BehindTheMedspeak: 'McSleepy' — World's first robotic anesthesiologist

Very exciting, to learn a machine can do what I do all day — sit on a stool and stare at multiple screens and listen to all manner of beeps and alarms, every now and then making a few marks on a piece of paper.

Finally.

What took so long?

Here's today's Canadian Press article about the new new thing — totally automated anesthesia.

Canadians create anesthesia system dubbed McSleepy

First there was McDreamy. Then came McSteamy. Now there's McSleepy.

No, the latest addition isn't yet another hunky doc from the TV series Grey's Anatomy, but an automated anesthesiologist developed by Canadian researchers that sends patients to the surgical equivalent of the Land of Nod.

Scientists at McGill University in Montreal believe they are the first in the world to perform surgery using a totally automated system for administering the drugs needed for general anesthetic.

Dubbed McSleepy, the computerized system administers three standard drugs used for putting patients under for surgery and monitors their separate effects automatically, without the need for manual intervention.

The researchers say the system can calculate the appropriate drug doses for any given moment of anesthesia faster and more precisely than a human. It has been designed to analyze biological information and constantly adapt to changes, even recognizing monitoring malfunction.

But that doesn't mean an anesthesiologist would turn the patient over completely to machines, said principal developer Dr. Thomas Hemmerling, who likens McSleepy to the automatic transmission in a vehicle.

"Automatic systems in life only help us to perform our task better, they will not replace us," Hemmerling said Thursday.

"The majority of our work is actually how we … manage everything that goes on with surgery. Bleeding, temperature control, all these kind of things should be much more important to us than just applying the drugs to make somebody sleepy, because that's how we help the surgeons to do their job.

"So if you have an automatic system covering the mere administration of these drugs, we can really focus on what else we're doing."

McSleepy can best be described as a software system that directs infusion pumps in a patient's vein to release specifically timed and measured doses of drugs that induce sleepiness, control pain and relax muscles during an operation.

The computerized system also provides continuous feedback on how the patient is responding to the drugs as surgery progresses, from brainwave patterns and muscle contractions to heart rate and blood pressure readings.

Dr. Shane Sheppard, president of the Canadian Anesthesiologists' Society, said McSleepy or a similar device would be a boon for his profession, especially during long operations.

For instance, during a recent seven-hour surgery for colorectal cancer, Sheppard had to administer muscle relaxant to the patient every 45 minutes.

"So this type of technology would eliminate the need to constantly be looking at the clock, looking at the patient, looking at the (muscle) twitch monitor to see if they need more drug right now," he said. "It would just go ahead and give it."

So, could McSleepy or a similar system one day replace human anesthesiologists? "The short answer is no," said Sheppard of Saskatoon, who's been practising for 20 years.

"Somebody has to start the intravenous, make sure it's in a vein and not interstitial (in the tissue). Somebody has to put the breathing tube in once they're asleep. Somebody has to watch for mechanical failure."

"And those of us who work in an operating room know that these machines are great, but they're only as good as the next time they break down or have interference from some other piece of equipment."

Hemmerling said that should a problem develop — either with the system or because an unexpected event occurs with the patient during surgery — the system can be manually overridden.

But beyond stepping in should something with the system go wrong, the anesthesia specialist also brings critical skills that computers just can't deliver, said Sheppard. "The value of the anesthesiologist is largely based around their judgment and their ability to discern what is the best plan for the patient, how to change plans if things change in real time."

The McGill system is not the first to use automation for at least some drug administration for anesthesia — researchers have been looking at this for 15 to 20 years — but the Montreal team's development of software to monitor pain using a feedback scoring system allowed them to automate the entire process.

"That was sort of the breakthrough to get McSleepy running," said Hemmerling.

So far, the system has been tested during operations on seven patients, the first a 3 1/2-hour surgery for a patient who had a tumour removed from his kidney.

"We have preliminary results which indicate it is actually better in terms of stability of anesthesia than us at this point," he said, referring to anesthesiologists. "But that is not the focus at this point."

"The focus is I want this software program, McSleepy, I want it to be as good as me on my best day — but not better."

Hemmerling said the system can communicate with personal digital assistants (PDAs), so an anesthesiologist can monitor a patient outside the OR, while checking on post-surgical patients in recovery, for instance.

"It would just again increase the safety," he said. "It wouldn't mean I'd be in Hawaii while I'm doing anesthesia at McGill."

Hemmerling predicts McSleepy could be on the market within five years, possibly developed at McGill in conjunction with biomedical engineers at the Université de Montreal, a partner in the research, or by a commercial biomedical company.

But before seeking approval from Health Canada and the FDA, the researchers plan to test the system on 1,000 to 2,000 surgical patients.

"It will probably take two years to perfect the system," he said.

"McSleepy is born but it needs a lot of work."

....................

Tell you what, it's no surprise this development comes out of Canada.

FunFact: "In Canada, it is possible to train as a GP anesthesiologist in one year. In the United States, it takes at least four years of specialist training, and in the United Kingdom a few years longer."

So many Canadian anesthesiologists, fed up with the country's national health system, have left for the U.S. over the years that the country's now suffering from a huge shortage of fully-trained specialists.

Nothing like a little "Anesthesia Helper" to stretch what remains.

[via Dr. Yoni Freedhoff]