New machine could one day replace anesthesiologists
New machine could one day replace anesthesiologists
By Todd C. Frankel May 11 at 9:51 PM
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.
But she had done her research. She had even asked a
family friend, an anesthesiologist, what he thought of the device. He was
blunt: “That’s going to replace me.”
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.
Everyone is watching to see how this goes.
“We’ve had a lot of anesthesiologists who’ve been
dropping by to get a look,” said Michael Basista, the gastroenterologist who
was about to work on Youssef-Ringle.
Then Sedasys did its job. And his patient was out cold.
‘Indication is very narrow’
Anesthesiologists tried to stop Sedasys.
They lobbied against it for years, arguing no machine
could possibly replicate their skills or handle an emergency if something went
wrong. Putting someone to sleep is an art, they said. Too little sedation, and
the patient feels pain. Too much, and the patient dies. Anesthesiology requires
four years of training after medical school, meaning careers might not launch
until the doctors are in their 30s. It’s one reason the profession’s median
salary is $277,000 a year, according to research firm Payscale.
At first, the FDA rejected Sedasys over safety concerns.
That was in 2010. But Johnson & Johnson, which began work on the device in
2000, won approval by agreeing to have an anesthesiology doctor or nurse
on-call in case of emergencies and to limit use to simple screenings such as
colonoscopies and endoscopies in healthy patients.
“The indication is very narrow, which is comforting to
anesthesiologists,” Paul Bruggeman, Sedasys general manager for Johnson &
Johnson, said in an interview.
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.”
It is. But many have changed tactics. The American
College of Anesthesiologists dropped its steadfast opposition as it became
apparent Sedasys was going to get approved. The group instead pushed for
restrictive guidelines.
Jeffrey Apfelbaum at the University of Chicago, co-chair
of the professional group’s Sedasys committee, said he has doubts “about how it
will pan out.”
“But is this a threat to a specialty?” he said. “Boy, I
just don’t see it.”
Rebecca Twersky at SUNY Downstate Medical Center, the
other committee co-chair, agreed.
“Clearly this is an example of disruptive innovation,”
Twersky said.
“But,” she added, “we’re not going away.”
Even boxed into its corner, Sedasys could have a major
impact.
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.
Sedation can cost even more than the colonoscopy, with anesthesiology
fees adding up to $2,000. By contrast, Sedasys costs $150 to $200 each time.
“There doesn’t need to be an anesthesiologist
participating anymore,” said Bruggeman, the Sedasys executive.
‘I guess this is the future’
In the Toledo hospital room, Basista told a nurse to
begin. She pushed a button on the Sedasys machine, sending a measured dose of a
sedation drug flowing into Youssef-Ringle.
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.
The machine was programmed with conservative parameters.
If it detected even the mildest problem, it slowed or cut off the drug’s
infusion. And that meant Basista and his two nurses had to constantly keep on
top of patients.
“Hey, Nancy, take a deep breath!” a nurse said, when
Youssef-Ringle’s blood oxygen was too low for the computer’s liking.
Nancy, in her sleepy state, did. The machine relented.
Minutes later, the machine beeped again. Low blood oxygen.
“Hey, Nancy, deep breath! Deep breath!”
The machine allowed less leeway in the patient’s vital
signs than any human anesthesiologist probably would have. Youssef-Ringle’s
numbers were fine.
As the machine did its job, Basista did his job,
threading a cabled camera through his patient’s colon and taking pictures.
Before Sedasys, Basista had two options for sedating
patients.
He could turn to an anesthesiologist, but finding one at
his short-staffed hospital was difficult.
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 difference is apparent in the hospital’s nine-bed
recovery unit, which used to be filled with drowsy patients after a colonoscopy
clinic. Most beds are empty now. Colonoscopy patients are ready to leave in 15
minutes.
“It’s amazing,” said Catherine Hall, a patient-care supervisor.
“And it’s not like we’re rushing them out.”
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.
“Once I was asleep, I was out. But now I feel fine,” said
Lisa McLaughlin, 49, sitting in the recovery area minutes after finishing her
colonoscopy.
Before the procedure, McLaughlin worried the machine
would not sedate her well enough.
“I guess this is the future,” she said, adding: “I hate
to put anesthesiologists out of work.”
Later that day, Youssef-Ringle sat in recovery. She was
alert. She wanted to know how long she was under.
Ten minutes, Basista said.
That felt like one minute, Youssef-Ringle said.
His patient was clear-minded enough that Basista didn’t
worry she would forget when he told her the screening was clear. No problems.
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.
Comments
Post a Comment