New machine could one day replace anesthesiologists – the washington post gas efficient cars 2015

TOLEDO — The new machine that could one day replace anesthesiologists sat quietly next to a hospital gurney occupied by Nancy Youssef-Ringle. She was nervous. In a few minutes, a machine — not a doctor — would sedate the 59-year-old for a colon cancer screening called a colonoscopy.

One day, maybe. For now, the Sedasys anesthesiology machine is only getting started, the leading lip of an automation wave that could transform hospitals just as technology changed automobile factories. But this machine doesn’t seek to replace only hospital shift workers. It’s targeting one of the best-paid medical specialties, making it all the more intriguing — or alarming, depending on your point of view.

Today, just four U.S. hospitals are using the machines, including here at ProMedica Toledo Hospital. Device maker Johnson & Johnson only recently deployed the first-of-its-kind machine despite winning U.S. Food and Drug Administration approval in 2013. The rollout has been deliberately cautious for a device that hints at the future of health care, when machines take on tasks once assumed beyond their reach.

But that comfort might be short-lived. More advanced machines are in the works. Researchers at the University of British Columbia, in Vancouver, are testing a device that can fully automate anesthesia for complicated brain and heart surgeries, even in children. Hospital administrators imagine the day when Sedasys or another device is used throughout their facilities for sedation.

“I dream about using it in bigger areas than endoscopy units,” said Joseph Sferra, vice president of surgical services at ProMedica Toledo Hospital, who had to overcome staff objections to get Sedasys into his medical center. “I’m sure this is very disconcerting to anesthesiologists.”

Colonoscopies are among the most common medical procedures, with about 14 million done annually. The screenings are often uncomfortable and sometimes painful. Many patients would prefer to be knocked out, and in recent years anesthesia has grown more common for these procedures. In 2009, an estimated $1.1 billion was spent on traditional anesthesia services for colonoscopies, according to one research study.

The machine monitored her breathing, the oxygen levels in her blood and her heart rate. Youssef-Ringle also wore an earpiece, where a computerized voice periodically instructed her to squeeze a controller in her hand. The goal was to keep her in a period of moderate sedation — unaware but still responsive.

He usually sedated patients himself with a drug such as midazolam. But the drug doesn’t work as well as stronger ones that are restricted to anesthesiologists. And midazolam wore off slowly. Patients would be in a day-long haze. They would linger in the hospital’s recovery area. Basista said it was a waste of time to give screening results or care instructions to patients in the recovery area. They never remembered the conversation.

Sedasys uses propofol, a powerful drug that works almost like flipping an on-off switch in patients. No hangover. Propofol’s quick action is ideal for colonoscopies, which usually take 20 to 30 minutes to complete. The drug’s reputation took a hit in 2009 after singer Michael Jackson overdosed on the drug at home and died. But when used properly, the drug is widely preferred by doctors as a sedative.

The hospital is considering eliminating a nurse shift in the recovery room, said Sferra, the hospital administrator. And he thinks the machine’s speed — patients go to sleep and wake up more quickly — will allow the hospital to squeeze in more procedures. The hospital could add two to three more to the current 15 per day per colonoscopy suite.

Sferra and Basista said the Sed­asys machine was better for patients, too. Clinical studies of Sedasys have shown patients like propofol-based sedation. At ProMedica Toledo, that’s important for competing with area hospitals for colonoscopy patients.

Youssef-Ringle called her experience “amazing.” She had gone into this with reservations. The machine seemed like just another way to cut costs, to remove the human factor. But now, after the procedure, she said she saw a potential upside, too: There was no human error, either.

Correction: An earlier version of this story misidentified a professional organization that had opposed the machine. It is the American Society of Anesthesiologists, not the American College of Anesthesiologists. This version has been corrected.