MDNews - Greater Boston

++++++++++++++++++++ + +++ +TECHNOLOGY U +++ ++++++++++++++++++++ Between Physicians and Machines By Valerie Lauer TERMINATOR DIRECTOR JAMES CAMERON CONCEIVED THE IDEA OF SKYNET IN THE 1980s. THIRTY YEARS LATER, ROBOTS HAVE BEGUN TO PERMEATE THE FIELD OF MEDICINE, MOST RECENTLY IN THE FORM OF AN AUTOMATED, ANESTHESIA-ADMINISTERING DEVICE. M EDICAL TECHNOLOGY IS playing an increasingly important and direct role in patient care. Robotassisted surgery is becoming the norm. Nearly 2,000 hospitals in the United States have da Vinci systems, and IBM's Watson supercomputer is learning healthcare diagnostics by processing massive amounts of patient data from Memorial Sloan-Kettering Cancer Center's database. Now, a new machine called Sedasys offers patients undergoing colonoscopy and esophagogastroduodenoscopy personalized sedation with the drug propofol. Unlike the da Vinci system, which augments physicians' skills with added precision and control, Sedasys can be used by professionals not trained in anesthesiology, effectively doing the job of an anesthesiologist at a fraction of the cost. But is this the best solution for patients and practices? Meet Sedasys Sedasys received premarket FDA approval in May 2013 and should begin appearing in early adopter offices in the first quarter of 2014. The system, produced by Johnson & 14 | Greater Boston MD NEWS I MDNEWS.COM Johnson's Ethicon Endo-Surgery subsidiary, consists of a bedside monitoring unit, a procedure room unit, displays, connectors and disposable, single-use devices. Patients are attached to the machine and receive sedation intravenously. The Sedasys system constantly monitors them before, during and after a procedure and adjusts sedation levels automatically based on blood oxygen levels, blood pressure readings and other vitals. It responds to verbal commands and can also be adjusted manually as needed. The average cost of anesthesia per procedure for Sedasys is expected to be around $150, a far cry from the $600 to $2,000 charged by anesthesiologists for similar services. A Human Element There is risk associated with receiving anesthesia, even from a system that automatically responds to patients' conditions. Propofol is not appropriate for all patients and can lead to dangerous side effects, such as allergic reactions, low blood pressure and decreased breathing rates. And one study found that 2.5 percent of patients anesthetized using the system were sedated more deeply than originally intended. Offices that use Sedasys must have an anesthesiologist available for immediate consultation as needed. In response to the release of the Sedasys system, the American Society of Anesthesiologists (ASA) has begun actively developing a relationship with Ethicon Endo-Surgery to discuss equipment safety concerns, such as loss of consciousness, risk associated with propofol and respiratory monitoring. It is also working with the FDA to cultivate a set of operational parameters and safety measures for this and any future anesthesia-administering equipment. "The Sedasys system will complement the services and care that are already provided by physicians for patients undergoing routine endoscopy procedures," says James Martin, PhD, Senior Research Fellow with Sedasys. "Collaboration is the key to our success. In fact, anesthesiologists and gastroenterologists have been key collaborators in the development of the Sedasys system." Navigating the gray area between clinicians and equipment requires cooperation and understanding from both the developers of the machines of tomorrow and the physicians of today. T he ASA encourages its anesthesiologist members to reach out with any questions or input about Sedasys by emailing sedasys@asahq.org. I

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