Computer assisted physiologic monitoring and stability assessment in vascular surgical patients undergoing general anesthesia--preliminary data

Automated anesthesia

PURPOSE OF REVIEW

Anesthesiologists are overloaded with information and multitasking necessities in an extremely complex work environment. The purpose of this review is to present recent developments toward automated anesthesia and present future technologies for everyday clinical practice.

RECENT FINDINGS

Decision support systems integrate different parameters, clinical scenarios and assessments by (non)-trained personnel into algorithms, which lead to diagnostic suggestions, triage evaluations or treatment options. Target-controlled anesthesia infusion systems reduce the anesthesiologist's workload; target-controlled analgesia systems have the potential to provide more stable hemodynamic control. Closed-loop delivery of anesthesia is feasible and provides anesthetic control as good as or better than human delivery. Teleanesthesia offers the possibility of distant preoperative assessment of the patient's fitness for anesthesia, aid of trained personnel to perform anesthetic tasks and the control of anesthesia delivery in a distant location.

SUMMARY

Decision support systems help to make reliable and standardized decisions in complex environments. Target-controlled infusion systems reduce the anesthetic workload. Closed-loop systems will automate anesthesia care in the near future. Teleanesthesia offers the opportunity to provide safe anesthetic care whenever trained personnel are not available or need support.

Hidden aspects of the anaesthesia chart

Anaesthesia is a complex task operating in an uncertain environment. Part of the problem is that many of the technologies developed to assist the anaesthesiologist hinder rather than help, because of increased complexity. We conducted an analysis of the domain in view of redesigning the anaesthesia chart as a digital artefact. We used an ethnographic approach that uncovered aspects of the anaesthesiologist's practice, as well as the fact that the chart was not used as a tool, because of its legal status.

Multimedia Data Capture and Management for Surgical Events: Evaluation of a System

The objective of this study was to design an electronic form of documentation of surgical procedures, which would include audio and video recording of the entire surgical procedure. Video clips have shown promise for teaching surgical procedures. To date, no systems have been described to fully record video and audio of all events during a surgical procedure. Much as such systems have aided the airline industry, surgical safety, documentation, and education could benefit from comprehensive, multimedia documentation systems. Four camcorders provided views of: (1) anesthetic monitors, (2) laparoscopic images, (3) room view, and (4) surgical field view. All video and audio were combined with real-time written documentation of events within a simple, inexpensive database for archiving, review, and evaluation. Electronic records provided answers to more than 90% of the structured review questions, leaving only 6% unanswered, versus 92% unanswerable based on the traditional paper records. This electronic documentation system provides a much more comprehensive and easily mined means of surgical documentation than traditional paper records.