
New machine could one day replace anesthesiologists - petethomas
http://www.washingtonpost.com/business/economy/new-machine-could-one-day-replace-anesthesiologists/2015/05/11/92e8a42c-f424-11e4-b2f3-af5479e6bbdd_story.html?tid=HP_more?tid=HP_more
======
davak
Non-anesthesiologist ICU physician here so slight bias should be noted.

I'm a huge fan of this. Machine will be much more anal about minor issues that
some anesthesiologists / CRNAs may ignore. Additionally, this will greatly
bring down costs for healthy routine procedures that need sedation. Machines
don't "get bored" and if things fall out of parameters they happily yell to
get attention. Properly coded they should also not make medication errors.
Additionally, they should be able to record data and find patterns in patients
that unexpectedly don't do well.

Michael Jackson would probably still be alive if a machine had been used to
help monitor his propofol!

Dialysis, for example, used to be a much more manual process. Now, it is
mostly driven by nurses and machines. Heck, people even do self-directed
dialysis at home.

This isn't the end of anesthesiology by any means. The more difficult patients
such as those who are obese or have a bunch of health problems will still need
more aggressive observations. However, I suspect these machines will move into
bigger and bigger surgeries to help assist the gas-passers provide safer
analgesia and sedation.

Just like robotic assisted surgery became too popular too fast and outcomes
suffered, I suspect these type of machines will not be trouble-free. How long
before the HN articles about one of these being hacked start appearing?
Nevertheless, medical machines like this with tight feedback loops are
essential for improving the safety and efficiency in the future practice of
medicine.

------
hamoid
From the name, I used to think that anesthesiologists just "put people to
sleep" or stopped patient's pain.

My view is now different. Their job (for what I'm told) is also to keep people
alive and stable. They administer drugs and employ machines and techniques to
control body temperature, blood pressure, oxygen levels, heart rate and
others. Sometimes it's a simple colonoscopy (like in the article), but other
times they are treating people who just had a stroke or a bad accident. They
have to react in seconds to the response they SEE on the patient (data coming
from machines, but also body movement, change in skin color, eye movement,
bleeding, and many subtle changes), connecting knowledge and years of
experience. It's also an art to be able to put tubes and needles on all kinds
of "strangely" shaped bodies (specially in old people).

A more precise title would be "new machine could one day replace some
anesthesiologists". I think it's going to take a while before we can trust
machines to keep us alive during emergencies and operations.

~~~
gokhan
My sister is an anesthesiologists. She sometimes anesthetize heart or brain
surgery patients without putting them to sleep, because they're too old or
unhealthy but need the surgery asap. These people normally cannot come back to
life from anesthesia, which is just making someone dead by stopping heartbeat
and respiratory functions with anesthetic agents and then animating them with
machines. So the creepy state of having your heart worked out while you're
awake. I believe this is something that can be fully automated by a machine in
the future.

But she also holds the hand of a child to calm her while preparing her to a
scary surgery, or talks to relatives waiting outside of intensive care,
sometimes tells people that they lost their loved one, or a miracle just
happened and they're good.

~~~
Mvandenbergh
>These people normally cannot come back to life from anesthesia, which is just
making someone dead by stopping heartbeat and respiratory functions with
anesthetic agents and then animating them with machines.

Hearts do not stop beating during ordinary general anaesthesia.

~~~
gokhan
You're right. My bad.

------
hamoid
"But now, after the procedure, she said she saw a potential upside, too: There
was no human error, either."

I knew it. Programmers are not human.

~~~
agumonkey
I'm saddened by the glorified view on non human systems. When they'll reach a
large scale enough, there will be too-complex conditions, confusion and bad
(contextually optimal) decisions and ordering, just like what happen to
humans.

~~~
jimmaswell
Code can reach close enough to perfection for errors to pretty much not happen
with a process like that NASA coding team

------
rdudekul
The technology that goes into a self driving car is possibly far more
sophisticated than this new machine. Anesthesiologists must have lobbied hard
to stop this machine from a more wide spread usage. However the writing on the
wall is clear. Machines in many cases are better than Doctors and they will
continue to become better more rapidly than say Doctors with their experience.
I wish US FDA gives a chance to these innovations and slowly tackle the rising
healthcare costs.

~~~
jepper
Yes, some standard procedures on ASA1 patiens do not require a lot of
sophistication. However do not underestimate how hard anesthesiology is, while
90% routine, 10% is incredibly complex stressfull scenarios in
trauma/emergency, surgical complications, adverse events. Its much more than
just heart rate, RR, oxymetry etc. Its knowledge about medicine interactions,
organ systems, physiological systems and the skill to perform under immense
pressure (trying to provide a permanent airway through facial trauma or large
bore IV access for fluid replacements on a patient in volumetric shock) And
while uncommon it can happen during standard procedures in ASA1 patients. I'd
rather have the anesthesiologist close please.

As a quick sedation system these sound wonderfull though, for example for
resetting joint dislocations in the OR where all emergency staff and equipment
is already in place.

~~~
hga
ASA1 == American Society of Anesthesiologists physical status classification
system "Healthy person", e.g.
[https://en.wikipedia.org/wiki/ASA_physical_status_classifica...](https://en.wikipedia.org/wiki/ASA_physical_status_classification_system)

With an increasingly graying population in the US, rdudekul's hopes ... well,
I suppose if you can decrease e.g. the ASA 1 need for anesthesiologists while
they're still on tap if things go south, it'll overall help. But it's probably
not going to get big, and will create triage like situations where people will
needlessly die when there's no anesthesiologist to spare.

------
mhuffman
As someone who has "been under" a few times, I am torn on this. I like the
idea of less errors due to a computer, but there is something comforting about
knowing that a human expert is "at the wheel".

I know it is irrational, but I feel similar about airplanes and cars -- much
more comfortable when you know there is a human at the helm.

Maybe it is the mortal peril part of the equation.

~~~
codingdave
I could foresee a setup like airline pilots - the autopilot truly does most of
the work, but humans monitor and are available in case of emergencies.

------
spyder
If the machine could detect the awareness well enough then it could reduce the
terrifying "accidental awareness" during surgery:

[http://www.iflscience.com/health-and-medicine/large-study-
ex...](http://www.iflscience.com/health-and-medicine/large-study-explores-how-
often-patients-wake-during-surgery)

[http://www.dailymail.co.uk/news/article-2750201/Three-
patien...](http://www.dailymail.co.uk/news/article-2750201/Three-patients-
week-report-waking-operation-Accidental-awareness-occurs-not-given-
anaesthetic.html)

------
planetjones
so does the machine also open the patients airway and safely insert the
breathing tube ?

~~~
bucketsofdirt
Or answer codes, sign out medication, or take the patient their consent forms?
It's cool, but no replacement for a person.

~~~
RobertoG
The article is telling specifically that the machine is already replacing a
person in some circumstances.

The kind of circumstances that it can manage are not going to shrink.

