.  That being said, it does leave one less spot in the OR.  Its not a big leap to say someday one MD to 4 robots might be the most cost effective option in the “cost-above-all-else” health care model.  Assuming the cost of the technology can only go down, the robots will be far cheaper than a living, breathing automaton.  McGill University is poised to make McSleepy a real game-changer:

From the Montreal Gazette:

Doctors at the Montreal General Hospital are claiming a world first after operating on a prostate cancer patient using two robots at once — a mechanical arm to perform the surgery and an automated machine to anesthetize the man.

What’s more, the Montreal General has invented the anesthesia robot, which it has patented and nicknamed McSleepy. Although the Da Vinci surgical robot has been around for years, doctors say this is the first time the two robots have been used together.

Oct 21, 2010 | 1 comment View Post

Invasion of the Anestho-bot!

I’ve previously chronicled the impending take-over by laryngoscope-wielding automatons here. CRNA jokes aside (!), I was intrigued by a new medical device that recently received an approvable letter by an FDA advisory panel: Sedasys is a device designed to deliver anesthesia, sans anesthesia provider:

Developed by Ethicon Endo-Surgery, a division of Johnson & Johnson, Sedasys combines a drug delivery system with sensors to monitor heart rate, blood pressure, oxygen saturation and other patient data. The machine is designed to be used by a team of nurses and physicians, although not necessarily anesthesiologists, for patients requiring light or moderate sedation. In submissions to the FDA, the company estimated than anesthetists participate in about 25% of all endoscopies.

The “who-pushes-what-drug-where” debate rages on. The development of fos-propofol was a non-event for the GI docs trying to push us out. This seems to me to have the same fate in store for it. I say so because of the following conversation:
Dr Endoscopist: “You are going to be sedated by a machine today”
Patient: “Ok, what if I stop breathing…like MJ?”
Dr Endoscopist:”I’ll have 911 on speed dial, don’t you worry!”
Ok so I exaggerate. The literature seems split on the issue depending on which special interest is doing the publishing, so in this instance I’m going to side with the anesthesia providers. I don’t discount the role technology can play in our practice, just keep the robots away from me and my loved ones please.

Aug 15, 2009 | 0 comments View Post