Vital Times 2021 - 62

use of hydroxyethyl starch products or assessing the
depth of anesthesia using lower esophageal contractility
measures. In addition, note that tests that are useful
to some clinicians may be less so to others, such as
the intraoperative use of BIS electroencephalographic
analysis. Such realities demand a critical eye
by anesthesiologists in assessing new clinical
developments.
Anesthesia technology is saving lives, but when this
technology is not working properly, the situation can
dramatically add to the anesthesiologist's task list.
Table 1. Some new technological innovations that will likely impact future anesthesia delivery: 5,6,7,8
WEARABLE SENSORS
These sensors, now in various phases of development,
include miniature devices worn on one's wrist that
can monitor heart rate and rhythm, blood pressure,
and arterial oxygen saturation. The latest Apple Watch
does some of these things already. Research into
non-invasive glucose, hemoglobin, cardiac output,
and ejection fraction measurements are underway in
laboratories around the world.
THE INTERNET OF THINGS (IOT)
This technology will help ensure that conventional and
wearable medical devices can communicate safely,
securely, and reliably, allowing clinical data network
systems to capture, share, and analyze clinical data.
AUTOMATED SYSTEMS
Artificial-intelligence-based systems that maintain
neuromuscular-blockade, hemodynamic, or level
of consciousness targets during anesthesia are in
development; preliminary studies suggest that such
systems may outperform humans acting alone.
CLOUD COMPUTING
It is expected that wearable sensors will work in
conjunction with local networks and cloud computing to
facilitate remote patient monitoring, in the hospital setting
as well as at home and on the go.
MACHINE LEARNING (ML)
AND PREDICTIVE ANALYTICS
Mathematical models predicting poor surgical outcomes
now exist, as well as models for predicting hospital length
of stay, perioperative mortality, delirium, renal injury, and a
host of other undesirable clinical
TELEMEDICINE IN ANESTHESIOLOGY
AND ICU MEDICINE
Preoperative virtual visits with histories being done
remotely and with electronic stethoscopes allowing
teleauscultation have been a reality for some time.
Satellite-based intraoperative teleanesthesia using a
remote system that collects intraoperative physiologic
data and supports videoconferencing has been used
experimentally. Similar arrangements have been developed
for the ICU setting.
5 Bitterman, D. S., Aerts, H., & Mak, R. H. (2020). Approaching autonomy in medical artificial intelligence. The Lancet. Digital health, 2(9), e447-e449.
https://doi.org/10.1016/S2589-7500(20)30187-4
6 Hofer, I. S., Lee, C., Gabel, E., Baldi, P., & Cannesson, M. (2020). Development and validation of a deep neural network model to predict postoperative mortality, acute kidney injury,
and reintubation using a single feature set. NPJ digital medicine, 3, 58. https://doi.org/10.1038/s41746-020-0248-0
7 Seger, C., & Cannesson, M. (2020). Recent advances in the technology of anesthesia. F1000Research, 9, F1000 Faculty Rev-375.
https://doi.org/10.12688/f1000research.24059.1
8 Seshadri, D. R., Bittel, B., Browsky, D., Houghtaling, P., Drummond, C. K., Desai, M. Y., & Gillinov, A. M. (2020). Accuracy of Apple Watch for Detection of Atrial Fibrillation.
Circulation, 141(8), 702-703. https://doi.org/10.1161/CIRCULATIONAHA.119.044126
62 | CSA Vital Times
https://doi.org/10.1016/S2589-7500(20)30187-4 https://doi.org/10.1038/s41746-020-0248-0 https://doi.org/10.12688/f1000research.24059.1 https://doi.org/10.1161/CIRCULATIONAHA.119.044126

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