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World's First Transcontinental Anesthesia 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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World's First Transcontinental Anesthesia

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  • Hmm (Score:2, Insightful)

    by Anonymous Coward

    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?

    • by Xugumad ( 39311 )

      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...

    • by tom17 ( 659054 )
      I thought the same.
    • 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!
    • by 228e2 ( 934443 )
      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.
    • That's what I thought too. I also think that's less scary than what they're actually doing.
  • Big deal (Score:1, Offtopic)

    by Locke2005 ( 849178 )
    Sadly, the field of teledildonics is still lagging behind...
    • Re: (Score:2, Funny)

      by Rip Dick ( 1207150 )
      With some things, you just *need* to be in the same room...
    • Re: (Score:3, Interesting)

      by Miseph ( 979059 )

      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.

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

  • by alphax45 ( 675119 ) <kyle.alfred@gmail . c om> on Friday September 10, 2010 @12:58PM (#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...
    • 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: (Score:3, Insightful)

        by Chowderbags ( 847952 )
        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
      • by Kilrah_il ( 1692978 ) on Friday September 10, 2010 @02:08PM (#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: (Score:3, Interesting)

          by Kilrah_il ( 1692978 )

          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: (Score:3, Interesting)

          by nospam007 ( 722110 ) *

          "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

          • 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

            • 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.)
            • I believe my success rate is closer to the lower numbers

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

        • by eth1 ( 94901 )


          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.

          • 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.

        • 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.

        • by olddoc ( 152678 )
          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 Ane
      • by sjames ( 1099 )

        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.

      • 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 yo
    • Re: (Score:3, Interesting)

      by berzerke ( 319205 )

      ...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 competen

  • Bad idea (Score:3, Insightful)

    by dkleinsc ( 563838 ) on Friday September 10, 2010 @01:00PM (#33535454) Homepage

    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.

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

  • by Zalgon 26 McGee ( 101431 ) on Friday September 10, 2010 @01:03PM (#33535516)

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

    • Seriously, if the anesthesia caused a patient's death due to negligence or malfunction, who would be responsible? and under which country's laws?
  • by EmagGeek ( 574360 ) <gterich&aol,com> on Friday September 10, 2010 @01:08PM (#33535588) Journal

    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.

    • 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.

    • 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 fo
    • Re: (Score:3, Insightful)

      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

    • 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 t

      • 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.

  • 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.

    • Yep, just like programmers and customer service reps, drinking pina colada on the tropical beach.
  • by Winckle ( 870180 ) <mark AT winckle DOT co DOT uk> on Friday September 10, 2010 @01:31PM (#33535898) Homepage

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

  • *5 second delay*


    Hi Doctor Nick!

  • 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!

  • 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.

  • Intercontinental (Score:3, Informative)

    by Doc Ruby ( 173196 ) on Friday September 10, 2010 @02:18PM (#33536634) Homepage Journal

    "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? (Score:3, Insightful)

    by treeves ( 963993 ) on Friday September 10, 2010 @02:21PM (#33536704) Homepage Journal
    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!
  • 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)
  • The data came in over an ETHERnet cable?

  • 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 physicall

    • by BKX ( 5066 )

      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."

  • That's nothing. Bob Ross [] used to remotely put countless PBS viewers to sleep every week.

  • 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:

  • 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
  • A similar story (Score:2, Interesting)

    by lsatenstein ( 949458 )
    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.
  • 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?

Karl's version of Parkinson's Law: Work expands to exceed the time alloted it.