Robot Anesthesiologist, Dr. Waxer

Nathan Waxer, DO

Can a machine perform anesthesia as well as a human?

This is a question that is not necessarily unique, however is certainly worth discussing.  A recent paper published in the February 2012 Journal, Anesthesiology by Liu et al. entitled "Feasibility of Closed-loop Titration of Propofol and Remifentail Guided by the Spectral M-Entropy Monitor" essentially compared humans and a machine in their ability to maintain patients sedated at a predetermined state entropy level.  The findings of their study suggest that a Dual closed-loop controller (a machine) outperformed manual control (a human).

Although this was a machine programmed to only control a few limited specific parameters and was not able to perform any other of the multitude of duties and responsibilities required of an anesthesiologist, it is fascinating to think of the possibilities that an "anesthesia machine" could provide.

We are already in full flight of the technological age with the majority of new anesthesia machines having electronic charting and vital sign monitoring.  If there was a machine able to safely titrate medications to maintain blood pressure and heart rate within a specific set of parameters, this could ultimately free up the hands of the Anesthesiologist to perform other important duties in the operating room.  Oftentimes when there is an unstable patient having an extra pair of hands is invaluable, but if a computer could essentially provide that pair of hands, it could perhaps make a challenging case more manageable and routine. 

Of course there are naysayers who will argue that a machine could never replace what an anesthesiologist does and is not able to multitask and provide the critical thinking and problem solving that a human can.  I for the most part am in agreement with this statement, at least for the recent foreseeable future.  However, we already have 'mechanical' ventilators, video laryngoscopes, echocardiography and a number of computerized devices that aid physicians already, and I only see that increasing as time goes on.  But at least for now, a human physician is able to see a patient, elicit a succinct but pertinent history and physical from a patient and determine an anesthetic plan in the matter of seconds.  At this time, there is no machine that could replace the airway management an anesthesiologist provides with induction of anesthesia.  And what if induction does not progress as planned, would a machine be able to quickly assess and skillfully utilize the difficult airway algorithm when necessary?   I feel that this is just the beginning of where we are headed.  And although one can look at these changes in a negative light, I feel that there is so much opportunity and potential that will prove to aid anesthesia providers in the future and improve the practice of anesthesia.   Let the future begin now.