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How has Anesthesia evolved with Technology?

Anesthesia is a state of induced, controlled, and temporary loss of sensation or awareness done for medical and surgical purposes. It is done to help with pain management and to enable the smooth flow of a surgical procedure. Anesthesiology refers to the perioperative care of patients before, during and after surgery, involving various facets such as anesthesia, critical care medicine and pain management, all of which are done by an anesthesiologist. 

Modern day anesthesiology is heavily dependent on technology. Anesthetics have become safer and more efficient due to advances in monitoring and delivery since its introduction in 1846.

Dr. Jesto Kurian, General Anesthetist and Associate Staff Physician at Cleveland Clinic, Abu Dhabi, spoke about the various ways technology has helped to improve both anesthesiology and the lives of anesthesiologists. Dr. Kurian’s expertise involves general anesthesiology, acute pain management, ultrasound-guided peripheral nerve blocks, and point of care ultrasonography. 

Anesthesia in Pain Management

Pain management was initially done by giving opioids. Analgesics and pain medications have since evolved to have lesser side effects which are now widely used in anesthesiology. Anesthesia was first developed to help alleviate the brutal pain that a patient faces while undergoing surgery. Inhalable ether was the first form of anesthesia used by Dr. William T.G. Morton (Father of Anesthesia) on October 16th (celebrated as World Anesthesia Day), 1846 at the Massachusetts General Hospital. He showed the world that surgeries can be conducted without any pain. 

Dr. Kurian explained how anesthesia has undergone many changes based on technological advancements and patient needs. Some of the common types of anesthesia include: 

  1. Local Anesthesia: a small area of the body is numbed and the patient remains fully conscious and is often used during minor procedures.
  2. Regional Anesthesia: a local anaesthetic given to a specific region of your body, leading to numbness or pain relief for deeper operations where more extensive numbness is needed.
  3. Epidural Anesthesia: a type of regional anaesthetic usually used to numb the lower half of the body to help in pain relief during labour and childbirth.
  4. Spinal Anesthesia: a type of regional anaesthetic used to give total numbness, lasting about 3 hours, to the lower parts of the body, such as in the base of the spine or in lower back, so surgery can be safely carried out in this area.
  5. Sedation: medicines that induce sleep and relaxation to keep the patient calm during minor, painful or unpleasant procedures. 
  6. General Anesthesia: where the patient is totally unconscious and unaware of the procedure and is often used for more serious and complicated surgical operations.

Technological advancements in anesthesiology have also helped with chronic pain management. Certain chips are inserted into the nerves which can then be stimulated and monitored to deliver the anesthetic, thus reducing the neuropathic pain in these patients. 

The influence of technology in anesthesiology

“Anesthesia is no more just anesthesia,” states Dr. Kurian. Anesthesiology is now more of a perioperative procedural medicine than intraoperative. This involves pre-operative care of the patient, collecting and assessing all patient vitals and blood work, and optimizing the conditions best suited for anesthesia delivery During the surgery, the anesthesiologist is involved in troubleshooting any problems or complications that can arise and also stabilising the post-operative conditions so as to ensure smooth discharge of the patient. 

The advances in anesthesia, such as the drugs used, and the lines through which the anesthesia needs to be introduced (central line, arterial lines) etc. have all enabled for a more non-invasive and safer anesthesia procedure. Ultrasound is also used to precisely deliver the anesthesia into the lines. Various softwares, Artificial Intelligence algorithms, and robotic systems can help to predict complications before and during the surgery. 

Dr. Kurian emphasizes that these technologies cannot entirely replace the physical presence of an anesthesiologist or any other surgeon in the operation room. These technologies still have to be driven by the handler whether it is fully automated or not and they aid in providing high quality healthcare to the patients. “Use the best of the traditional ways and use the best of the modern ways in order to provide the best form of care for the patients,” says Dr. Kurian. 

Technologies currently in use in anesthesiology

Robots are used in various hospitals to mainly help with the precise delivery of the anesthetic. The closed loop anesthesia delivery system (CLADS) relies on a completed or ‘closed’ feedback loop. In the US, no truly automated CLADS is approved for commercial clinical use. Outside the US, automated CLADSs are employed in research and increasingly in clinical practice. 

Non-invasive monitoring systems have replaced needles with cuffs or patches that can be placed on the wrist, to give real-time cardiac output, and can thus help in complicated procedures. The EEG and saturation machines will give a real-time status which informs the anesthesiologist on how much anesthesia should be administered. 

Electronic Health Records and Medical Records help with documenting and noting the necessary patient information which can be accessed by the anesthesiologist in the surgery room. These records also help with any kind of evidence needed for legal issues. 

The impact of the COVID-19 pandemic on anesthesiologists

According to the World Federation of Societies of Anesthesiologists (WFSA), five billion people out of the seven billion population in the world do not have access to anesthesiologists. The WFSA states that there should be at least five anesthesiologists per 100,000 patients which is absent in many of the countries. 

During and after the COVID-19 pandemic, hospitals have recruited more anesthesiologists as they can easily manage critical care settings. Even then, many hospitals run on fewer anesthesiologists. The Indian Society of Anesthesiologists (ISA) recommends that there should be a 1:1 ratio i.e. there should be one anesthesiologist per OR with a patient with proper monitoring devices. 

Innovations in anesthesiology continue to be driven by the aim of health care for the benefit of patients and society and the trends toward automation, non-invasive monitoring, remote monitoring and management, enabled by AI has made the lives of anesthesiologists a lot easier.

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