Connect with us

Anesthesia Equipment

Anesthesia evolving with technology

Innovations in anesthesiology continue to be driven by the aim of healthcare for the benefit of patients and society, and the trends toward automation, non-invasive monitoring, remote monitoring and management, enabled by AI have made the lives of anesthesiologists a lot easier.

Scientists are learning more about how anesthetics work at the most basic level. They are also studying the short- and long-term effects of these drugs on specific groups of people, such as the elderly, children, and cancer survivors. These studies will reveal whether certain anesthetics are better than others for those groups.

Research on how a person’s genetic makeup affects how they respond to anesthetics will allow doctors to further tailor drugs for each patient. In the future, scientists hope to design anesthetics that are safer, more effective, and more personalized.

Knowing how anesthetics affect pain and consciousness could also lead to new treatments for conditions that affect consciousness, such as epilepsy or coma. Studies of anesthesia may even help us better understand the nature of consciousness itself.

Recent technological advancements have been moving anesthesia research forward and also changing the practice of anesthesiology. Integration of new technologies (like wireless communication) has improved control of anesthesia delivery and patient monitoring during procedures. Application of artificial intelligence (AI) approaches, like machine learning, has shown a great potential to further transform the field and improve patient care.

Indian market dynamics
The Indian anesthesia equipment market in 2022 saw a huge increase over 2021. At ₹300-crore market size, it was at its highest than ever before. Many operation theaters were set up, and there was huge demand for the machines from all parts of India. The government, including AIIMS, too upped its buying, and closed orders on the bids invited in 2021, apart from fresh bids invited in 2022. Corporate chains invited RFPs, and smaller hospitals too came forward.

The trend that started in 2021, when demand moved in favor of the value segment continued, and this segment dominated with a 70-percent share. This is in strong contrast to 2019, and earlier years, when the performance segment had dominated with a 50-percent share. The prices have remained relatively stable.

GE had supply problems as its factory in China was at times not able to send supplies to India, and others with prices being extremely competitive, and margins wafer-thin, were not that interested in the Indian market. This could not be confirmed from GE.

Leading players*
Tier I Tier II Tier III
GE and Mindray Dräger, BPL, Skanray, Allied Medical, Aeon Medical, Penlon, Comen, local and regional brands
*Vendors are placed in different tiers on the basis of their sales contribution to the overall revenues of the Indian anesthesia equipment market.

ADI Media Research

2022 was the first year for Penlon Limited by itself. The vendor has become part of Medcaptain Medical Technology Ltd. (MMTL) through the acquisition of 100 percent of shares by MMTL from BPL Medical Technology.

GeM continues to be stringent on its clause that the company of origin must be declared, thereby hurting the share of some of the smaller Chinese brands.

Imported brands continue to dominate the Indian anesthesia equipment market.

Global market dynamics
The global anesthesia machines market size will grow from USD 18.87 billion in 2022 to USD 20.86 billion in 2023 at a compound annual growth rate (CAGR) of 10.6 percent. The Russia-Ukraine war disrupted the chances of global economic recovery from the Covid-19 pandemic, at least in the short term. The war between these two countries has led to economic sanctions on multiple countries, a surge in commodity prices, and supply chain disruptions, causing inflation across goods and services, and affecting many markets across the globe. The global anesthesia machines market size is expected to grow to USD 29.91 billion in 2027 at a CAGR of 9.4 percent.

Technological advancements and emerging trends
Sumi P. Potty
Senior Design Engineer,
Skanray Technologies

The medical practice of administering anesthesia inevitably banks on technology and its advancements. The recent technologies used in anaesthesia administration have been oriented toward handling the surge in volume, variability, and complexity of patient records. Anesthesia is more of pre-operative care rather than an intraoperative procedure. The key trends in anaesthesia equipment are listed below.

Leverage of ultrasound techniques. Ultrasound guidance with AI and ML methodologies aids the anaesthesia equipment, which adds positive outcomes and timely discharge of the patient. The latest methodologies help to understand deep at individual nerve/plexus levels.

Digital flow meters help the clinician/user to deliver the specific amount of anaesthetic gases precisely, especially while operating with low-flow anaesthesia.

Laryngeal mask airway (LMA) is a tube comprising an inflated cuff that can be inserted in the pharynx to protect the airway, which will not require paralyzing the patient. This is very easy to use and has less discomfort.

ETCO2 and SpO2 monitoring. Non-invasive EtCo2 and SpO2 monitoring are the key features that will help the clinician diagnose early obstruction in the airway during a pre-operative procedure. It also helps the clinician to understand whether or not the ventilation is adequate.

Pain pumps. For the timely discharge of the patient, targeting multimodal pain management is imminent. A single-shot nerve block that sustains the entire surgery, or an electronic pain pump with localized pain relief, can be used.

Information management (IM) and decision support systems. Highly sophisticated hardware and software systems have evolved in anaesthesia IM systems, which are integrated with the electronic health record (EHR) of the hospital and help to annotate the intraoperative practices. Integration of IM with the clinical decision support system (CDSS) provides an efficient and optimized way of delivery. This can also administer beta blocker medication, curtailing the dissemination of inhaled anaesthetic agents, and modernizing the administration of hypertension/hypotension medications.

Depth of anaesthesia monitoring. BIS monitors can administer the target sites, and can assess simultaneously the level of consciousness.

Anesthesia machines have undergone a relentless technological transformation. Opposed to the conventional pneumatic systems, the contemporary versions are more sophisticated, fully integrated, and computer-based.

As the global population continues to surge, more number of minimally invasive surgeries are taking place on a day-to-day basis, which is reflecting favorably on global sales of anesthesia machines. This is because anesthetic machines are one of the important pieces of equipment used for surgeries to ensure that patients do not feel pain during surgeries. With the increasing number of chronic illnesses like cataracts, nervous disorders, muscle repair, oral problems, and abdominal issues that require surgeries, the use of anesthesia machines has also increased.

Currently, most machines support the continuous-flow anesthetic system, which is designed to manage a continuous and accurate flow of medical gases (such as nitro oxide or oxygen), diluted with a measured concentration of anesthetic gas. Anesthesia system technology ensures an uninterrupted and controlled supply of anesthetic gases to the patient.

Moreover, incessant technological advancements in anesthetic systems are boosting their adoption in the healthcare industry.

The risk of contamination because of the use of anesthesia machines during surgical procedures is an important restraint for the anesthesia machines market. This is mainly because the chances of bacterial infections are getting higher with an increasing number of surgeries and the use of anesthesia machines. Many anesthesia machines are often colonized by microorganisms. One such example is an anesthesia machine’s outer region, which contains bacterial species that may be transferred from the machine to the anesthetist and then to the patient, resulting in bacterial contamination and infection.

The use of computer-controlled anesthesia machines is an emerging trend in the anesthesia machines market. Computer-controlled anesthesia machines help in reducing the patient’s pain during surgical procedures, and also provide features such as alarms to notify in case of an emergency or backup required to switch the defected pipeline or cylinder. For example, the Dräger Primus anesthesia workstation provides advanced display and monitoring settings and an automatic checkup option, thereby reducing human time and effort. Similarly, GE Healthcare’s Aisys CS² station manages the oxygen flow, records the consummation data, and avoids wastage of fresh gas.

Evolution of anesthesia
Dr D Dasgupta
Director, Anesthesiology Department,
Jaslok Hospital and Research Centre

Anesthesiology was developed with a delivery system and the chronological development of a work station, anesthetic vapors, gases, drugs, appliances, and a monitor. This progress rolled over for nearly 180 years. The term anesthesia was coined by Dr Oliver Wende Holmes, an anatomy professor. The first documented anesthesia was delivered by William Thomas Green Morton, a qualified dentist, who switched over to medicine at Harvard Medical School in Boston, Massachusetts, and to anesthesia.

He began experimenting with diethyl ether vapor, first on dogs and then on humans, anesthetizing and even freezing patients for dental extraction under ether inhalation. He continued to successfully administer ether vapor to thirty-seven patients with Dr Henry Bigelow. The epic success was painless jaw tumor removal. On September 15, 1846, the demonstration took place in front of a large crowd at the Massachusetts General Hospital, with the Boston patient Gilbert Abbott and the surgeon Dr John Collins.

This revolutionary discovery made William Thomas Green Morton an all-time father in the field of general anesthesia. This priceless gift of freedom from surgical pain spread like wildfire around the world. Anesthesia was born, and it has since undergone a number of developments, including safety monitoring. Gwathmais and Boyle to the most modern anesthesia station, anesthetic gases (oxygen-nitrous oxide, cyclopropane, carbon dioxide), drugs, particularly induction agents, muscle relaxants, sedative-narcotics, and life-saving techniques, drugs, and extensive monitoring bolstered the applicant’s case.

Monitoring the vital systems, cardiovascular, respiratory, neuro, and various appliances continue to deliver safe anesthesia – beginning with the airway, oxygen prongs, masks, endotracheal, endobronchial tubes, blockers, supraglothic devices, thrive, ventilators with all possible variations, both invasive and non-invasive, electronic as well as pneumatically driven, electrical and non-electrical with computerized function added glory to anesthesia. This classic scientific advancement can combat all possible as well as advanced diseases for safe anesthesia revival.

North America held the largest anesthesia machines market share in 2022, owing to large number of surgeries and sizeable public expenditure on healthcare and rise in pipeline activities in research and development institutes to improve efficiency of anesthesia machinery. Asia-Pacific is anticipated to witness the highest anesthesia machines market growth, owing to increase in the patient base and rise in healthcare expenditure.

Major players in the anesthesia machines market are GE HealthCare, Dragerwerk, Smith Medical, Spacelabs Healthcare, Covidien, Aeonmed, Heyer Medical, Oricare, Dameca A/S, and Getinge Group.

Significant advances in anesthesiology in the past decade
Modern-day anesthesiology is heavily dependent on technology. Anesthetics have become safer and more efficient due to advances in monitoring and delivery since its introduction in 1846. Some of the most significant advances in anesthesiology in the past decade include:

Closed loop TIVA (total intravenous anesthesia). Anesthesiologists and pharmacologists have been working on the pharmacokinetics of automated administration of intravenous anesthetics for years. Utilizing EEG monitoring data (BIS monitor levels) to titrate the depth of anesthesia shows promise. For a typical anesthetic, TIVA requires more work than vapor anesthesia with sevoflurane, because the anesthesiologist must load a syringe with propofol and/or remifentanil, attach an infusion line, load the syringe into the infusion pump, and program the pump to the correct infusion rate. In contrast, a sevoflurane vaporizer is already loaded with liquid anesthetic, is easy to use, and merely requires the pushing of one button and turning of one dial. Closed-loop TIVA is not in clinical use at this time, but you can expect that the future anesthesia recipes will include automated sedation/anesthetic depth titration via computer administration. The TIVA research of the past ten years has paved the way for this advance.

Furtherance of anesthesia techniques
Aditya Kohli
CFO and Director – Sales,
Allied Medical Limited

Primary equipment that the anesthesiologist uses in the operation theater is the anesthesia machine. Safe use of anesthesia machine depends upon an interaction between the basic design of the machine with its safety features, ease of use, and operational readiness. The original concept of continuous-flow machines was popularized by Boyle’s anesthetic machine, invented by the British anesthetist Henry Boyle at St Bartholomew’s Hospital in London, United Kingdom, in 1917, although similar machines had been in use in France and the United States.

General anesthesia, basically a reversible, medically induced coma, is one of the marvels of modern medicine. Carefully calibrated drugs, ventilators, and other technology keep patients breathing and comfortable during their most vulnerable moments – and gratefully unable to recall what transpired on the surgical table. From their perspective, it is simple – breathe in, breathe out, wake up in a recovery bed.

But for the healthcare providers, it is a delicate art as well as science. Since last four decades, Allied Medical Limited (AML) has developed a new line of advanced anesthesia machines that help doctors deliver high-quality patient care, while also gathering oodles of detailed data about what is happening with the device and the patient during surgery. The end-product is the Neptune Prime, a fully digital anesthesia machine with Neptune legacy insights, along with an advanced feature like fresh gas flow optimizer. Combined, these tools help clinicians deliver the right levels of anesthetic gas for their patients, more safely and efficiently. Electronic flowmeters developed by AML for Neptune Prime anesthesia workstation are scrupulous and do not have the disadvantages of having multiple mechanical parts, which are prone to leaks and breakages. Neptune Prime is equipped with electronic gas mixing that facilitates digital setting of the fresh gas flow, with measurement of delivered gases both in digital and virtual forms. Built in digital hypoxia guard controls, the oxygen to nitrous oxide setting is such that the patient does not get gas flow of nitrous oxide concentration beyond the permissible range.

The ultrasound-guided regional anesthesia boom. In the past ten years, the number of ultrasound guided regional anesthesia blocks has mushroomed. Regional nerve blocks decrease the need for postoperative narcotics. Evidence shows that ultrasound guidance reduces the incidence of vascular injury, local anesthetic systemic toxicity, pneumothorax, and phrenic nerve block for interscalene blocks, but there has not been consistent evidence that ultrasound guidance is associated with a reduced incidence of nerve injury. The ultrasound-guided regional anesthesia boom has led to tens of thousands of additional nerve blocks, and an unfortunate fact is that a small but non-zero number of these patients develop permanent nerve damage in their arms or legs after their blocks. Regional anesthesia specialists who publish in the medical literature have made little effort to quantify or report these complications. Prospective data on nerve injuries is needed. Honest verbal informed consent of each patient before a nerve block is needed.

High-flow nasal cannula enhances safe anesthesia
Ankit Gupta
Deputy Product Manager – Anesthesia,
Mindray Medical India Pvt. Ltd.

Airway management is an essential topic of expertise that every anesthesiologist works toward every day. But sometimes the current airway-management methods are not optimal to handle certain difficult situations, so anesthesiologists need to be continuously updated with new developments related to airway devices and techniques. Among these developments, high-flow nasal cannula (HFNC) oxygenation is particularly prominent due to its multiple benefits and less training requirement.

As advised clinically, all patients of unanticipated difficult intubation in adults should be preoxygenated before the induction of general anesthesia, which will increase the oxygen reserve, delay the onset of hypoxia, and allow more time for laryngoscopy, tracheal intubation. On the other hand, inadequate preoxygenation may lead to fatal complications like hypoxic brain injury, hemodynamic instability, cardiac arrest, and even death. There are some identified categories of patients who are at higher risk of showing a reduced oxygen reserve, including obese, neonatal, pediatric, pregnant, septic, and critically ill patients. HFNC can be very helpful in sailing through the difficult intubation for these patients particularly.

Scholarly, HFNC is a humidified and heated gas or oxygen-delivery system that allows inspired oxygen (FIO2) to be delivered at very high flow rates of 60 liters per minute and eventually higher. The use of a high-flow, heated, humidified, and controlled concentration of oxygen via the nasal route has several clinical benefits, including more precise oxygen delivery, and improved patient comfort and others.

HFNC has demonstrated the advantages of prolonging the safe apnea window, reducing instances of hypoxemia and allowing clinicians more time to manage patients with difficult or compromised airways. HFNC also provides anesthesiologists with safer alternative of one-handed mask-holding technique, which is prone to errors and provides compromised results. HFNC offers other useful physiological benefits to increase patient safety and reduce pressure on clinicians. HFNC oxygen delivery creates positive airway pressure that increases end-expiratory lung volume and functional residual capacity, known as the positive end-expiratory pressure (PEEP) effect. HFNC also accelerates the washout of gases from anatomical dead space, including more distal conducting airways.

HFNC has displayed benefits during multiple phases of anesthesia management, including induction period and intraoperative period. Many a times, apparently HFNC also offers advantages during perioperative phases, particularly for obese patients, pediatrics patients, critically ill, difficult airway, and pregnancy. HFNC also carries advantages during intraoperative period for ENT surgery, tubeless anesthesia, bronchoscopy, and awake fiber-optic intubation.

As HFNC brings a lot of PROS to the OR, if introduced, but if used as a standalone device will add to space constraint and cause loss of data related to patient surgery. Mindray has displayed commitment in bringing the advantages of HFNC without its CONS getting added. So Mindray has brought new offering to high-end anesthesia system by integrating HFNC, which empowers anesthesiologists to ensure comprehensive patient safety throughout the perioperative period, from induction to recovery. Using HFNC oxygen extends safe apneic time from 8 to up to 30 minutes to help clinicians intubate more easily. We implore that HFNC technology integration can provide great support to the anesthetists for improving outcome of difficult airways management.

AIMS and CDSS systems. Anesthesia technology advancements are improving patient care. Developments that have become available in recent years include progress in software, such as in anesthesia information management and clinical decision support systems (AIMS and CDSS systems).

The increasing use of AIMS and CDSS systems across anesthesia departments and practices has enabled the establishment and growth of large data sets describing anesthesia patients, procedures, and outcomes. These data sets present a potential, prediction, decision, support, and ultimately allow data transmission to quickly integrate information directly from the monitors in real time and provide vital information to the anesthesia specialist.

Point-of-care ultrasound (POCUS). In recent years, anesthesiologists began to aim their ultrasound probes at the abdomen, thorax, and airway to gain real-time information and immediate knowledge of the anatomy and pathology beneath the skin and to better manage and treat critically ill patients. POCUS is proving useful in trauma, chest examination, and pediatric anesthesia. Because POCUS is a recent development, the majority of anesthesiologists do not have the training, skills, or knowledge needed to use this new technique. Recent graduates of residency and fellowship programs will lead the way as the anesthesia workforce transitions toward mastery of POCUS.

Zacceleromyographic monitors. Another attractive class of devices is Zacceleromyographic (AMG) monitors. These devices measure the acceleration using a piezoelectric sensor attached to a freely moving thumb. These devices take advantage of the direct proportionality between acceleration and force to measure the evoked force of the thumb. A significant impediment to this type of monitoring is the fact that the piezoelectric sensor may not always be properly aligned to the optimal plane of the thumb movement. Several other attractive noninvasive monitoring systems, smart pumps, and computer-controlled drug infusion delivery have been released and promoted in the anesthetics community and to the general public as accessible vital signs-tracking systems. Integrated pulse oximeters, smartphone electrocardiogram single-lead devices, and applications for at-home screening for intermittent hypoxia in children are also now available.

Safer care. Anesthesia care has become safer and safer. Deaths and adverse outcomes continue to decrease because of improved monitoring, vigilance, education, and training. The Cleveland Clinic writes, “In the 1960s and 1970s, it wasn’t uncommon to have a death related to anesthesia in every one of every 10,000 or 20,000 patients. Now it’s more like one in every 200,000 patients – it’s very rare.” The continuing advances in anesthesia safety are a bellwether for other specialties, who must envy the progress made in anesthesiology quality assurance.

Sugammadex. Sugammadex was FDA-approved in December 2015, and the practice of chemically paralyzing surgical patients and reversing their paralysis has been forever changed. For my non-medical readers, sugammadex is an intravenous drug, which reverses the paralysis of rocuronium, the most commonly used anesthetic paralytic drug, in approximately one minute. Sugammadex replaced the decades-old practice of injecting a combination of neostigmine and glycopyrrolate to reverse paralysis. Neostigmine and glycopyrrolate were slow to act (a wait of up to nine minutes), and could not reverse paralysis if zero twitches were present on a nerve stimulator monitor. In addition, 16 mg/kg of sugammadex IV can reverse an intubating dose of rocuronium, which makes rocuronium more quickly reversible than succinylcholine for rapid-sequence intubation. Sugammadex is not cheap (a cost of USD 100 per 200 mg vial), but since the availability of sugammadex, no anesthesia practitioner should ever have an awake-and-still-paralyzed patient at the conclusion of an anesthetic. A terrific advance.

Research update – AI assisting anesthesiologists in OR
A new study by researchers at MIT and Massachusetts General Hospital (MGH) suggests the day may be approaching when advanced AI systems could assist anesthesiologists in the operating room.

In a special edition of Artificial Intelligence in Medicine, the team of neuroscientists, engineers, and physicians demonstrated a machine learning algorithm for continuously automating dosing of the anesthetic drug propofol. Using an application of deep reinforcement learning, in which the software’s neural networks simultaneously learned how its dosing choices maintain unconsciousness, and how to critique the efficacy of its own actions, the algorithm outperformed more traditional software in sophisticated, physiology-based simulations of patients. It also closely matched the performance of real anesthesiologists when showing what it would do to maintain unconsciousness given recorded data from nine real surgeries.

The algorithm’s advances increase the feasibility for computers to maintain patient unconsciousness with no more drug than is needed, thereby freeing up anesthesiologists for all the other responsibilities they have in the operating room, including making sure patients remain immobile, experience no pain, remain physiologically stable, and receive adequate oxygen, say co-lead authors Gabe Schamberg and Marcus Badgeley.

“One can think of our goal as being analogous to an airplane’s autopilot, where the captain is always in the cockpit paying attention,” says Schamberg, a former MIT postdoc who is also the study’s corresponding author. “Anesthesiologists have to simultaneously monitor numerous aspects of a patient’s physiological state, and so it makes sense to automate those aspects of patient care that we understand well.”

Anesthesia market trends
Pradeesh CB
National Product Manager – Critical Care & Anesthesia,
BPL Medical Technologies

Anesthesia machines are used inside operating rooms to facilitate administration of anesthesia to patients who undergo a surgical procedure. Anesthesia machines do many functions, such as supply compressed gases, measure flow of gases, add vapors in known concentrations, deliver the gas mixture to patient via a breathing system, mechanical ventilation, scavenge waste, monitor patient parameters with safety alarms, etc.

It is evident that the market is moving toward a fully integrated system. Most of the hospitals are upgrading their old basic anesthesia delivery systems to anesthesia workstations with comprehensive patient-monitoring systems. Modern anesthesia machines use advanced electronics, software, and technology to offer extensive capabilities for ventilation, monitoring, inhaled agent delivery, low-flow anesthesia, closed-loop anesthesia, electronic record keeping, etc. These developments have really helped the clinicians to deliver a safe anesthesia to their patients.

Two-gas or three-gas system with dual cascaded tubes, along with a fully integrated ventilator, which supports control and support ventilation mode, is still the highest selling product. Many vendors are improving this segment by adding better features, such as integrated EtCO2 and gas measurements, dual-flow sensing for better ventilation control, electronic flow measurements, bigger screen for accommodating more patient parameters, low- and minimal-flow application, etc.

More and more users are showing interest in electronic flow control, which is with better accuracy, especially for low- and minimal-flow anesthesia applications. With electronic flow control, the consumption also can be monitored. This helps in saving gases and costly agents. Integrated anesthesia gas module, combined with a patient monitor having depth of anesthesia and muscle relaxation monitoring, brain function monitoring, etc., are commonly seen on such high-end anesthesia workstations.

Digital fresh gas control with closed-loop system, along with electronic delivery of anesthetic agents, will be the future. Connectivity solutions are available with many players so that the hospital can have paperless OR. Currently, this type of solution is available at a premium price point.

MRI-compatible anesthesia machine is becoming more popular and is sometimes also treated as statutory requirement inside the MRI room. Now a days, most of the new purchases of MRI equipment are packaged with MRI-compatible anesthesia machine, MRI-compatible patient monitor, MRI-compatible pumps, laryngoscopes, suction, etc.

For small setups, portable anesthesia machines are also available in the market. The advantages are it occupies less space, light weight so easy to transport, can be easily mounted on rails, table-top version also available, lower in price.

Senior author Emery N. Brown, a neuroscientist at The Picower Institute for Learning and Memory and Institute for Medical Engineering and Science at MIT and an anesthesiologist at MGH, says the algorithm’s potential to help optimize drug dosing could improve patient care.

“Algorithms such as this one allow anesthesiologists to maintain more careful, near-continuous vigilance over the patient during general anesthesia,” says Brown, the Edward Hood Taplin Professor Computational Neuroscience and Health Sciences and Technology at MIT.

Both actor and critic. The research team designed a machine learning approach that would not only learn how to dose propofol to maintain patient unconsciousness, but also how to do so in a way that would optimize the amount of drug administered. They accomplished this by endowing the software with two related neural networks – an actor with the responsibility to decide how much drug to dose at every given moment, and a critic whose job was to help the actor behave in a manner that maximizes rewards specified by the programmer. For instance, the researchers experimented with training the algorithm, using three different rewards – one that penalized only overdosing, one that questioned providing any dose, and one that imposed no penalties.

In every case, they trained the algorithm with simulations of patients that employed advanced models of both pharmacokinetics, or how quickly propofol doses reach the relevant regions of the brain after doses are administered, and pharmacodynamics, or how the drug actually alters consciousness when it reaches its destination. Patient unconsciousness levels, meanwhile, were reflected in measure of brain waves, as they can be in real operating rooms. By running hundreds of rounds of simulation with a range of values for these conditions, both the actor and the critic could learn how to perform their roles for a variety of kinds of patients.

The most effective reward system turned out to be the dose penalty, one in which the critic questioned every dose the actor gave, constantly chiding the actor to keep dosing to a necessary minimum to maintain unconsciousness. Without any dosing penalty the system sometimes dosed too much, and with only an overdose penalty it sometimes gave too little. The dose penalty model learned more quickly and produced less error than the other value models and the traditional standard software, a proportional integral derivative controller.

An able advisor. After training and testing the algorithm with simulations, Schamberg and Badgeley put the dose penalty version to a more real-world test by feeding it patient consciousness data recorded from real cases in the operating room. The testing demonstrated both the strengths and limits of the algorithm.

During most tests, the algorithm’s dosing choices closely matched those of the attending anesthesiologists after unconsciousness had been induced and before it was no longer necessary. The algorithm, however, adjusted dosing as frequently as every five seconds, while the anesthesiologists (who all had plenty of other things to do) typically did so only every 20–30 minutes, Badgeley notes.

As the tests showed, the algorithm is not optimized for inducing unconsciousness in the first place, the researchers acknowledge. The software also does not know of its own accord when surgery is over, they add, but it is a straightforward matter for the anesthesiologist to manage that process.

One of the most important challenges any AI system is likely to continue to face, Schamberg says, is whether the data it is being fed about patient unconsciousness is perfectly accurate. Another active area of research in the Brown lab at MIT and MGH is in improving the interpretation of data sources, such as brain wave signals, to improve the quality of patient monitoring data under anesthesia.

In addition to Schamberg, Badgeley, and Brown, the paper’s other authors are Benyamin Meschede-Krasa and Ohyoon Kwon.

Ultrasound, bringing more meaning to anesthesiology
Dr Vivek Gupta
Senior Consultant and HOD,
Saroj Hospital

Surgery has made immense progress in the last two and a half decades. Complex advanced surgeries are now possible, and they can be done safely and painlessly. This has all been made possible because of the amazing developments in the field of anesthesia. It is much safer and comfortable now.

Anesthesia is very safe now because of the development of newer anesthetic agents and their delivery systems, called anesthesia machines. Equally responsible for carrying out safe anesthesia is the development of new monitoring systems and equipment. Morton used the open-drop method to administer long back ether anesthesia without the use of any equipment. Initially, only pulse and respiration, then blood pressure, were used to monitor the patient.

We have come a long way from that situation. We now have very sophisticated automated anesthesia-delivery systems, with all the necessary safety features and monitors, capable of measuring so many parameters that were previously unheard of. Some 40 years ago, when I started my PG in anesthesia, we had a very simple Boyles machine with four gas rotameters – oxygen, N2O, CO2, and cyclopropane. Simple ether and trilene vaporizers were there. Soon, halothane was introduced. Initially, only a few could afford halothane and halothane vaporizers. As such, Goldman vaporizers were mostly in use.

Slowly, things progressed and cardiac monitors showing ECG started appearing on the shelves of anesthesia machines. Not long after, blood pressure monitoring was added to monitors, but there was no SpO2 measurement available. It took two deaths in a big hospital to awaken the government from its slumber. Very fast, SpO2 was introduced, and anesthesia machines were made compulsory for the registration of nursing homes and hospitals. Multipara monitors, at that time, were a rarity. Things really moved fast from here.

Multiple safety devices, like NitroLock, RatioControl, and OxygenAlarm, were incorporated in anesthesia machines. Monitoring also improved and progressed rapidly. Multiparameter monitors were introduced. Now we could monitor an array of parameters. I consider SpO2 and EtCO2 to be the most useful parameters available. Nerve blocking was introduced and for that, nerve stimulators were made available. It also had the facility to monitor the train of four. Anesthesia machines began to become digital and electronic for non-depolarizing neuromuscular blocks.

Simultaneously, anesthesia ventilators were introduced and incorporated into anesthesia machines. This made the life of an anesthetist very easy. He now no longer needed to ventilate with hand for long hours. It was now possible to monitor and adjust various ventilatory parameters based on patient condition. It was now easy to perform low-flow anesthesia, introduce PEEP, CPAP, etc. Another breakthrough and revolution came with the introduction of ultrasound in anesthesia. I envision future anesthesia machines including ultrasound and ECHO as standard features.

While developing nations still need to catch up, developed nations have already embraced advanced methods and are far ahead. Continuous innovation is changing the healthcare industry. New digital solutions are enabling clinicians to access patient data from any location at any time. To offer better treatment and real-time services to numerous care centers, regardless of their locations, developing countries require seamless integration of all semi-urban/urban hospitals. To assist healthcare providers collect and exchange patient healthcare information more effectively, anesthesiologists require data security. In the upcoming years, anesthesiologists will have a productive system for exchanging patient data that will direct patient management even in faraway locations.

The industry requires IT systems that integrate clinical assistive/AI applications, enabling doctors to readily access vast amounts of clinical data for the prediction, prevention, and diagnosis of numerous diseases. To close the enormous gap in high-quality healthcare expertise between rural and urban locations, emerging nations must invest in building tools like hospital management systems, cloud storage, and AI technology. All this technology will make healthcare safer.

Copyright © 2024 Medical Buyer

error: Content is protected !!