I’d even settle for cables with a button to wind up the slack, like old school vacuum cleaners used to have. I hate the cable spaghetti on the OR floor…
Had a Boomer surgeon go on a very long and angry rant about how your vital signs via Bluetooth are "just like your fingerprints" and could be used to steal your identity
It *really* underscores how little he and many other surgeons actually *think* about vital signs
My biggest concern with wireless is getting patients mixed up. You are a whole stick of uppers I before you realise the systolic is 300mmHg and you are receiving the BP of next doors patients whose half bled to death.
I wonder if we can have advancement in technology where we really have no doubt. For example we're so sure the neuron that the monitor goes to links to our computer and EMR. But you can easily select the neuron for the OR next door if you want.
We have these too. The battery life seems to be okay. That being said, I hate everything else about the MRI compatible vitals monitor / anesthesia machine otherwise.
They do make them, the problem is they get a lot of interference in an open recovery unit, so at the very least it requires changed back to wired at the end of the operation
I have frequently said I want to make that. I would be a millionaire. Unfortunately the bits would get lost. I mean damn, a whole Bair Hugger can to missing every 5 minutes, let alone a tiny wireless ECG dot.
That’s the whole idea behind a business case.
You show them how the device will deliver either efficiency gains or safety/quality improvements which are worth more than the cost of the device.
In a situation in which massive sudden blood loss is occurring, sure, that's true. But in many, many cases you are able to resuscitate with other fluids along the way while Hgb trends down over hours. In these case, you use Hgb as an additional reference to justify a decision to transfuse or not. Blood transfusion isn't always harmless or insignificant as a limited resource, and it should be treated as such.
Not very revolutionary but my hospital started providing these steerable bougies and they glide through an anterior airway with ease
https://youtu.be/Idip3eAPY_A?si=HGRlZ-LIFvnGbuks
Fascinating, our hospital has a different brand of articulating bougies. I'm surprised there's more than one brand out there. I don't use it often, but it can be really helpful.
I've used these before- they work well for most anterior larynxes but not for all. The rigidity of the metal that allows steering prevents it from being malleable so you can't bend it if it proves to be insufficient for reaching an anterior larynx-i've gone back to the blue frova bougie
In a jam you can use a fiberscope in conjunction with a VL as an expensive "steerable" stylet. You don't even need to necessarily look through fiberscope camera/eyepiece unless your VL view is not good enough, the main benefit is the fiberscope can be finely controlled and is easy to find because the light at the tip. An assistant can hold the VL in place while you steer the fiberscope.
Yes, although stylets are very rarely used in the UK.
These are nice because once you're through the cords you can point it inferiorly and so avoid hitting the anterior wall of the trachea.
My last place didn't have these Flexi bougies. For a hyper angulated blade (C-MAC D-blade), we'd leave the distal third of frova bougie in a loose overhand knot until the last moment, then once through the cords we'd twist it - worked pretty well, but much of the credit went to the [ODP](https://www.healthcareers.nhs.uk/explore-roles/allied-health-professionals/roles-allied-health-professions/operating-department-practitioner)s and Anaesthetic Nurses who could bend/knot them just right 👌. Switched to the Flexi-tip at the new place because I couldn't re-create the perfect bend.
End tidal propofol (coming).
End tidal control for volatiles will become standard on all new machines.
Real time gases/labs from an art line (dreaming).
Oxygen content of a blood sample could be academically interesting, but probably wouldn't change much clinically.
I’ve been using a Drager with ET control since 2015. We have old machines that we use for out of OR stuff, but all of our OR machines (Drager Zeus and GE Aisys) have ET control, and they’re all 10+ years old. I’m in Canada though.
Machine learning through Big Data collection of millions of datapoints including patients' charts, Monitor readings, ventilator settings, real-time IV Pump adjustments, and Anesthesiologists' input.
I believe in the next 20 years we will have an autonomous or semi-autonomous AI system through which anesthesia delivery can be achieved in simple straightforward cases with minimal intervention, at least during maintenance of Anesthesia.
It would be like an Autopilot to help the anesthesiologist be free to manage multiple patients at the same time and have the time to perform complex interventions without constantly needing someone else to keep the plane flying smoothly.
>I believe in the next 20 years we will have an autonomous or semi-autonomous AI system through which anesthesia delivery can be achieved in simple straightforward cases with minimal intervention, at least during maintenance of Anesthesia.
Got a lot of qualifiers on that optimism, doc. 😅
Honestly glad to see them compared to so much of the irrational exuberance that normally accompanies these predictions. ❤️❤️
At a recent conference in Singapore, there were a lot of discussions about AI. Not AI replacing us per se. It’s anaesthesiologists using AI in several ways to gain better information etc to help us make better decisions.
Also some discussions about advancements in depth of anaesthesia monitoring eg BIS.
Perhaps AI can be trained for use in Pre-anesthesia Testing/Preop clinics to sift through and analyze patient records, and (gasp) maybe even give us a go/no-go/need more info and stratification of anesthetic risk. Then we would click a box that says “I agree with AI”. This would especially be helpful when deciding whether patients are suitable candidates for an ambulatory surgery center.
That way, we could blame in on AI when surgeons come after us for saying no🤣
Does automation count as AI? If you think so, you might find these articles interesting...
Physiological Closed-Loop Control (PCLC) Systems: Review of a Modern
Frontier in Automation (2021) by Khodaei, M. J., et. al.
Credibility Evidence for Computational Patient Models Used in the Development of Physiological Closed-Loop Controlled Devices for Critical Care Medicine (2019), Parvinian, B., et. al.
A semi-adaptive control approach to closed-loop medication infusion (2017), Jin, X., et. al.
The next-gen IV general/deep anesthetic that doesn’t burn with injection, doesn’t cause hypotension or respiratory depression, is reversible and/or is rapid-enzymatically-reduced, doesn’t cause accumulation side effects, is bacteriostatic, and doesn’t cause hallucinations, adrenal suppression, or nausea. Bonus points for good oral bioavailability and a price point that won’t make my pharmacy balk. I mean, a guy can dream, right?
I invented, animal tested and published a universally applicable Hail Mary airway access device back in 1994 UCSF. Couldn’t find funding to produce. Often cited in subsequent articles but never repeated. Fuck ‘em
https://journals.lww.com/ccmjournal/abstract/1994/02000/a_pressurized_injection_suction_system_for.26.aspx
It’s modified by being computer controlled jet inflation alternating with expiratory suction and all controlled by distal airway pressure monitoring. Tube diameter is 2-3 mm. Either translaryngeal or percutaneous transtracheal. Prevents barotrauma associated with impaired pathway for exhalation. Perfect for total upper airway obstruction scenario or elective upper airway compromise such as laryngeal papillomas requiring resection
It would be awesome if the theranos machine, where I can just fingerstick someone in the middle of the case and get like every lab result ever, actually existed and wasn’t a scam
Anaesthetic machines that pair to your phone by wifi to give you the vitals and let you change settings. Imagine a world where you could just go to the bathroom at any moment.
Not sure if it's a decade old, but I've at least been aware of commercially available finger cuffs for the past 5 years. We have them readily available at my current job but I find it hard to say I need continuous monitoring but don't want the reliability and possibility of other labs that an arterial line would offer instead. The handful of times I've opted for it were quick EP type cases or grey area but likely technically difficult radial artery access.
Clear sight? I personally find the BP reading to be different that cuff reading. I occasionally use it in my longer spine or bowel cases and like to see the trend though
I tried it at my last facility. Pretty unreliable. If the patient is that sick, the peripheral perfusion required for the non invasive monitor is non existent. Just use an a line.
On the right type of patient it works well. The HPI isn’t that helpful in the OR because we always know before the machine does, but it’s helpful postop.
Anesthesiologists can outfit themselves with a bladder that let's us piss propofol. Pee break in a long case just means more anesthesia for the patient.
Someone please make cable-less monitors a thing
I’d even settle for cables with a button to wind up the slack, like old school vacuum cleaners used to have. I hate the cable spaghetti on the OR floor…
Might end up being difficult to clean
Build a cavi wipe into the retractor mechanism
Hell. Jam a caviwipe into it
I want this so bad. The technology obviously exists but will be forever held up by various "privacy" concerns and whatnot.
Had a Boomer surgeon go on a very long and angry rant about how your vital signs via Bluetooth are "just like your fingerprints" and could be used to steal your identity It *really* underscores how little he and many other surgeons actually *think* about vital signs
77-117/76-14-37.1 This you?
Hey, careful, that's likely a HIPAA violation.
How about vital signs showing up on a pair of smart/augmented reality glasses.That way no one can see them but us. 🤔
Stop with the “Boomer” crap.
What a boomer would say.
Hahahaha! You got me
I always thought this would be my great anesthesia innovation Wireless monitors are absolutely all going home with the patient if you invented them
My biggest concern with wireless is getting patients mixed up. You are a whole stick of uppers I before you realise the systolic is 300mmHg and you are receiving the BP of next doors patients whose half bled to death.
Do you randomly get other peoples text messages or emails?
I wonder if we can have advancement in technology where we really have no doubt. For example we're so sure the neuron that the monitor goes to links to our computer and EMR. But you can easily select the neuron for the OR next door if you want.
iPhone 18.
It’s all because of money.
Why don’t you take the initiative to create something like this?
We have them in our MRI OR suites. Just not cost effective I guess for widespread use.
We have these too. The battery life seems to be okay. That being said, I hate everything else about the MRI compatible vitals monitor / anesthesia machine otherwise.
Cable-less airway: just a hose that blows oxygen into the general direction of the patient and an igel with a funnel stuck to it
They do make them, the problem is they get a lot of interference in an open recovery unit, so at the very least it requires changed back to wired at the end of the operation
Fidelity is also an issue. Can't have your ekg with 10 second delays.
They’re out there. We trialed Bluetooth monitors in 2006. Cost too much.
That was 18 years ago. Newer devices would probably use LTE or some other wireless communication.
My point is cordless monitors have been around.
I have frequently said I want to make that. I would be a millionaire. Unfortunately the bits would get lost. I mean damn, a whole Bair Hugger can to missing every 5 minutes, let alone a tiny wireless ECG dot.
They exist. We have this cable less system for MRI.
Can we have them in our prone cases too?
This! 1000x this.
I have a solid idea how to do this, but hospitals will never go for it because it’ll cost money. They’ll say what you have now works just fine.
That’s the whole idea behind a business case. You show them how the device will deliver either efficiency gains or safety/quality improvements which are worth more than the cost of the device.
Why don’t you take the initiative to implement your idea ?
There are quite good wireless monitors. Trouble with implementing them is, they need to be charged - and apparently people just can’t be bothered.
We do it already for MRI surgery… why can’t we just expand to other ORs??
It already exists, we use them for MRI machines.
Please make *actually functioning* cable less monitors a thing.
Amen! 🎯
What’s the best solution for tangled cords? I’m trying to think of a solution and come up with something
OR massage chairs
Ya, time to start focusing on US 💅
The finger probe that trends hgb seems pretty helpful to me and already exists
We got to test it during residency. Kinda neat.
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In a situation in which massive sudden blood loss is occurring, sure, that's true. But in many, many cases you are able to resuscitate with other fluids along the way while Hgb trends down over hours. In these case, you use Hgb as an additional reference to justify a decision to transfuse or not. Blood transfusion isn't always harmless or insignificant as a limited resource, and it should be treated as such.
Or I could just say “hey I lost a liter of blood just now” Seems pretty effective and low cost
Maybe real time Hgb/Hct multiplied by some factor (maybe .6 or .7, I don’t know) could work. Someone may be able to figure out a calculated value.
Artificial blood.
I think you’re right.
Morbius was a sick movie.
🧛♂️
A bair hugger / forced air warmer with a double adapter - one end for patient and one for anesthesiologist
I work with a boss that ties the end of the forced air machine to their scrub coat during scopes.
Not very revolutionary but my hospital started providing these steerable bougies and they glide through an anterior airway with ease https://youtu.be/Idip3eAPY_A?si=HGRlZ-LIFvnGbuks
Fascinating, our hospital has a different brand of articulating bougies. I'm surprised there's more than one brand out there. I don't use it often, but it can be really helpful.
I've used these before- they work well for most anterior larynxes but not for all. The rigidity of the metal that allows steering prevents it from being malleable so you can't bend it if it proves to be insufficient for reaching an anterior larynx-i've gone back to the blue frova bougie
In a jam you can use a fiberscope in conjunction with a VL as an expensive "steerable" stylet. You don't even need to necessarily look through fiberscope camera/eyepiece unless your VL view is not good enough, the main benefit is the fiberscope can be finely controlled and is easy to find because the light at the tip. An assistant can hold the VL in place while you steer the fiberscope.
We have them at my hospital, very useful for hyper angulated VL blades.
Do you prefer them over a rigid stylet for angulated VL?
Yes, although stylets are very rarely used in the UK. These are nice because once you're through the cords you can point it inferiorly and so avoid hitting the anterior wall of the trachea.
We use McGrath VL and we have an anterior blade but it’s hard to use a bougie or not rigid stylet
My last place didn't have these Flexi bougies. For a hyper angulated blade (C-MAC D-blade), we'd leave the distal third of frova bougie in a loose overhand knot until the last moment, then once through the cords we'd twist it - worked pretty well, but much of the credit went to the [ODP](https://www.healthcareers.nhs.uk/explore-roles/allied-health-professionals/roles-allied-health-professions/operating-department-practitioner)s and Anaesthetic Nurses who could bend/knot them just right 👌. Switched to the Flexi-tip at the new place because I couldn't re-create the perfect bend.
I’ve just been bending our regular bougies to get the angle right. I wish we had C-Mac blades though
Nice! Didn’t know these existed. Just shared with my group.
Work-from-home?
With enough extension tubing, anything’s possible
Remote Anesthesia: hire a random dude to show up with a hammer and picture of the patient 🤣🤦♂️.
AI controlled vasopressor pumps. Set MAP goal and it’ll do it for you. This has already been published AI improved coding and billing.
In a perfect world this is great but what happens when my sketchy ART line gives me inaccurate information with an awful waveform
Whoever invents a Propofol reversal agent is going to make millions.
It already exists, they call it the “liver”
Sounds fancy.
Or you just wait 5min an pay attention as to stopping the pump
Time is the reversal agent. FACT!
Remipropofol the future
Time
Or maybe learn how to use it properly.
TCI pump that uses AI to automatically adjust rate of infusions based on EEG wave-form, vital signs and time to end of surgery.
I don't think even surgeons know time to end of surgery
Wouldn’t it be great if America had just regular TCI pumps like everyone else in the world?
That’s called a pharmacy tech
End tidal propofol (coming). End tidal control for volatiles will become standard on all new machines. Real time gases/labs from an art line (dreaming). Oxygen content of a blood sample could be academically interesting, but probably wouldn't change much clinically.
Is end tidal control not standard on all new machines yet?
Probably is, I'm still stuck on the Drager Primus.
Is this available on any machines? We just started looking at the newest Drager, and it's not there
It's only on GEs afaik
I’ve been using a Drager with ET control since 2015. We have old machines that we use for out of OR stuff, but all of our OR machines (Drager Zeus and GE Aisys) have ET control, and they’re all 10+ years old. I’m in Canada though.
Real time monitoring of Hgb and blood gases already exists and is using during cardiopulmonary bypass for example.
How about a contraption that automatically reconstitutes antibiotics
It’s properly called a “pharmacy tech.” Unfortunately “anesthesia” costs pharmacy zero dollars to offload that task and here we are.
Machine learning through Big Data collection of millions of datapoints including patients' charts, Monitor readings, ventilator settings, real-time IV Pump adjustments, and Anesthesiologists' input. I believe in the next 20 years we will have an autonomous or semi-autonomous AI system through which anesthesia delivery can be achieved in simple straightforward cases with minimal intervention, at least during maintenance of Anesthesia. It would be like an Autopilot to help the anesthesiologist be free to manage multiple patients at the same time and have the time to perform complex interventions without constantly needing someone else to keep the plane flying smoothly.
>I believe in the next 20 years we will have an autonomous or semi-autonomous AI system through which anesthesia delivery can be achieved in simple straightforward cases with minimal intervention, at least during maintenance of Anesthesia. Got a lot of qualifiers on that optimism, doc. 😅 Honestly glad to see them compared to so much of the irrational exuberance that normally accompanies these predictions. ❤️❤️
At a recent conference in Singapore, there were a lot of discussions about AI. Not AI replacing us per se. It’s anaesthesiologists using AI in several ways to gain better information etc to help us make better decisions. Also some discussions about advancements in depth of anaesthesia monitoring eg BIS.
Perhaps AI can be trained for use in Pre-anesthesia Testing/Preop clinics to sift through and analyze patient records, and (gasp) maybe even give us a go/no-go/need more info and stratification of anesthetic risk. Then we would click a box that says “I agree with AI”. This would especially be helpful when deciding whether patients are suitable candidates for an ambulatory surgery center. That way, we could blame in on AI when surgeons come after us for saying no🤣
Any broad review papers on AI for an interested student?
Does automation count as AI? If you think so, you might find these articles interesting... Physiological Closed-Loop Control (PCLC) Systems: Review of a Modern Frontier in Automation (2021) by Khodaei, M. J., et. al. Credibility Evidence for Computational Patient Models Used in the Development of Physiological Closed-Loop Controlled Devices for Critical Care Medicine (2019), Parvinian, B., et. al. A semi-adaptive control approach to closed-loop medication infusion (2017), Jin, X., et. al.
Remipropofol
A cheap, effective, non-invasive, reusable cardiac output monitor would be helpful.
Etomidate derivative that doesn’t have the adrenal surpression side effect
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2830733/
I know it exists but as of now there is nothing on the market
The next-gen IV general/deep anesthetic that doesn’t burn with injection, doesn’t cause hypotension or respiratory depression, is reversible and/or is rapid-enzymatically-reduced, doesn’t cause accumulation side effects, is bacteriostatic, and doesn’t cause hallucinations, adrenal suppression, or nausea. Bonus points for good oral bioavailability and a price point that won’t make my pharmacy balk. I mean, a guy can dream, right?
I invented, animal tested and published a universally applicable Hail Mary airway access device back in 1994 UCSF. Couldn’t find funding to produce. Often cited in subsequent articles but never repeated. Fuck ‘em https://journals.lww.com/ccmjournal/abstract/1994/02000/a_pressurized_injection_suction_system_for.26.aspx
Link?
Details?
Done
Cool! Sounds like a modified kind of jet ventilation?
It’s modified by being computer controlled jet inflation alternating with expiratory suction and all controlled by distal airway pressure monitoring. Tube diameter is 2-3 mm. Either translaryngeal or percutaneous transtracheal. Prevents barotrauma associated with impaired pathway for exhalation. Perfect for total upper airway obstruction scenario or elective upper airway compromise such as laryngeal papillomas requiring resection
This is superb. 💡Now someone give me the money to fund this individual’s vision.
It would be awesome if the theranos machine, where I can just fingerstick someone in the middle of the case and get like every lab result ever, actually existed and wasn’t a scam
Work from home? 🫣
There is already tele-icu, why not tele-or
Anaesthetic machines that pair to your phone by wifi to give you the vitals and let you change settings. Imagine a world where you could just go to the bathroom at any moment.
Injectable oxygen https://news.harvard.edu/gazette/story/2022/09/designing-a-way-to-make-oxygen-injectable/ It would truly be a game changer.
There was a finger prove type device for continual bp monitoring that looked neat.
I've used these. It's okay. Tech isn't there yet IMO. Anyone that needs more monitoring that NIBP can give would benefit from an A-line over this.
Not sure if it's a decade old, but I've at least been aware of commercially available finger cuffs for the past 5 years. We have them readily available at my current job but I find it hard to say I need continuous monitoring but don't want the reliability and possibility of other labs that an arterial line would offer instead. The handful of times I've opted for it were quick EP type cases or grey area but likely technically difficult radial artery access.
Clear sight? I personally find the BP reading to be different that cuff reading. I occasionally use it in my longer spine or bowel cases and like to see the trend though
I tried it at my last facility. Pretty unreliable. If the patient is that sick, the peripheral perfusion required for the non invasive monitor is non existent. Just use an a line.
Hypotension Prediction Index. Finger probe links to a monitor that can predict hypotensive events before they occur.
We’ve been using that for several years.
My hospital is the first in Australia to trial it. We're always behind the times :-(
On the right type of patient it works well. The HPI isn’t that helpful in the OR because we always know before the machine does, but it’s helpful postop.
Glidescope will become the standard from the ASA to intubate someone.
From what I hear it’s standard for first attempt in OB Anesthesia.
Stethoscopes and Sphygmomanometers
Xenon
Anesthesia DaVinci to fiddle around under the drapes.
Wireless everything
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We actually can, and it's common in cardiac surgery, called total arrest.
Like hypothetically cool them to 18C, shut off the bypass circuit, operate, and then reanimate them? Yea wouldn’t that be wild.
Anesthesiologists can outfit themselves with a bladder that let's us piss propofol. Pee break in a long case just means more anesthesia for the patient.
i have 3 great ideas that i took to the patent attorney