CRNA Automation?

Bluebolt · Jul 1, 2019

It will not be fully automated. It will always require a human component to at least monitor and assess the machines and take over in case of emergencies or electrical shut down.

Would you go into surgery knowing that if there is a power outage or a plug pulled you're definitely going to die? I didn't think so, neither would anyone else in a first world country.

In probably 30-40 years when the technology has advanced to a level that could potentially change the practice model we use today where machines are practically doing anesthesia, you will still be needed. At that point, I plan to incorporate cyborg technology into my person and assimilate with the machines while keeping my own cognition. The ultimate anesthesia expert with rapid recall of all medications/dosages/pathophys and machine-like precision of skills.

Thank you for coming to my TED talk.

Seth96 · Jul 1, 2019

This is so true. Automation is something I've been concerned with, but in all other fields, it still requires some human oversight. The cyborg portion of your response would be so helpful, all the info you need would be just a download away instead of hours of reading.

Editorial Team / Admin · Jul 2, 2019

Previous thread on this topic where you might find some additional info (not sure if all of the posters are still around)

SDStudent1 · Jul 16, 2019

On 7/1/2019 at 11:32 AM, Bluebolt said:
It will not be fully automated. It will always require a human component to at least monitor and assess the machines and take over in case of emergencies or electrical shut down.
Would you go into surgery knowing that if there is a power outage or a plug pulled you're definitely going to die? I didn't think so, neither would anyone else in a first world country.
In probably 30-40 years when the technology has advanced to a level that could potentially change the practice model we use today where machines are practically doing anesthesia, you will still be needed. At that point, I plan to incorporate cyborg technology into my person and assimilate with the machines while keeping my own cognition. The ultimate anesthesia expert with rapid recall of all medications/dosages/pathophys and machine-like precision of skills.
Thank you for coming to my TED talk.

I feel like the horses in the 1800's told each other the same thing. They thought they had job security because the horse and buggy would always require a "horse component". Excluding the horse power comparison in cars, that turned out not to be true ?. But on a serious note, I would respectfully disagree. In nursing school I briefly considered CRNA and ruled it out shortly thereafter when I read an article about "Mcsleepy, the automated anesthesiologist" which started being used live in surgeries back in 2008.

Personally, I believe it's only a matter of time until it doesn't require a human component and I think it's next to impossible to say with any degree of certainty that it wont happen within your career timeframe. Use cell phones for example. Moores law (which states the number of transistors in a dense integrated circuit doubles about every two years) took the cell phone from a brick in 1993 to me being able to use my Galaxy Note 4 in virtual reality goggles too see a panoramic view of mars (as seen from the mars rover). I don't think anyone could have predicted how quickly the technology progression would happen and what changes would occur as a result.

There are tons of articles out there about jobs that are more likely to be automated vs those that aren't. The general trend I see is that jobs that rely heavily on interacting with (conscious) people seem to be the hardest to automate at this point. Long answer short, I don't think anyone could answer your questions with any degree of certainty but I would be worried about the fact that they are already trying to automate anesthesiologist / CRNA.

allnurses Guide · Jul 16, 2019

6 hours ago, SDStudent1 said:
I feel like the horses in the 1800's told each other the same thing. They thought they had job security because the horse and buggy would always require a "horse component". Excluding the horse power comparison in cars, that turned out not to be true ?. But on a serious note, I would respectfully disagree. In nursing school I briefly considered CRNA and ruled it out shortly thereafter when I read an article about "Mcsleepy, the automated anesthesiologist" which started being used live in surgeries back in 2008.
Personally, I believe it's only a matter of time until it doesn't require a human component and I think it's next to impossible to say with any degree of certainty that it wont happen within your career timeframe. Use cell phones for example. Moores law (which states the number of transistors in a dense integrated circuit doubles about every two years) took the cell phone from a brick in 1993 to me being able to use my Galaxy Note 4 in virtual reality goggles too see a panoramic view of mars (as seen from the mars rover). I don't think anyone could have predicted how quickly the technology progression would happen and what changes would occur as a result.
There are tons of articles out there about jobs that are more likely to be automated vs those that aren't. The general trend I see is that jobs that rely heavily on interacting with (conscious) people seem to be the hardest to automate at this point. Long answer short, I don't think anyone could answer your questions with any degree of certainty but I would be worried about the fact that they are already trying to automate anesthesiologist / CRNA.

Mcsleepy was discontinued shortly after it was released and it was never approved for anything but moderate sedation cases mainly for GI sedation cases.

Actual replacement of anesthesia providers by automation is not just a technical matter but a political matter. The anesthesia lobby is the most powerful and well funded medical speciality lobby there is even eclipsing AMA at times. Further, the process from research to active use in medicine averages over 17 years with no complications.

IMHO I think it is safe to say anesthesia providers in the US aren’t going to be replaced for several decades. I can safely say that knowing how anesthesia PACs protect their market, how long research takes to make it into practice, previous history of anesthesia innovations coming to market, and people’s reluctance to trust machines without someone directly monitoring them that can take over for them at a moments notice.

SDStudent1 · Jul 16, 2019

3 hours ago, wtbcrna said:
Mcsleepy was discontinued shortly after it was released and it was never approved for anything but moderate sedation cases mainly for GI sedation cases.
Actual replacement of anesthesia providers by automation is not just a technical matter but a political matter. The anesthesia lobby is the most powerful and well funded medical speciality lobby there is even eclipsing AMA at times. Further, the process from research to active use in medicine averages over 17 years with no complications.
IMHO I think it is safe to say anesthesia providers in the US aren’t going to be replaced for several decades. I can safely say that knowing how anesthesia PACs protect their market, how long research takes to make it into practice, previous history of anesthesia innovations coming to market, and people’s reluctance to trust machines without someone directly monitoring them that can take over for them at a moments notice.

Again, I will have to respectfully disagree. And again, I would use the cell phone as an example. The “Brick” cell phone was discontinued within a few years of its creation, but I am willing to bet you have a far more advanced and capable version of it in your pocket right now. Just because a first-generation version of a technology did not become mainstream does not mean that is the end of the story. In fact, in the case of Mcsleepy I would argue the opposite. It actually did receive FDA approval to autonomously provide anesthesia in a live surgery. I don’t think it is a stretch to worry about that fact if my job revolved around providing anesthesia.

The general trend with technology advancements is that initially it augments and later it replaces. Most likely, AI and Robotics would initially be used to automate the mundane and repetitive tasks and then at some point would entirely replace the Anesthesiologist/CRNA. I would further argue that the technology currently exists to do so. It is more of an implementation problem at this point. The reason Mcsleepy failed is because a closed loop feedback system is very rigid and rule based which is inadequate to handle the complexities of providing anesthesia. With the advances in machine learning, that limitation is no longer present. This NCIB article says as much, stating “hand dexterity” is likely the only thing that may not be able to be automated “at this time”.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5903534/

I do agree with you that it is not only a technical matter but a political one as well. But I also feel the politics of it become decidedly less complicated when there is substantial financial incentive, which would be the case if Mcsleepy 5.0 proves to be cheaper with as good if not better outcomes. It wouldn’t matter how strong a single special interest lobbying group was, it would not be as strong as all the member who would profit from it.

I am not arguing that I know for a fact that it will occur within a given time frame. I am only arguing that the OP has a very legitimate concern given the interest in automating anesthesia, when coupled with the technological advances that have already occurred. I feel the only thing that can be said for certain is that Robotics and AI will drastically change a CRNA job description. Whether that is primarily augmentation or complete replacement I don’t think you nor I can say for certain.

(That being said, I am definitely rooting for you to be right about the cyborg technology assimilation ?)

"We always overestimate the change that will occur in the next two years and underestimate the change that will occur in the next ten. Don't let yourself be lulled into inaction." - Bill Gates

CRNA Esquire, DNP, CRNA · Jul 16, 2019

It's a relief that CRNAs are all getting doctorates for entry into practice. That way even if autonomous AI takes over the hospitals and performs spinals, epidurals, intraop management of complex physiology, airway emergencies, self-diagnostic immediate machine repair, perioperative analgesia management, preop assessments to determine the type of anesthesia needed, etc CRNAs will still have their terminal degrees to fall back on.

They can always be a professor or perhaps do quality control for the anesthetic machines.

allnurses Guide · Jul 16, 2019

10 hours ago, SDStudent1 said:
Again, I will have to respectfully disagree. And again, I would use the cell phone as an example. The “Brick” cell phone was discontinued within a few years of its creation, but I am willing to bet you have a far more advanced and capable version of it in your pocket right now. Just because a first-generation version of a technology did not become mainstream does not mean that is the end of the story. In fact, in the case of Mcsleepy I would argue the opposite. It actually did receive FDA approval to autonomously provide anesthesia in a live surgery. I don’t think it is a stretch to worry about that fact if my job revolved around providing anesthesia.
The general trend with technology advancements is that initially it augments and later it replaces. Most likely, AI and Robotics would initially be used to automate the mundane and repetitive tasks and then at some point would entirely replace the Anesthesiologist/CRNA. I would further argue that the technology currently exists to do so. It is more of an implementation problem at this point. The reason Mcsleepy failed is because a closed loop feedback system is very rigid and rule based which is inadequate to handle the complexities of providing anesthesia. With the advances in machine learning, that limitation is no longer present. This NCIB article says as much, stating “hand dexterity” is likely the only thing that may not be able to be automated “at this time”.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5903534/
I do agree with you that it is not only a technical matter but a political one as well. But I also feel the politics of it become decidedly less complicated when there is substantial financial incentive, which would be the case if Mcsleepy 5.0 proves to be cheaper with as good if not better outcomes. It wouldn’t matter how strong a single special interest lobbying group was, it would not be as strong as all the member who would profit from it.
I am not arguing that I know for a fact that it will occur within a given time frame. I am only arguing that the OP has a very legitimate concern given the interest in automating anesthesia, when coupled with the technological advances that have already occurred. I feel the only thing that can be said for certain is that Robotics and AI will drastically change a CRNA job description. Whether that is primarily augmentation or complete replacement I don’t think you nor I can say for certain.
(That being said, I am definitely rooting for you to be right about the cyborg technology assimilation ?)
"We always overestimate the change that will occur in the next two years and underestimate the change that will occur in the next ten. Don't let yourself be lulled into inaction." - Bill Gates

We can always add more technology to Anesthesia but for the foreseeable future anesthesia providers aren’t going anywhere. The job of doing anesthesia encompasses much more than just pushing drugs and intubating people.

allnurses Guide · Jul 16, 2019

6 hours ago, CRNA Esquire said:
It's a relief that CRNAs are all getting doctorates for entry into practice. That way even if autonomous AI takes over the hospitals and performs spinals, epidurals, intraop management of complex physiology, airway emergencies, self-diagnostic immediate machine repair, perioperative analgesia management, preop assessments to determine the type of anesthesia needed, etc CRNAs will still have their terminal degrees to fall back on.
They can always be a professor or perhaps do quality control for the anesthetic machines.

If we ever invent a machines to take over what anesthesia providers to do the vast majority of anesthesia providers wouldn’t have jobs anywhere in healthcare.

allnurses Guide · Jul 17, 2019

The earliest date that anesthesia full automation could even start to be a viable time is 2030-2045 when AI is expected to exceed human intelligence/capabilities.

That being said even if in 2030 the AI was capable of doing it then the robotics portion would have to be developed and tested. That would take a minimum of 10+ years and as stated previously it normally takes 17+ years for research to come into practice. Then there are the FDA approvals, public acceptance, the anesthesia/medical PACs to buy off on it. The McSleepy/Sedseys system was discontinued d/t lack of sales because it was never accepted by medical providers and the public not because it couldn’t do the very limited job it was designed for.

The average age of a CRNA is 47 y/o with most CRNAs graduating in their early to mid 30s assuming that they these new CRNAs are expected work for average of 30-35years or less. There is zero reason to think the next generation of CRNAs that graduate in the near future will have anything to worry about from anesthesia job loss d/t automation.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3961028/

https://www.stahq.org/

Editorial Team / Admin · Jul 17, 2019

Closed for Admin review.