"Automated Anesthesia"?!? -- no need for Anesthesia staff in the room reported

loveanesthesia · Dec 18, 2008

I've been hearing of systems like this for awhile, but I can't imagine them replacing CRNAs. The big flaw is they only react, instead of anticipating. In a good anesthetic the CRNA knows the surgeon and procedure and prepares the patient for the varing levels of stimulation rather than waiting for the patient to respond. Also many procedures are so fast that it wouldn't be practical to use. I'm not worried.

stanman1968 · Dec 21, 2008

no way

mammothsnw · Dec 21, 2008

When McSleepy can intubate, extubate, bag-mask, provide MAC, insert regionals, invasive lines, keep the surgeon from knocking out the ETT, and respond to codes you can start to worry. There's more to anesthesia than titrating in some fentanyl or NDMR based on some numbers on the monitors. A machine like this would be an adjuct to titrating drips during a long case at best. Don't worry ..there will always be a need for a real person that can look at the patient and as previous poster stated "anticipate" rather than react.

n_g · Dec 27, 2008

But what percentage of the operation involves "intubate, extubate, bag-mask, provide MAC, insert regionals, invasive lines"? Very little. Most of the time, the anesthesia is uneventful and can easily be handled by an automated system. You will still need people for the take off and landing, but it can be autopilot rest of the time.

mammothsnw · Dec 28, 2008

n_g...to answer your question...100% of the operation involves someone to be there during a MAC case...that's why it's called Monitored Anesthesia Care.

So let's say YOU are given a spinal for a knee arthroscopy...the anesthesia person leaves and allows the machine to maintain your sedation level during the "uneventful portion" of the case. Now lets say the spinal goes higher than expected and knocks out your cardioaccelerator or better yet the innervation to your diaphram...are you OK with being hypoxic until someone can show up to intubate you? (So airway management is ongoing for 100% of the case as well...no matter what type of anesthesia we're talking about.)

Or how about during those "uneventful" routine ex lap cases...what is the machine going to do when the surgeon knicks the IVC or renal artery? Or how about some anaphylactic reaction, laryngospasm, etc..anyone in this field could go on and on about how the routine can to turn to disaster in a matter of seconds....and that **** can hit the fan at any time..even during a MAC case for a bunyon removal.

This is why you WILL ALWAYS need a person there who can anticipate and be prepared to intervene when it happens. Have you thought about this from a hospital liability or licensure standpoint? Who's going to be held responsible for an unfavorable patient outcome...McSleepy?? Better yet...try explaining to the parents of a six year old that the machine will take good care of their little one during surgery. Come on..are you even being serious with the autopilot analogy?? As a said before...a machine like this would be an adjunct to anesthesia at best.

n_g · Dec 28, 2008

But you assume that an automated system would use the same room setup we have today. What if we have better room design that would accomodate such a system?

Imagine if you will a spoke and hub design. The spokes outline the OR's and the hub is central anesthesia control room. From the hub, the staff can peer into any room. From the hub, the staff can be in any room within 5 seconds. With such a setup, it would be feasible to have an automated system.

There is plenty of financial incentive for hospitals to explore different ideas to take advantage of technology. Don't think that anesthesia 50 years from now will look like anything today.

stanman1968 · Dec 28, 2008

N_g, you obviously do not know a thing about anethesia, tell you what I will let Mcsleepy work on you.

mammothsnw · Dec 28, 2008

OK n_g ...a couple beers down and I'm willing to play along....the spoke and hub design makes perfect sense...I'm sure that the financial incentive to incorporate McSleepy far outweighs the minor cost to completely redesign and rebuild OR's across the nation. One question though...If there are several OR's, with multiple surgeries happening, you would need several anesthesia staff in "the hub" to respond to any issue right?? What if several patients required intervention simultaneously??...I guess they would have to staff the hub with an anesthesia person for each patient just in case, maybe even a few extra in case backup is needed...wait a minute...this model already exists..its called the ACT...and the "hub" is the breakroom.....brilliant!...I really think you're on to something.

loveanesthesia · Dec 28, 2008

Imagine if you will a spoke and hub design. The spokes outline the OR's and the hub is central anesthesia control room. From the hub, the staff can peer into any room. From the hub, the staff can be in any room within 5 seconds. With such a setup, it would be feasible to have an automated system.

Several years ago I heard this design discussed (I can't remember where, but it was the 'spoke and hub' concept) For the investment in the design to be practical, those five rooms would need to be going simultaneously a large portion of the week. Most ORs don't work that way, espicially with the opening of all the small surgicenters. You would need to have the induction and emergence times coordinated so that one person could attend all of them, not to mention coordinating any critical incidences. I propose that is impossible, so then you'll have to have multiple anesthesia providers at the ready at all times. That will eliminate cost savings which is the only reason to even think about doing this. While there are times when it appears the anesthesia is on 'auto pilot' you never know when the 'turbulence' is going to hit. And as for 'autopilot', how many times have you given someone a lunch break, their patient has not varied the BP or anything else for the past 30 minutes, about 5-10 minutes after you take over, the patient coughs or something else. You think you are maintaining the patient just the same, but we all respond to subtle patient changes almost automatically, and since I've just come in to the case I don't 'know' the patient yet.

n_g · Dec 28, 2008

You guys are forgetting something.

At least 40 successful surgeries (at the time of the writing) have been performed so far with this McSleepy system. I read that the inventors want to do a 1000 surgeries.

Kinks will have to be worked out. OR designs have to be worked out to take full advantage of the system.

Don't mistake the financial incentive to implement something like this. At $140k per year for a CRNA and each room requiring one, can you imagine how much money hospitals can save by implementing such systems? Do you know how much a company like GE can make by selling these systems?

You guys can rationalize all you want about why this or why that won't work. If you guys don't anticipate and embrace the future, you'll end up like the carriage makers when the automobile came out.

stanman1968 · Dec 28, 2008

I have no doubt ALL of medicine will be different 50 years from now, but Mcsleepy is just an oddity, no more no less.