National Post (National Edition)
A surgical knockout from across the Atlantic
As the 20 patients in Pisa, Italy, waited to undergo thyroid surgery, they descended into unconsciousness thanks to a cocktail of anaesthetic drugs delivered from a surprising destination.
The infusion machines in Pisa were controlled remotely by specialists in Montreal, a unique experiment in “transcontinental anaesthesia” that could eventually make operations safer in isolated communities, a new study indicates.
The McGill University doctors adjusted doses of drugs, monitored vital signs, watched the patient on webcams and even guided the breathing tube into place, linked to Italy via laptop computers and the Internet.
The procedures went off without a hitch, researchers from both centres reported in the British Journal of Anaesthesia. Backup anaesthesiologists were at the ready in Pisa, though, in case of a break in the Internet connection or other glitch, according to the paper.
More than just an intriguing display of modern technology in the operating room, the system could one day be employed in remote parts of Canada or the developing world, where anaesthesia is often now handled by non-specialists, said Dr. Thomas Hemmerling, the McGill professor who spearheaded the study.
“Nurses have maybe good manual skills,” Dr. Hemmerling said.
“But they might not have the pharmaceutical knowledge to deliver the top-quality anaesthesia ... If you installed systems like that, you could have the same quality of anaesthesia everywhere. It doesn’t matter whether you were in Africa, or here in Montreal.”
The experiment is “exciting,” and part of a broader movement to develop automation as an aid to the specialists, said Dr. Stephan Schwartz, an anaesthesiology professor at the University of British Columbia.
He said he would be concerned, though, to see the doctors replaced in the operating room by machines operated from a distance, which he compared to far-removed military “pilots” controlling unmanned drone aircraft.
Delivering anaesthetic drugs is a relatively small part of the specialty, which also involves intervening if something goes wrong during surgery, resuscitating patients smoothly and providing post-operative care, said Dr. Schwartz.
“Just imagine that inadvertently some mishap occurs during surgery … maybe the patient reacts very strongly to some of the anesthetic medicine and stops breathing,” he said. “You need a physician right there, right now to rectify that issue. That cannot be achieved by being 10,000 kilometres away.”
For the study, Dr. Hemmerling worked with Pisa because of a longstanding research collaboration with the university there.
The Italian O.R . was equipped with a “slave” computer system connected to the drug-infusion and other de-
It doesn’t matter whether you were in Africa, or here in Montreal
vices and webcams. A regular Internet service was used to connect to “master” laptops in Montreal.
Only commercially available computers and off-theshelf software were used. All the patients asked to take part in the study readily agreed, said Dr. Hemmerling.
The Montreal team also used the Skype video-calling program to conduct “airway examinations,” where the anaesthesiologist measures the patient’s mouth opening, peers down their throat and does other checks to prepare for installing the breathing tube.
The Canadians even controlled the Glidescope, a machine that allows doctors to remotely direct the tube into the patient’s airway, guided by a tiny camera attached to the device.
Dr. Hemmerling said the system could be used some day in remote parts of Canada, where there is a lack of anaesthesiologists and the work is often performed by family doctors with some extra training.
Shortages are worse in the developing world, with nurses often handling anaesthesia, he said. Such a system could be installed relatively cheaply, the local person handling any physical interaction with patients.
Dr. Schwartz, though, said it might be just as easy to bring a specialist to such a location as to set up a sophisticated computer system.