Tusha

in Anaesthesia
Current Trends & Future Prospects

Robot
Anesthetist

Dr. Tushar Chokshi

Vadodara
 Tusha

Outlines

• Audience Poll
• Introduction and Definition of AI
• History and Evolution of AI
• Stages and Types of AI
• How AI works and Uses of AI
• History of AI in Healthcare
• History of AI in Anesthesiology
• Current status of AI in Anesthesiology
• Future of AI in Anesthesiology
• Will AI replace Anesthesiologist
• Journal Articles of AI in Anesthesia
• Conclusion
• Take home message
• My Verdict
• Cartoons & Thanks
 Tusha

• Do you know you are already using AI in your practice ?

• How will AI affect or change clinical decision making in
Anaesthesiology ?
• Will AI reduce errors in Anaesthesia practice ?
• Will you accept AI Anaesthesia practice in future ?
• Will AI replace Anaesthesiologist ?
 Tusha
Which medical technologies and digital health
innovations can expect the brightest future in the next
decade of Anesthesiology ?

• Health Sensors and Telehealth

• Mixed Reality
• Surgical and Medical Robots
• Brain Computer Interfaces
• Nanotechnology
• 5G
• Direct to Consumer Genetic Testing
• 3D Printing

• Artificial Intelligence
• Quantum Computing
Artificial intelligence is the capability of computers to
respond in a manner resembling human intelligence
Human Computer

Dictionary Definition
 Tusha

Which Technologies use AI

53%
40%

AI is like Electricity
Without electricity we can’t think this world Today
Like this
Without AI we won’t think this world in Future
 Tusha

Fathers
of
AI

Marvin Minsky John McCarthy

In the 1956 they described

Artificial Intelligence
and gave the definition
 Tusha

To studies of how
An approach to make
human brain thinks,
computer, robot, or
learns, decides and
product to think how
works, when it tries to
smart human think
solve problems

To improve computer
functions which are The ultimate aim is
related to human technological
knowledge, for singularity the point at
example, reasoning, which technology
learning, and problem- overtakes the human
solving
 Artificial Intelligence (AI), (John McCarthy)Tusha
Is the capability of computers to respond in a
manner resembling human intelligence (Machine to
thinks without any human intervention) examples are
Drones, Self driving cars, Search engines like Google
and Medical diagnosis with procedures e.g. Robots in
medicine
AI
1956
DS Machine Learning (ML), (Arthur Samuel)
Is a subset of artificial intelligence (AI) that
Data Science provides systems the ability to automatically
is a multi-disciplinary field learn and improve from experience without
that uses scientific methods,
processes, algorithms and
ML 1959
being explicitly programmed (Provides
statistical tools to explore data, so here
systems to extract knowledge machine learns automatically from past data
(It applies all mathematical without any confusion of any programme)
rules)

DL
1965
Deep Learning (DL), (Alexey Ivakhnenko )
Is a subset of machine learning where artificial neural
networks, algorithms inspired by the human
brain, learn from large amounts of data (Human
brain thinking, also called as Deep Neural Network or
Deep Neural Learning)
 Tusha
Artificial Intelligence

AI Machine Learning
Subset of AI

ML
Deep Learning
DS DL Subset of ML

Data Science
All three
AI + ML + DL

Basic Structure of Complete Artificial Intelligence

 Tusha

of AI >> ML >> DL >> Data Science

DATA
SCIENCE

2020’s 2030’s
Tush AI in the 1970s AI in the 1980s
ar gave way to accelerated The rapid growth of artificial
advancements, particularly intelligence continued
focusing on robots and through the 1980s. Mercedes-
automatons. WABOT-1, the Benz built and released a
first anthropomorphic robot, driverless van equipped with
was built in Japan at Waseda cameras and sensors
University. Its features
History of AI included moveable limbs,
ability to see, and ability to AI in the 1990s
converse
The end of the millennium has
helped artificial intelligence in its
AI in the 1960s continued stages of advance
growth. Deep Blue, a chess-playing
Innovation in the field of computer developed by IBM became
artificial intelligence grew the first system to win a chess game
AI from 380 BC to 1900 and match against a reigning world
rapidly through the 1960s. champion Sony introduced AIBO
Various mathematicians, Unimate, the first industrial
theologians, philosophers, (Artificial Intelligence RoBOt), a
robot was developed to work robotic pet dog
professors, and authors on a General
mused about mechanical Motors assembly
techniques, calculating
machines, and numeral AI from 2000-2010
systems AI continued its trending
AI in the 1950s upward. Professor Cynthia
Breazeal developed Kismet, a
Advances in the field of robot that could recognize
AI from 1900-1950 artificial intelligence came. and simulate emotions with
Claude Shannon, “the father of its face. Honda releases
People took the “robot” idea information theory,” published
and implemented it into their ASIMO, an artificially
“Programming a Computer for
research, art, and discoveries Playing Chess. In 1956 John intelligent humanoid robot
and in 1929 the first robot McCarthy gave the official birth
was built in Japan of the word AI
 AI 2010 to Present Day Tusha
From 2010 onward, artificial
The last decade was In Smartphone having voice assistants
intelligence has become
immensely important for AI and computers that have
embedded in our day-to-day
innovation “intelligence” functions are everything
existence
through advance AI

2015-2017 2016
2010
Google released Google
Microsoft launched Kinect for Google DeepMind’s Alpha Go,
Home, a smart speaker that
Xbox 360, the first gaming a computer program that
uses AI to act as a “personal
device that tracked human plays the board game Go,
assistant” to help users
body movement using a 3D defeated various (human)
remember tasks, create
camera and infrared detection champions
appointments, and search for
information by voice.

2011 2015
Apple released Siri, a virtual Elon Musk, Stephen Hawking,
2017
assistant on Apple iOS operating and Steve Wozniak among The Face book Artificial
systems. Siri uses a natural-
3,000 others started the Intelligence Research lab
language user interface to infer,
observe, answer, and
development and use of introduced chatbots to
recommend things to its human autonomous weapons for communicate with one
user wars and autonomous cars another

2014 2018
2014
Samsung introduced Bixby, a
Microsoft released Amazon created Amazon
virtual assistant. Bixby’s
Alexa, a home assistant that
Cortana, their version of a developed into smart speakers
functions include Voice, where
virtual assistant similar to the user can speak to and ask
that function as personal
Siri on iOS questions, recommendations,
assistants
and suggestions
 Tusha

Landmark Years in

Landmark Year of
2011 AI in Anesthesiology
 Tusha

Natural
language
processing
(NLP)

Machine
Chatbot + What to Learning and
expect for AI
Virtual in 2020
Automated
assistants and beyond ?
Machine
Learning

Autonomous
vehicles
 Tusha

of AI
1) Artificial Narrow Intelligence (ANI)
Weak AI
- Machines has a narrow defined role of task
- e.g. SiRi, Alexa, Sophia, Self Driven Car
2) Artificial General Intelligence (AGI)
Strong AI
- Machine starts thinking just like humans
- under creation and developing all over world
3) Artificial Super Intelligence (ASI)
Super Strong AI
- Computers or Machines will surpass human beings
- Not exist and only seen in science fiction movies
 Tusha
Reactive Machines AI Self-Awareness AI
Involves machines that have human-level
A basic type of AI system, they consciousness. This form of AI is not
can only react to currently currently in existence, but would be
existing situations. e.g. Deep considered the most advanced form of
Blue, a chess-playing artificial intelligence known to man and
supercomputer created by IBM.
(So it works on preset data) (Pray to GOD it will not exist)

Four Types
of
Artificial
Intelligence
Limited Memory AI Theory of Mind AI
Comprises of machine learning Is the decision-making ability equal
models that derive knowledge to the extent of a human mind, but
from previously-learned by machines. Two notable examples
information, stored data, or are the robots Kismet and Sophia,
events. e.g. Autonomous created in 2000 and 2016.
vehicles, or self-driving cars. (So it works on emotional
(So it works on past data) intelligence)
 Tusha

How AI Works

AI
 Tusha
Uses of AI
Aeronautics
Construction Metal Industries
Automobiles

Moles & Multiplex

Roads & Highways

Robotics

Architect
Factories

Air-Condition

Windmill

Medicine
Solar Energy
Computers

Smartphone Electricity
 History of AI in Healthcare
First problem-solving program, or expert system, known as Dendral and
1960-70 considered one of the most significant early uses of artificial intelligence
in medicine

Brought the proliferation of the microcomputer and new levels of

1980-90 network connectivity and applied to intelligent computing systems
in healthcare
AI programs have been developed and applied to practices such
Beyond as diagnosis processes, treatment protocol development, drug
1990 development, personalized medicine, and patient monitoring and
care
Various specialties in medicine have shown an increase in
research regarding AI e.g. Radiology, Imaging, Disease
2010 Diagnosis, Telehealth, Electronic health records, Drug
Interactions, Robotic surgery and Anesthesiology

800 uses of AI are being benchmarked, e.g. Assessing

breast cancer risk from histopathological imagery,
2019 Guiding anti-venom selection from snake images, and
Diagnosing skin lesions
 Tusha

Uses of AI in Healthcare
 Tusha

Uses in Healthcare
Artificial Intelligence
 Tusha

Artificial Intelligence
In
Anesthesiology
 In historical development, anesthesia was the
earliest subject to implement artificial
intelligence

Anesthesiology first established the concept and

model of pharmacokinetics-pharmacodynamics of
clinical drugs PK/PD model (Pharmacological Robots)

In the 1980s, Servo anesthesia theory system

was formed, this was embryonic form of

History automated anesthesia and robotic anesthesia

Of AI in In 1990s, intravenous anesthesia Target-

Controlled drug Infusion (TCI) has been applied
Anaesthesiology in clinical practice

With the gradual improvement of anesthesia

monitoring, especially anesthesia depth EEG
monitoring system, the open-loop and closed-
loop automatic anesthesia system established

In recent years, anesthetic robots, technology

robots, diagnosis robots developed rapidly
 Since 2011
AI in anaesthesiology
is developing
tremendously
 Tusha

Current Status
of
AI in Anaesthesiology

(from 2011 to 2020)

 Tushar The iControl-RP machine
Two types Anaesthesia closed-loop system
Robots were developed intravenous anesthetic
delivery system which makes
1) Manual Robots
its own decisions regarding
2) Pharmacological Robots the IV administration of
remifentanil and propofol

Manual robots include the Kepler Pharmacological robots include the

Intubation System (KIS) intubating 2011 McSleepy intravenous sedation
robot, designed to utilized video to machine, designed to administer
laryngoscopy and a robotic arm to propofol, narcotic, and muscle
place an endotracheal tube
2020 relaxant

The use of the DaVinci The use of the Magellan

surgical robot to robot to perform
perform regional peripheral nerve blocks
anesthetic blockade
 Preoperative
assessment of all
past medical
problems from the
history
Placement of an ET tube Physical examination

Currently AI
Removal of the ET tube
involved in all
at the conclusion of Anesthetizing Laboratory evaluation
most surgeries
patient, who
requires
Observation of all vital Mask ventilation of
monitors during surgery an unconscious patient
The diagnosis
and treatment of
any complication
during or
following the
anesthetic
 Tusha

From onwards
Anesthesia Practice
with AI will be
 Tusha

AI in Pre Anaesthesia Checkups(PACs)

• Google Translate will be very useful in PAC

• We can talk and do PAC in patient’s mother tongue

language by AI interface

• e.g. English Speech ---> English Text ---> Local text --->
Local Speech

So communication with patient through AI in their

language will become routine and already established
 Tusha

AI in Operation Theatres in Future

In future anaesthesiologist will command all gadgets,
monitors and lights in OT by AI which will be
connected with different AI systems

• Ok Google – Increase the height of OT table

• Alexa – Brighten and adjust the OT head lights

• Siri – Increase the AC cooling to 20 degree

-- Start the Music and adjust the voice

 Tusha

Contd.
• Our future Anaesthesia work station will be
operated by AI with just voice command & data
entry
• Monitors will be controlled and self checked by AI
• Switch On and Switch Off Anaesthesia will become
reality through AI in near future

And, some AI enabled functions are already in

some OT machines and monitors
 Tusha

AI in Tele Anaesthesia
• With AI you will be virtually present with patient and
colleague anaesthesiologists to guide them in their Peri
operative period and in all procedures
• Even you can control all OT gadgets with your Smartphone
AI Apps
• Tele anaesthesia is not a new concept but combined with AI
it is very useful for teaching, in CMEs and Conferences (e. g.
my webinar talk)
• Combined with Augmented Reality(AR) and AI will change
the concept of Tele Anaesthesia, and you will be giving
virtual anaesthesia to distant OT patients (and it’s a reality
e.g. Tele anaesthesia from Canada to Italy by Dr Hammerling
and colleagues)
 Tusha

In Future
from 2025 Onwards
We
 Tusha

2025 Onwards
 Tusha

AI healthcare Model in Future

Augmented Reality
 Tusha

AI Anaesthesiology
AI will work in Anaesthesiology as a Specialty
• Anaesthesiologists need a good mix of cognitive and
dexterity based labour
• AI will primarily result in the automation of cognitive work,
it may be that our hands prevent full automation of the
specialty
• The general dexterity that humans possess allows for a wide
range of functional interaction with our environment
• As AI-based automation systems gain further capability, they
may be able to perform semiautonomous anesthesia
maintenance, where the AI-enabled machine takes over
specified domains of anesthesia maintenance
 Tusha

Contd.
• Anaesthesia might never be fully automated because it
involves dexterity-based labour
• Current robotic devices don't have exact dexterity
required for tasks
• However, AI could be used in anesthesia to develop
more advanced clinical decision support tools based on
machine learning
• Ultimately, AI and machine learning could enable
anesthesia to become a true perioperative medicine
specialty rather than just an intraoperative specialty
• AI could assume some of anaesthesiologists' cognitive
workload and support "a renewed emphasis on the
doctor-patient relationship,"
 Tusha
Will AI reduce
Errors in Anesthesiology ?
• Depends on Safety Vs. Complexity (Complication)
• Human dexterity (skill hands) works will not be
replaced by AI Anaesthesia or Robotic Anaesthesia
• AI can control the gadgets, monitors but
anaesthesiologist will require all the time to do
dexterity works like to fill the syringes, to put chest
electrodes or to take clinical decision in odd situations
 Tusha

that
But
 Tusha
Will AI replace Anesthesiologist ?

There are clearly cognitive tasks that AI will eventually assume

from human anesthesiologists, but AI is not able to deal with many
areas of decision making that anesthesiologists routinely perform

Like when the patient‘s well being deteriorates in the OT, almost all
surgeons want an anesthesiologist being to discuss what it will take
to get the patient stable again.

Talking to a robot or machine (no matter how smart it is) just isn’t
the same as addressing the guy who’s been doing anesthesia for
your patients for long time
 Tusha

>> I do not think that AI will replace anaesthesiologist anytime

soon
>> Artificial intelligence is still at the very beginning of prototyping, fixing and testing all
errors in anaesthesia

>> On the flip side, we should start actively using and testing AI that is available in order
to experience it and learn to corroborate it in our anaesthesia practice

>> The AI of today will help anaesthesiologists to skip the boring stuff and hopefully
make them more focused and smarter. If you have a talented team and the resources to
play with intelligent monitors and anaesthesia machines, you will get the best results

>> However, in the future we might see particular roles being replaced. The first people
to be let go will likely be those roles that are very task-based and lack creativity

>> The future of artificial intelligence in anaesthesia is unpredictable

>> What is predictable is the intention for AI development. Five years from now, we
might see amazing game-changing inventions as well as continuous steady progress
towards more intelligent, self-thinking monitors, anaesthesia machines and TCI pumps
 Tusha
Intelligent control in Anaesthesia
(super super speciality)
• Intelligent control is a new and interdisciplinary subject
developed on multiple directions, such as artificial
intelligence and automatic control
• In 1967, Leonde and Mendel first used the concept of
"intelligent control" to apply techniques of memory and
goal decomposition to improve their ability to deal with
uncertainty
• The intelligent control summarized as the combination of
automatic control and artificial intelligence
• Closed loop TCI with anaesthesia depth monitor is
intelligent control system ( Auto Anaesthesia )
• It is widely used in clinical applications, including cardiac
surgery, pheochromocytoma surgery, gastrointestinal
surgery and has had good clinical results
 Tusha

Intelligent control In Auto Anaesthesia

 Tusha
Close Loop Anesthesia Delivery System
(CLADS)

Determines Right Drug with Right Dose at Right Time by AI

 Tusha

Articles
from
 Tusha

Pub Med Research

• Artificial Intelligence and Anesthesiology – 833

• Computerized Analysis and Anesthesiology – 282

• Machine Learning and Anesthesiology – 337

• Deep Learning and Anesthesiology – 157

• Smartphone in anaesthesia -- 134

More than 1700 articles in journals

( In Last 15 years)
 Tusha
Artificial Intelligence in Anesthesiology:
Current Techniques, Clinical Applications, and Limitations
Anesthesiology. 2020 Feb;132(2):379-394. doi: 10.1097/ALN.0000000000002960.
Hashimoto DA, Witkowski E, Gao L, Meireles O, Rosman G.

Six themes of applications of artificial Based on papers identified in the review,

intelligence in anesthesiology: several topics within artificial
e.g. intelligence were described and
(1) Depth of anesthesia monitoring, summarized:
(2) Control of anesthesia, (1) Machine learning (including supervised,
(3) Event and risk prediction, unsupervised, and reinforcement learning),
(4) Ultrasound guidance, (2) Techniques in artificial intelligence (e.g.,
(5) Pain management, and classical machine learning, neural networks and
(6) Operating room logistics deep learning, Bayesian methods),
(3) Major applied fields in artificial intelligence

CONCLUSIONS
Artificial intelligence has the potential to impact the practice of anesthesiology in aspects
ranging from perioperative support to critical care delivery to outpatient pain management

https://www.ncbi.nlm.nih.gov/pubmed/31939856
 Recent advances in the technology of anesthesia
F1000Res v.9; 2020 PMC7236591, 2020 May
Christian Seger, Maxime Cannesson,

 Automation in the delivery of anesthetics and artificial intelligence

 Monitoring inside the operating rooms: advances in non-invasive monitoring
 Monitoring beyond the operating room: telemedicine and wearable health-care technologies
 Clinical decision support and anesthesia information management systems
 The innovation landscape in anesthesiology technology

Conclusions

 The practice of anesthesiology is inextricably dependent upon technology

 Consumer technology and telemedicine have exploded onto the scene of outpatient
medicine, and perioperative management
 Preoperative evaluations have been done via teleconference, with copious consumer-
generated health data
 Inside the operating suite, monitoring has become less invasive, and clinical decision
support systems are common
 Automation looms large in the future of anesthesiology as closed-loop anesthesia
delivery systems are being tested in combination
 Tusha

A Novel Artificial Intelligence System for Endotracheal Intubation

Prehosp Emerg Care. 2016 Sep-Oct;20(5):667-71. doi: 10.3109/10903127.2016.1139220. Epub 2016 Mar 17.

Carlson JN, Das S, De la Torre F, Frisch A, Guyette FX, Hodgins JK, Yealy DM

CONCLUSIONS

Initial efforts at computer algorithms using artificial

intelligence are able to identify the glottic opening with over
80% accuracy. With further refinements, video laryngoscopy
has the potential to provide real-time, direction feedback to
the provider to help guide successful ETI

https://www.ncbi.nlm.nih.gov/pubmed/26986814
 Tusha

Machine Learning Models of Post-Intubation Hypoxia During General Anesthesia

Stud Health Technol Inform 2017;243:212-216.

Sippl P , Ganslandt T , Prokosch HU , Muenster T , Toddenroth D

CONCLUSIONS

We interpret that our machine learning models could be instrumental for

computerized observational studies of the clinical determinants of post-
intubation oxygen deficiency. Future research might also investigate
potential benefits of more advanced preprocessing approaches such as
automated feature learning

https://www.ncbi.nlm.nih.gov/pubmed/28883203
 Tusha
Machine Learning Approach for Preoperative Anaesthetic Risk Prediction
Int. J. of Recent Trends in Engineering and Technology, Vol. 1, No. 2, Nov 2009

Karpagavalli S , Jamuna KS , and Vijaya MS

Risk is ubiquitous in medicine but anesthesia is an unusual specialty as it routinely

involves deliberately placing the patient in a situation that is intrinsically full of risk.
Patient safety depends on management of those risks; consequently, anesthetist has
been at the forefront of clinical risk management. Anaesthetic risk classification is of
prime importance not only in carrying out the day-to-day anesthetic practice but
coincides with surgical risks and morbidity condition. The preoperative assessment is
made to identify the patients risk level based on American Society of Anesthesiologists
(ASA) score that is widely used in anesthetic practice. This helps the anesthetist to
make timely clinical decision.

CONCLUSIONS

In the research work, three supervised machine learning schemes were applied on the
preoperative assessment data to predict the anaesthetic risk of the patients and the
performance of the learning methods were evaluated based on their predictive
accuracy and ease of learning
 Tusha
Prediction of Bispectral Index during Target-controlled Infusion of
Propofol and Remifentanil: (A Deep Learning Approach)
Hyung-Chul Lee, M.D.; Ho-Geol Ryu, M.D., Ph.D.; Eun-Jin Chung, M.D.; Chul-Woo Jung, M.D., Ph.D.

ANESTHESIOLOGY : Perioperative Medicine | March 2018

Conclusion

Our study demonstrated that the deep learning model is superior to traditional
PK–PD model in predicting BIS during Propofol and Remifentanil target-controlled
infusions in surgical patients. The major advantage of the deep learning approach
is its performance and extensibility. We expect that the accumulation of clinical
big data will make the deep learning model more powerful and extend its
application to a variety of clinical situations in the future.

https://anesthesiology.pubs.asahq.org/article.aspx?articleid=2656314
 Tusha
Automated anesthesia carts reduce drug recording
errors in medication administrations - A single centre
study in the largest tertiary referral hospital in China
Wang Y, Du Y, Zhao , Ren Y, Zhang W.

J Clin Anesth. 2017 Aug;40:11-15. doi: 10.1016/j.jclinane.2017.03.051. Epub 2017 Apr 13.

The total error rate was 7.3% with the automated anesthesia carts (1 in 14
administrations) and 11.9% with conventional manual carts (1 in 8 administrations)

CONCLUSIONS

The utilization of automated anesthesia carts reduced the

drug recording errors in medication administrations of
anesthesia

https://www.ncbi.nlm.nih.gov/pubmed/28625429
 Tusha
First robotic tracheal intubations in humans
using the Kepler intubation system (KIS)
BJA: British Journal of Anaesthesia, Volume 108, Issue 6, June 2012, Pages 1011–
1016, https://doi.org/10.1093/bja/aes034
T. M. Hemmerling R. Taddei M. WehbeC. Zaouter S. Cyr J. Morse

Conclusions
We present the first human testing of a robotic intubation system for oral
tracheal intubation. The success rate was high at 91%. Future studies are
needed to assess the performance and safety of such a system

aes034
 Tusha
Technical communication:
First robotic ultrasound-guided nerve blocks in humans using the Magellan system
Anesth Analg. 2013 Feb;116(2):491-4. doi: 10.1213/ANE.0b013e3182713b49. Epub 2013 Jan 9.

Hemmerling TM, Taddei R, Wehbe M, Cyr S, Zaouter C, Morse J.

Conclusions

Ultrasound-guided nerve blocks are becoming a standard of modern anesthesia.

We developed a robotic system, Magellan, to perform nerve blocks using a
remote control center.

We present the first human testing of a robotic ultrasound-guided nerve

block system. The success rate was 100%. The total performance time was
approximately 3 minutes to 4 minutes

https://www.ncbi.nlm.nih.gov/pubmed/23302984
 Tusha
"We have been working on closed-loop systems, where drugs are administered, their
effects continuously monitored, and the doses are adjusted accordingly, for the last five
years,” said Dr. Thomas M. Hemmerling of McGill’s Department of Aesthesia and the
Montreal General Hospital, who heads ITAG (Intelligent Technology in Aesthesia research
group), a team of anesthesiologists, biomedical scientists and engineers.

World's first totally automated

administration of an anaesthetic in May 2008

McSleepy: Automated Anaesthesia System

 Tusha

Father of
Robotic Anesthesia
 Tusha

Robotic Anesthesia – A Vision for the Future of Anesthesia

Transl Med UniSa, 2011 Sep-Dec; 1: 1–20. Published online 2011 Oct 17.
Thomas M Hemmerling, MSc, MD, DEAA, Riccardo Taddei, MD,* Mohamad Wehbe,
MSc, Joshua Morse, Shantale Cyr, PhD, and Cedrick Zaouter, MD*

It offers a first classification of robotic anesthesia by separating it into pharmacological

robots and robots for aiding or replacing manual gestures. Developments in closed loop
anesthesia. First attempts to perform manual tasks using robots

From airway control to anesthesia control

Pharmacologic Robots
Closed loop for hypnosis
Closed loop of Anaesthesia
Closed loop of Analgesia
Anesthesia robots to aid or replace manual gestures
Teleanesthesia
Regional anaesthesia procedure
Placing a perineural catheter for continuous nerve block
Robotic Intubation
Artificial intelligence
 Automated Assessment of Difficult Airway With Facial Tusha
Recognition Techniques (PeScho)
https://clinicaltrials.gov/ct2/show/NCT02022397
Responsible Patrick Schoettker,MD PD, Associate Professor, University of Lausanne Hospitals
Party:
ClinicalTrials.gov NCT02022397
Identifier:
Other Study ID 183/09
Numbers: CTI ( Other Grant/Funding Number: Swiss Commission Technology and Innovation
12636.1 )

First Posted: December 27, 2013

Last Update September 26, 2019
Posted:
Last Verified: September 2019
Study Type : Observational [Patient Registry]
Estimated Enrolment : 6000 participants
Observational Model: Cohort
Time Perspective: Prospective
Target Follow-Up 1 Day
Duration:
Official Title: Automatic Assessment of Difficult Ventilation and Intubation From Automatic Face Analysis
and Artificial Intelligence
Study Start Date : March 2012
Estimated Primary December 23, 2020
Completion Date :
Study Completion Date : December 23, 2020
 Tusha
Artificial Intelligence and Machine Learning in Anesthesiology
Christopher W. Connor, M.D., Ph.D

Anesthesiology 12 2019, Vol.131, 1346-1359. doi:

https://doi.org/10.1097/ALN.0000000000002694

Advances in technology and monitoring can change the impetus for machine learning.
For example, a neural network developed to detect esophageal intubation from flow-
loop parameters and will be obviated by continuous capnography
Uses a very highly augmented data set in conjunction with logistic regression to produce
an algorithmic model that can, in post hoc analysis, detect the incipient onset of
hypotension up to 15 min before hypotension actually occurs

Neural network approach to predicting the Bispectral Index (BIS) based upon the
infusion history of propofol and remifentanil
The most plausible route to the introduction of artificial intelligence and machine
learning into anesthetic practice is that the routine intraoperative management of
patients will begin to be handed off to closed-loop control algorithms
 Tusha

SEDASYS
Ethicon Endo-Surgery, a Johnson & Johnson
subsidiary, created SEDASYS, a computer-assisted
device that administers the prescription drug
propofol into the bloodstream via intravenous IV
infusion (approved in 2013)

The device can detect signs associated with over

sedation and can automatically modify or stop
infusion

But it was withdrawn from market

 Tusha

Artificial intelligence, machine learning and the pediatric airway

Matava C, et al. Paediatr Anaesth. 2019.

Artificial intelligence and machine learning are rapidly expanding fields

with increasing relevance in anesthesia and, in particular, airway
management. The ability of artificial intelligence and machine learning
algorithms to recognize patterns from large volumes of complex data
makes them attractive for use in pediatric anesthesia airway management

They critically assess the current evidence on the use of artificial

intelligence and machine learning in the assessment, diagnosis,
monitoring, procedure assistance, and predicting outcomes during
pediatric airway management
 Tusha
The Feasibility of a Completely Automated Total IV
Anesthesia Drug Delivery System for Cardiac Surgery
Anesth Analg 2016;123:885–93
Cedrick Zaouter, MD, MSc, Thomas M. Hemmerling, MD, Romain Lanchon, MD,
Emanuela Valoti, MD, Alain Remy, MD, Sébastien Leuillet, MSc, and Alexandre Ouattara, MD, PhD

In this pilot study, we tested a novel automatic anesthesia system for closed loop
administration of IV anesthesia drugs for cardiac surgical procedures with
cardiopulmonary bypass. This anesthesia drug delivery robot integrates all 3 components
of general anesthesia: hypnosis, analgesia, and muscle relaxation

CONCLUSIONS:

The completely automated closed-loop system tested in this investigation

could be used successfully and safely for cardiac surgery necessitating
cardiopulmonary bypass. The results of the present trial showed satisfactory
clinical performance of anesthesia control
 Tusha
Existing AI enabled Monitors and Anaesthesia Work Station ( Very Complex )

67
Tusha
 Tusha
Today’s Robotic and Artificial Intelligence Theatre
 Tusha

In 2030
AI will replace this type
of complex anaesthesia monitors and machine
into
Tusha
 Tusha

Future AI Anaesthesia Work Station

In 2030
Switch On AI
& Monitor
Switch Off
Anaesthesia
Machine
Robotic Anaesthesia
 Tusha

With AI

Will go away

And Will BE ACCURATE

 Applications of artificial intelligence (AI) and machine learning (ML) have
A shown promising results in anesthesiology
It is clear that AI will find many applications in anesthesia care, in
B delivering real-time results
The contributions of AI to general anesthesia have got advancements in
C monitors, TCI machines & closed-loop systems
The fields of postoperative pain management and chronic pain have also
D benefited from AI by developing software
AI will also increase the training power of simulations thereby improving
E education in anesthesiology
Much more work is required to understand exactly the scope, that AI
F will play in anesthesiology
But, in general AI will certainly continue enhancing the patient
G experience and Anesthesiologist expertise
 Artificial intelligence (AI) in anesthesia is the use of complex
1) algorithms and software to estimate human cognition

2) It will never replace Anaesthesiologist

AI or Robot will be Pilot, but we will always be

3)
there as Co-Pilot

4)
AI will definitely reduce the errors in
anaesthesia practice

5) In near future we all will witness the changes of

anaesthesia practice with AI
6) AI in anaesthesia will put zero complication rate
in our practice, which we never recognised
7) Ultimately we have to accept artificial intelligence in our
practice which we are already practicing
 Tusha

The potential of Artificial Intelligence in

anesthesiology with changing patient’s lives beyond
recognition is both exciting and challenging

The anaesthesiologist has to accept the use of AI in

their future practice for learning the art of modern
AI enabled Anaesthesia Machines, Monitors and
Gadgets
 Tusha

2025 2030
 Tusha

This will be Reality in Future

 Tusha

BLOCKS

Artificial Intelligence Under Litigation

 Tusha

In Future
Anesthesiologist will be the assistant of AI Robots
 Tusha

Finally We have to accept Robots and AI

Will be Our Pilots & Teachers in our practice
 AI means
Artificial Intelligence
but
AI means
Anesthetist Intelligence
also
 Join
Face Book Groups of
“TIVA Society of India”
&
“Indian Society for Opioid Free Anesthesia”

[email protected]

https://sites.google.com/site/tusharchokshisite

9825062245/9979319721
Tushar