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World's First Transcontinental Anesthesia

samzenpus posted more than 3 years ago | from the ping-me-when-the-patient-is-asleep dept.

Canada 83

An anonymous reader writes "Medical Daily reports: 'Video conferences may be known for putting people to sleep, but never like this. Dr. Thomas Hemmerling and his team of McGill's Department of Anesthesia achieved a world first on August 30, 2010, when they treated patients undergoing thyroid gland surgery in Italy remotely from Montreal. The approach is part of new technological advancements, known as 'Teleanesthesia', and it involves a team of engineers, researchers and anesthesiologists who will ultimately apply the drugs intravenously which are then controlled remotely through an automated system.'"

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83 comments

Hmm (2, Insightful)

Anonymous Coward | more than 3 years ago | (#33535380)

World's First Transcontinental Anesthesia

When I read that title and saw that picture, I thought they were talking about a service where an anesthesia team puts someone to sleep for a 14 hour transcontinental flight. Anyone else?

Re:Hmm (1)

Xugumad (39311) | more than 3 years ago | (#33535636)

As someone who last got out of a proper bed 28 hours ago, of which 9 was a transcontinental flight, that sounds good...

Must... not... sleep yet...

Re:Hmm (0)

Anonymous Coward | more than 3 years ago | (#33535812)

Don't give them any ideas!

Re:Hmm (1)

cpscotti (1032676) | more than 3 years ago | (#33535834)

Mod Parent Up! Or better, since he/she posted as an Anonymous Altruist Coward, let me apply a patent on this!
I got really pissed off upon realizing that was NOT the case!

Re:Hmm (1)

228e2 (934443) | more than 3 years ago | (#33537388)

14 hours of sleep will be plenty of time to perform inception. I just hope the sedative is strong enough . . . I have a empire to break up.

Big deal (0, Offtopic)

Locke2005 (849178) | more than 3 years ago | (#33535402)

Sadly, the field of teledildonics is still lagging behind...

Re:Big deal (2, Interesting)

Miseph (979059) | more than 3 years ago | (#33535972)

In all honesty, I see and hear a lot about sex toys, particularly off-kilter ones (hazard of the side gigs), and teledildonics is progressing pretty rapidly. They actually have working, commercially available models with bilateral controls... 10 years ago the idea was just a bad joke.

The more you know, the more you sometimes wish you didn't.

Re:Big deal (1)

PitaBred (632671) | more than 3 years ago | (#33536064)

Links or it didn't happen

does this mean doctors can be outsourced? (2, Informative)

AvitarX (172628) | more than 3 years ago | (#33535416)

That's gonna suck for them, but drop medical costs for me...

Re:does this mean doctors can be outsourced? (1)

lazlo (15906) | more than 3 years ago | (#33542012)

Which brings up the really important question here... what jurisdiction would a malpractice suit be brought in?

Encrypted and validated data stream? (2, Insightful)

alphax45 (675119) | more than 3 years ago | (#33535448)

Is there end to end encryption for this? What if a bit gets dropped? Is there a CRC above and beyond the standard CRC already done? Not sure I trust this...

Re:Encrypted and validated data stream? (1)

camperdave (969942) | more than 3 years ago | (#33535634)

I am not a doctor, nor an anesthesiologist, but I think this is one job that could easily be automated. Feed the patient's pulse, respiration rate, eeg, whatever, into a computer and have it dole out the sleeping gas appropriately. Pulse rate too high, more gas. EEG showing pain response, more gas. Breathing too shallow, less gas.

Re:Encrypted and validated data stream? (2, Insightful)

Chowderbags (847952) | more than 3 years ago | (#33535750)

Dunno about complete automation. Each patient is different, and it's a bit tougher than saying "pulse under 20, bad" or "O2 saturation under 90%, no more gas"(if you're getting operated on due to problems leading to hypoxemia, you want a way to override the settings) (I am neither a doctor nor an anesthesiologist, but I imagine that there's situations like that that aren't extremely rare).

Maybe something more akin to autopilot, which is fine for most of the flight, but you still want a pilot there to deal with the trouble scenarios.

Re:Encrypted and validated data stream? (-1, Offtopic)

Anonymous Coward | more than 3 years ago | (#33536184)

Why is the sky blue?
Well, molecules in the air scatter blue light from...
I asked why, not how.

Because God farts blue.
He's everywhere you want to be, just like Visa.

Re:Encrypted and validated data stream? (3, Informative)

Kilrah_il (1692978) | more than 3 years ago | (#33536472)

Disclaimer: I am a doctor, Jim, not a ****.

A few problems:
1) The technical act of anesthetizing a patient involves, amongst other things, putting a tube inside the patients trachea (AKA intubation) so he can be artificially ventilated - a task that demands a qualified human being. A robot can't do it. Even if you could develop a robot to do it, you would want someone near at hand in cases of difficult intubations.
2) Some operations need more than just a regular IV (intravenous) line and intubation. Sometimes you need a central venous line, arterial line, urine catheter, gastric tube, etc. I don't know how it is in the US, but in Israel most, if not all, of these procedures are performed by the anesthesiologist.
3) In 95% of the cases the anesthesia is going smoothly throughout the operation and the anesthesiologist can sit back and relax (and try not to fall asleep). However, in some of the cases things go wrong. Some of them are easy to fix (blood pressure too low/high - give medication X/Y). But some are harder. For example, in one operation I was in, the patient's O2 saturation went plumbing down. What was the problem? The tubing from the intubation tube to the ventilation machine got disconnected along the way. The anesthesiologist is the one who needs to solve problems such as this. Even for the easy problems, when they happen you want a speedy response. If something happens to the connection at the critical time (and statistics assure you that once in a while something bad will happen at the worst possible moment), the patient could suffer. Gives a whole new meaning to "Denial-of-service" attack.
4) Even if nothing goes wrong, some operations (esp. in the head and neck region) need the anesthesiologist's help during the surgery.
5) The waking up part of the operation also needs an anesthesiologist in the room to carry out some procedures (e.g. extubating the patient, suctioning his airways, making sure he is breathing OK, re-intubating if he can't breath well).

So, while I am all in favor of automation, robots and remote control, I for one see plenty of downsides, but no upside. If anyone has an idea how this can help the patient, I would be glad to start thinking about the cost/benefit ratio. Right now, for me, the ratio is approaching infinite.

Re:Encrypted and validated data stream? (2, Interesting)

Kilrah_il (1692978) | more than 3 years ago | (#33536616)

Oh, and one more things: For many tasks there is still no better tool than a doctor's assessment. One of those tasks is assessing if a patient is properly anesthetized. There has been no success in developing a tool (including EEG) that can give better results than a doctor's opinion.

Re:Encrypted and validated data stream? (2, Interesting)

nospam007 (722110) | more than 3 years ago | (#33536984)

"A robot can't do it."

Lots of doctors can't either. From Wikipedia: ....
However, tracheal intubation requires a great deal of clinical experience to master[208] and serious complications may result even when properly performed.[209] When performed improperly, the associated complications (e.g., unrecognized esophageal intubation) may be rapidly fatal.[210] Without adequate training and experience, the incidence of such complications is unacceptably high.[158] For example, among paramedics in several United States urban communities, unrecognized esophageal or hypopharyngeal intubation has been reported to be 6%[211][212] to 25%.[210] Among providers at the basic emergency medical technician (EMT-B) level, reported success rates for tracheal intubation are as low as 51%.[213] In one study, nearly half of patients with misplaced tracheal tubes died in the emergency room.....

Re:Encrypted and validated data stream? (1)

Kilrah_il (1692978) | more than 3 years ago | (#33538902)

Your post does not invalidate my comment. A lot of doctors can't perform an intubation, but doctors that perform it on a daily basis and are very skilled in performing this procedure (e.g. anesthesiologists), have a very high success rate. I believe that the lower percentage in your post (6%) is more fitting for a skilled anesthesiologists, whereas the higher percentage is for doctors who do not perform intubation on a regular basis*.
Furthermore, I believe the numbers you cite refer to any attempt. Since if at first you don't succeed you should "try try again", the chances of not succeeding at all in a given patient are slim. As an ENT doctor who is called to perform a cricothyrodotomy [wikipedia.org] whenever there is a patient who cannot be intubated, I assure you it is a rare occasion.

* - No citation, but although I am not an anesthesiologist, I try to perform an intubation whenever possible (I ask anesthesiologists to perform intubations in surgeries of my patients) and I believe my success rate is closer to the lower numbers... and I am not as skilled as an anesthesiologist.

Re:Encrypted and validated data stream? (1)

demonlapin (527802) | more than 3 years ago | (#33540456)

That's a 6% unrecognized esophageal. In the OR, the end-tidal CO2 monitor makes unrecognized esophageal intubations essentially nil. I'd say a first-attempt success rate for an experienced anesthesiologist should be about 95%, second-attempt around 99+%. (The bougie, Glidescope, etc., make the second attempt much higher, and that 95% figure counts the times that I take a look, figure out there's no way I'm going to get this via straight DL, and grab one of those intubation aids as a failed attempt.)

Re:Encrypted and validated data stream? (1)

Kilrah_il (1692978) | more than 3 years ago | (#33542938)

I believe my success rate is closer to the lower numbers

of course, I meant my fail rate. My bad.

Re:Encrypted and validated data stream? (1)

eth1 (94901) | more than 3 years ago | (#33538182)

IANAD...

I believe what you say is true for developed nations, but I think the real use of tech like this would be in situations where there normally *wouldn't* be an anaesthesiologist available. Developing countries, field hospitals, etc., where something is better than nothing.

Re:Encrypted and validated data stream? (1)

Kilrah_il (1692978) | more than 3 years ago | (#33538950)

But that is the problem, the main skills for which you need an anesthesiologist are the technical skills (see points 1,2 and 5 in my original post), not so much the giving of drugs. The part about giving medications is easy (at least on a basic level) and can be taught to any doctor in a relatively short period of time. It is the technical skills that take time to learn.

Re:Encrypted and validated data stream? (1)

swamp_ig (466489) | more than 3 years ago | (#33540790)

I too don't see how this is an advance. Controlling the anethesia machine is really just the smallest fraction of an anethetist's skill. TFA talks about videoconferencing for the pre-op visit, but one still needs to assess the patient's airway and suchlike to do that.

This is really a non-advance.

Re:Encrypted and validated data stream? (1)

olddoc (152678) | more than 3 years ago | (#33540802)

I am an Anesthesiologist in the US. Yes, in the US most of those tubes are put in by the Anesthesiologist. People tend to think of Anesthesiologists as being experts in giving drugs to make someone sleep. That is actually easy to do. The problem is keeping them breathing and the ABCs: Airway, Breathing, Circulation. People don't usually die from drug overdoses, they die from lack of oxygen to the brain because they stop breathing. THE experts in keeping the airway open and keeping someone breathing are Anesthesiologists. I could give a person a synthetic narcotic that is 100x as potent as Heroin and give them a 100 fold overdose and keeping them alive would be easy for me: just breathe for the patient until the drug wears off. Developing some kind of remotely controllable robot to keep a moving 400 pound (in the US we have many obese patients) patient's airway open would not be easy. Another other difficult problem would be nerve blocks: remotely advancing a needle to just outside the spinal cord, or just into the left brachial plexus seems like a difficult job to do by remote control. So cool use of a remote connection, but I'm not worried that I'll be outsourced anytime soon. I will be physically present at 2am putting that epidural in your back for your labor pains.

Re:Encrypted and validated data stream? (1)

sjames (1099) | more than 3 years ago | (#33537092)

Actually, I find it more concerning than the primary surgeon being remote. Anesthesiology is still an art as much as a science. Too shallow and the patient will remember the surgery and pain and could end up with a really nasty PTSD. Too deep and the patient never wakes up. A bit less deep and they are out of it for days. The effectiveness of bilateral EEG is now in question. That leaves watching for subtle signs of awareness that might or might not be apparent on a video link.

Re:Encrypted and validated data stream? (1)

demonlapin (527802) | more than 3 years ago | (#33540412)

Wrong. (I am a board-certified anesthesiologist in the US.)

You don't pay me to do the boring stuff. 99% of the stuff in the OR can be done by someone with less training. It often is; in my practice, I supervise up to four nurse anesthetists at a time. They sit in the room, watching your vital signs and adjusting your anesthesia as needed. I'm there to plan the anesthesia for everyone when they arrive, I'm by their side as they put you to sleep, and I'm there for when the shit hits the fan. That is what you pay me for - to be on standby in case anything goes wrong.

There are just too many physical pieces of the puzzle to automate very much of it. Someone has to intubate the patient. Someone has to start the IV, put in the arterial line, place the central line, perform the spinal or epidural, and be there when they wake up. Laryngospasm can't be fixed by a computer. In short, adjusting the gas to keep someone unconscious and comfortable is the least complicated thing we do. I could teach a bright high school student to do a decent job of it in an afternoon. We're not there to do that job; it's just something that we take care of while we're in the room watching the monitors.

Re:Encrypted and validated data stream? (2, Interesting)

berzerke (319205) | more than 3 years ago | (#33535746)

...Not sure I trust this...

Really sure I don't trust this. It's bad enough with all the mistakes doctors make now. Now add to it the possibility of service interruption (cut cables, DOS attacks). Then add what could happen if the computers involved become infected with malware. If the systems were isolated, then *maybe* they could be trusted, but in this case, they are not. Then factor in whether or not the doctor is licensed to operate in a particular country...

So you get around this by having a competent team standing by to take over. But in that case, there's very little potential benefit.

units units units (0)

Anonymous Coward | more than 3 years ago | (#33535450)

Fortunately medicine is almost all metric these days. It would really be a bad thing if a Mars-lander-like unit conversion bug were to happen.

Bad idea (2, Insightful)

dkleinsc (563838) | more than 3 years ago | (#33535454)

For one very simple reason: network outage. If the anesthesiologist is present, s/he can react if something goes wrong. If they aren't, the patient may well be SOL.

Re:Bad idea (1)

Hoi Polloi (522990) | more than 3 years ago | (#33536422)

Or they lose two-way communication and don't realize their commands aren't being received until there is a crisis.

Re:Closer (0)

Anonymous Coward | more than 3 years ago | (#33535570)

What's with the US obsession with violence. They'd probably allow this and be up in arms if someone figure out how to have real, live sex over the 'net.

Let's hope they are not running Windows (2, Interesting)

Zalgon 26 McGee (101431) | more than 3 years ago | (#33535516)

A whole new meaning to "Blue Screen of Death".

Re:Let's hope they are not running Windows (1)

LA Thierry (923197) | more than 3 years ago | (#33535552)

Seriously, if the anesthesia caused a patient's death due to negligence or malfunction, who would be responsible? and under which country's laws?

Outsourcing Potential (3, Insightful)

EmagGeek (574360) | more than 3 years ago | (#33535588)

This is truly a breakthrough, but not one with which I am particularly thrilled. I am definitely not comfortable with my life being in the hands of a doctor half way around the world with only a small view of what is going on, and one that depends entirely on network availability.

Also, if something goes wrong that is beyond the scope of what the robot is capable of, how am I guaranteed a competent doctor will be right there locally ready to step in and take over?

While this might be a big TECHNOLOGICAL advancement, I can't really see how this is a MEDICAL advancement or a viable cost-saving measure for health care.

Re:Outsourcing Potential (1)

kurt555gs (309278) | more than 3 years ago | (#33535868)

Think about how "Net Neutrality" will affect this.

Version: I don't care if a life is on the line, they didn't pay extra. throttle 'em.

Re:Outsourcing Potential (1)

ThinkWeak (958195) | more than 3 years ago | (#33535956)

While this might be a big TECHNOLOGICAL advancement, I can't really see how this is a MEDICAL advancement or a viable cost-saving measure for health care. A lot of your anethesia is monitored/performed by assistants these days, with an anethesiologist in the building just incase something goes wrong. You will now have the ability to have LESS people walking around monitoring things because it can be administered/controlled remotely. The results will be:

1) Less assistants assisting.
2.) More territory for an anethesiologist to cover.

It's the same formula that has been sweeping the nation for years. Do more with less, with someone remotely "assisting." I don't think they'll offshore anethesia, but there are possible applications for this.

Re:Outsourcing Potential (2, Insightful)

Superdarion (1286310) | more than 3 years ago | (#33536112)

Well, my guess is that the idea is in the lines of schools via videoconference. I don't know about other parts of the world, but here in Mexico there are a lot of schools in faraway small communities, well outside the bulk of civilization, that have no teachers, just tv screens. There is one teacher in a major city broadcasting his/her class so that these schools can learn. There's a whole system with details that are unknown to me, but the system is there.

So why use a doctor that's not physically there but on a videoconference? That's simple; if you need an emergency surgery and live in a remote island with only one doctor and a few nurses, this system might save your life.

Re:Outsourcing Potential (0)

Anonymous Coward | more than 3 years ago | (#33536194)

You realize that if there's an anesthesiologist working that there is also a surgeon, right? Your life is already in the hands of the surgeon, the anesthesiologist is not playing the main role. And there is always a CRNA helping him live.

And they can always just call the anesthesiologist on the phone if something goes wrong with the network. Have the surgery tech or CRNA get on the phone, "Ya, the O2 sat is now 95%. Now it's 96. back to 95. Oh shit, dropped to 86! Spin this dial thingy up 3 notches? Ok, back to 95."

No big deal.

Re:Outsourcing Potential (1)

demonlapin (527802) | more than 3 years ago | (#33540526)

I know a very lot of very intelligent surgeons. Almost none of them know any substantive anesthesia. That's fine; I certainly wouldn't attempt a surgical procedure more complicated than a lipoma excision. But there's no substitute for being there, and the phone is a poor substitute. The only time my CRNAs use the phone is to tell me to come by, we're ready to go to sleep or wake up. If it's an emergency, they tell the OR nurse to page me overhead. (And I'll be there in about 20 seconds.)

While your life is indeed in the hands of some surgeons - there's nothing I can do to help you if the heart surgeon rips a hole in your aorta - but in other fields, like orthopedics, where the surgery all happens at the periphery, your life is definitely mine to lose or save.

Re:Outsourcing Potential (0)

Anonymous Coward | more than 3 years ago | (#33536258)

It's a medical advancement because if you look at top paid careers in the United States, Anesthest's cost the most money - since any overdose can instantly kill you. Ever had a pet put down? That's an Anesthesia overdose. I don't know about you but I would much prefer someone far more qualified, even if 1,000's of miles away...

Re:Outsourcing Potential (1)

DerekLyons (302214) | more than 3 years ago | (#33536374)

This is truly a breakthrough, but not one with which I am particularly thrilled. I am definitely not comfortable with my life being in the hands of a doctor half way around the world with only a small view of what is going on

Even though it's pretty much the same view as an anesthesiologist in the same room has.
 

Also, if something goes wrong that is beyond the scope of what the robot is capable of, how am I guaranteed a competent doctor will be right there locally ready to step in and take over?

Even though an anesthesiologist in the same room can't do anything that the robot can't do.

Re:Outsourcing Potential (1)

demonlapin (527802) | more than 3 years ago | (#33540550)

Even though an anesthesiologist in the same room can't do anything that the robot can't do.

What future are you from? When you've got something with the maneuverability of the loader robots from Aliens, tactile feedback, and dexterity, maybe that will be true.

Re:Outsourcing Potential (0)

Anonymous Coward | more than 3 years ago | (#33536488)

What do you mean you can't see how outsourcing could be a cost-saving measure? I could hire cheap doctors in a 3rd world country to perform my surgery.

Great! (1)

jasno (124830) | more than 3 years ago | (#33535670)

This is just great - soon doctors won't need to live anywhere near the dirty people they have to care for. The doctor class could safely live on a few tropical islands and still provide care for the masses.

Re:Great! (1)

oldhack (1037484) | more than 3 years ago | (#33536276)

Yep, just like programmers and customer service reps, drinking pina colada on the tropical beach.

Bad Idea (0)

Anonymous Coward | more than 3 years ago | (#33535854)

I have to say, this is an astonishingly bad idea
I know telesurgery has been around for years, but it almost always includes laparoscopic and otherwise routine procedures. General anesthesia is not a "sure thing" and thousands of patients have unforeseen and dangerous complications in anesthesia every year. The immediate responsiveness of a clinician in these scenarios can mean the difference between survival or death of the patient. Furthermore, anesthesia is far from an exact science- can a remote system analyze the perceived BMI of the patient and compensate for it? Yes, it can, but only in a strictly controlled environment in which everything goes right. In trauma surgery or emergency procedures, minutes matter, and a living, breathing anesthesiologist is a necessary component to every OR.

It's been done before in acadamia (3, Funny)

Winckle (870180) | more than 3 years ago | (#33535898)

My university has loads of remote learning resources that have a similar effect!

Yay! (1)

Andrewkov (140579) | more than 3 years ago | (#33536076)

This is fantastic!! Now we can outsource all anesthesiologists to India and reduce the costs of healthcare for everyone!

After all, it worked great for call centers and programmers!

Interesting terminology (1)

TheCaptain (17554) | more than 3 years ago | (#33536174)

On a somewhat related note, we first achieved transcontinental euthanasia many decades ago, and we have an alarming rate of post-birth abortions these days.

Paperless Hospitals First Please (0)

Anonymous Coward | more than 3 years ago | (#33536246)

"By the best count, only 1.5 percent of the nation's roughly 6,000 hospitals use a comprehensive electronic record." http://www.msnbc.msn.com/id/31766190/ [msn.com]

"If these results were to hold for all hospitals in the United States, computerizing notes and records might have the potential to save 100,000 lives annually,"
http://www.medicalnewstoday.com/articles/136847.php [medicalnewstoday.com]

Yes, the availability of a specialist to treat a patient globaly is a huge advancement in the field. However making changes in the way we do simple paperwork can save thousands of lives localy.

Re:Paperless Hospitals First Please (0)

Anonymous Coward | more than 3 years ago | (#33538286)

The biggest problem with electronic medical paperwork is the fact that so many people in the medical profession are simply incapable of using a computer, even for rudimentary tasks. I don't mean that they haven't been trained properly, but that they cannot be trained properly. I work at the Hell Desk of a hospital, and I spend much of my day dealing with nurses and therapists and social workers who don't understand that pushing the power button on their monitor doesn't turn off the computer, or who cannot figure out (without being carefully coached over the phone) which of the five cables plugged into the computer is the "power" cable. They may (or may not) be good at what they do now, but they will fuck up any EMR system you put together, I promise you that.

BSOD FTL (0)

Anonymous Coward | more than 3 years ago | (#33536292)

Title says it all.

Seriously though, why?
You need as much expertise if not more, at the remote location as you do at the joystick.

Intercontinental (2, Informative)

Doc Ruby (173196) | more than 3 years ago | (#33536634)

"Transcontinental" means "across the (same) continent".

"Intercontinental" means "across (or between) multiple continents".

The Internet is a network of networks. The Transnet is nothing.

Why in Idle? (2, Insightful)

treeves (963993) | more than 3 years ago | (#33536704)

Some Slashdot stories clearly belong in Idle and are not there. This is clearly the opposite case. It's not about entertainment or something funny and it's definitely technology related. Anyway, I'd like to know what my brother-in-law has to say about this. He's an anesthesiologist who has a home on the west coast [of the US] but works at a hospital in the midwest, so I'm sure he has an opinion about it!

Outsourcing (0)

Anonymous Coward | more than 3 years ago | (#33537118)

Does no-one else realize that this most likely going to result in even more medical outsourcing (right now reading of X-ray pictures/etc. and lab result interpretation is being outsourced). While I'm not inherently against globalization and the race to the economic bottom (who can provide the service the cheapest) there are obviously some concerns about the quality of care/etc. Although with the US spending 16% of it's GDP (so for every $6 dollars spent in the US today, $1 goes into the health care system) and having poor outcomes (lower life expectancy than virtually all other western nations, higher infant mortality, etc.) things probably can't get much worse.

Now, your tech support AND back surgery from India (0)

Anonymous Coward | more than 3 years ago | (#33537812)

Thank you please come again

Transcontinental Anesthesia (1)

BlindRobin (768267) | more than 3 years ago | (#33537964)

Was accomplished long ago by Yani concerts. My ex once sat next to him on a flight to from NYC to London and claimed to have gotten her best in-flight kip ever just from the proximity. ( True story)

Not sure we're there yet (2, Interesting)

Sevorus (1754146) | more than 3 years ago | (#33538276)

Well, as a practicing anesthesiologist at a major academic center on the West Coast, I'd call this interesting but not medically practical at the moment. As a technological breakthrough, it's not really all that novel. So they transmitted vital signs around the world along with a video feed? Okay...but how is that any different from a teleconference?

The problem with "teleanesthesia", as I see it, is that medical knowledge is only a part of what my presence in the OR provides. The ability to physically intervene is something that can't be done by telepresence (not yet, anyway). If the endotracheal tube comes out during surgery, then you're relying on a technician to replace it. If you need a central line (big IV access in the neck or groin), you need a technician or the surgeon to place it. The hundreds of little things like that are what keep an anesthesia care provider with patients in the OR for the entirWell, as a practicing anesthesiologist at a major academic center on the West Coast, I'd call this interesting but not medically practical at the moment. As a technological breakthrough, it's not really all that novel. So they transmitted vital signs around the world along with a video feed? Okay...but how is that any different from a teleconference?

The problem with "teleanesthesia", as I see it, is that medical knowledge is only a part of what my presence in the OR provides. The ability to physically intervene is something that can't be done by telepresence (not yet, anyway). If the endotracheal tube comes out during surgery, then you're relying on a technician to replace it. If you need a central line (big IV access in the neck or groin), you need a technician or the surgeon to place it. The hundreds of little things like that are what keep an anesthesia care provider with patients in the OR for the entire duration of each and every surgery that goes on.

The other issue as I see it is that monitoring the vitals is important, but there are a lot of things that happen in an operating room that you can't monitor as well over a video feed. How much blood is really being lost? Can I visually sweep the floor, the surgical drapes, and the suction canisters easily and get an estimate? A patient can lose a third to half of their blood volume in some cases before you're going to see that reflected in vital signs, by which time you're way behind.

I suppose there is a place for this kind of thing in battlefield medicine and maybe remote third-world locations, but in those cases the anesthesiologist should be considered a consultant to the people on the ground and not "the primary provider", as it were. In order to make this real-world applicable, you'd need a robot on the far end with visual, audio, and tactile feedback, the ability to move around the room, etc - really a surrogate you that you could reliably control as well as your own hands and eyes. Of course, then you've got the issues with dropped connections, security of the feed, etc. What happens when a script-kiddie hacks your anesthesiabot-3000 and goes nuts with the drug delivery system?

Don't get me wrong, like everyone else I'd love to do my job sitting on my couch in my undies via video feed to the "office", but I'm not really sure this much more than a bit of a publicity stunt at this point.e duration of each and every surgery that goes on.

The other issue as I see it is that monitoring the vitals is important, but there are a lot of things that happen in an operating room that you can't monitor as well over a video feed. How much blood is really being lost? Can I visually sweep the floor, the surgical drapes, and the suction canisters easily and get an estimate? A patient can lose a third to half of their blood volume in some cases before you're going to see that reflected in vital signs, by which time you're way behind.

I suppose there is a place for this kind of thing in battlefield medicine and maybe remote third-world locations, but in those cases the anesthesiologist should be considered a consultant to the people on the ground and not "the primary provider", as it were. In order to make this real-world applicable, you'd need a robot on the far end with visual, audio, and tactile feedback, the ability to move around the room, etc - really a surrogate you that you could reliably control as well as your own hands and eyes. Of course, then you've got the issues with dropped connections, security of the feed, etc. What happens when a script-kiddie hacks your anesthesiabot-3000 and goes nuts with the drug delivery system?

Don't get me wrong, like everyone else I'd love to do my job sitting on my couch in my undies via video feed to the "office", but I'm not really sure this much more than a bit of a publicity stunt at this point.

Re:Not sure we're there yet (1)

BKX (5066) | more than 3 years ago | (#33541162)

Is this some kind of bizzare "yo dawg" joke. Like, "Yo dawg, I heard you liked comments from anesthesiologists so I put a comment in your comment so you could read while you read."

Health Care is ready for this (1)

adamwpants (858079) | more than 3 years ago | (#33539614)

The health care system is most definitely ready for this.

You might be familiar with Nurse Anesthetists, or the newer Anaesthesia Assistant role (often filled by Respiratory Therapists with advanced training). These people are qualified to start IVs, administer drugs, insert breathing tubes, monitor during anaesthesia, and troubleshoot when things go wrong. They can be trained to insert arterial lines, central lines, etc.

The role of the anaesthesiologist then becomes more big-picture... the doc is able to:
* develop a treatment plan
* oversee the patient
* respond to emergencies, and
* attend to the more difficult cases.
Those first two can easily be done remotely, especially under the conditions in the article (like patients in very low-density areas). The point is, there are people available to handle the basic technical skills, and under extreme conditions this system could bring anaesthesia to areas it'd be otherwise unavailable.

Everybody wants fast access to health care. They should diagnose expeditiously, start a treatment plan immediately, and treatment should progress rapidly. We should absolutely embrace ways to free up doctors so they can treat more people, and sooner.

The least the anestetist could do is attend! (1)

thegarbz (1787294) | more than 3 years ago | (#33540694)

Seriously, my last operation was trivial yet more than half (literally more than 50%) of the fees went to the anesthetist. This guy comes in gives me a drip and sits down and opens a book about a quarter way through. I woke up briefly half way through the operation and was knocked out again within about 4 seconds. At the end I get woken up, and he's on the last few pages of his book.

He's come in, taken the money, done sweet fuck all, and screwed up, meanwhile the doctor who did all the hard work gets a pittance of the profit of the operation. They get paid through the nose to mostly do nothing. The LEAST they co do is have the decency to actually be there!

A similar story (2, Interesting)

lsatenstein (949458) | more than 3 years ago | (#33542086)

I heard about a Montreal Hospital exchanging digital xrays with an Austrialian hospital. When radiologists are asleep in one country, they are awake in the other, and as long as volumes of xrays are within reasonable limits, the radiologists are not overburdened. Most new Xrays are digitalized, so film xrays as we know it is passé, except for dentists, and here too, it is moving to digital.

What happens when the president pushes the button? (1)

Nyder (754090) | more than 3 years ago | (#33542508)

Okay, so we are using the internet for long distance surgery and what the fuck else.

the USA has a big red button that says, "Press to shut down Internet in case of emergency".

Can we see a problem here?

Lag kills, (0)

Anonymous Coward | more than 3 years ago | (#33562362)

so what happens when we [NO CARRIER] ^(*$&(*%&$#

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