Those in medical school pondering career specialties need consider which fields may soon vanish to robots. Anesthesiology is one field in the robotic spotlight.

Please consider this Washington Post headline quote: “We are Convinced the Machine can do Better than Human Anesthesiologists”.

I wrote recently about Sedasys, a machine that automates anesthesia. It’s a first-of-its-kind device in the United States. Only four hospitals use it for now. It’s restricted to colonoscopies in healthy patients.

But Sedasys, in development for 15 years, is no longer on the true cutting edge of what’s possible with automated anesthesia.

A machine with the clunky name of iControl-RP is. It’s an experimental device that pushes the boundaries of how much responsibility is turned over to technology. It monitors brain wave activity. And it’s even been tested on children.
One of the reasons that Sedasys was approved by U.S. health regulators is that it’s a conservative leap forward. The device is innovative, but it doesn’t decide alone how much anesthesia to give to a patient.

It’s an open-loop system. The initial dose is pre-determined based on a patient’s weight and age. And Sedasys only reduces or stops drug delivery if it detects problems. Only a doctor or nurse can up the dose. That gave regulators a level of comfort.

But the iControl-RP makes its own decisions. It is a closed-loop system.

This new device, being tested by University of British Columbia researchers, monitors a patient’s brain wave activity along with traditional health markers, such as blood oxygen levels, to determine how much anesthesia to deliver.

“We are convinced the machine can do better than human anesthesiologists,” said Mark Ansermino, one of the machine’s co-developers, who works as director of pediatric anesthesia research at the university’s medical school in Vancouver.

Sedasys dips its toes into what’s possible. The iControl-RP dives right in.

Anesthesia is tricky. It’s often compared to flying a plane – keeping a patient hovering in just the right plane of consciousness. It’s called depth of hypnosis. Surgeons don’t want patients writhing on the table. And patients don’t want to be aware of the operation. Of course, no one wants patients to die, a distinct possibility if too much of an anesthesia drug is delivered.

The iControl-RP aims to thread that needle by using an EEG to scan a patient’s brain waves to make sure the sedation is adequate. And it looks at heart and breathing rates and blood oxygen levels to make sure the patient is not slipping too deeply into sleep. The machine’s algorithm makes all the medical decisions that a doctor usually does.

Ansermino said anesthesiologists are not very good at maintaining just the right amount of sedation. This is especially important in children, where studies show that deep sedation can have negative longterm cognitive impacts on infants and toddlers.

The iControl-RP team says it has struggled to find a corporate backer for its project. Ansermino, the anesthesiologist in Vancouver, thinks he knows why.

“Most big companies view this as too risky,” he said.

But, he said, a device like this was inevitable.

“I think eventually this will happen,” Ansermino said, “whether we like it or not.”

Anesthesiology Robots Coming Like It or Not

I side with Ansermino. These devices will happen, like it or not. Look for approval in Canada first, then Europe. The US will then be forced to catch up.

Meet iControl-RP Your New Anesthesiologist

The iControl-RP, which fully automates anesthesia for operations, stands on the right. On the left are traditional anesthesia monitors that would be used by a human doctor. UNIVERSITY OF BRITISH COLUMBIA PHOTO

Clinical Trials in Canada

iControl-RP is in Clinical Trials in Canada. The study is currently recruiting participants.

It’s increasingly important to choose your career wisely. Healthcare in general may be a good choice, but select fields in healthcare will go to robots.

Mike “Mish” Shedlock