"Going under" anesthesia involves many biological and pharmacological parameters needed to carefully monitor patient need versus appropriate dosage required. Such a delicate balance of science and experience usually requires the skilled hands of a living, breathing anesthesiologist.

No longer. Researchers at McGill University and the McGill University Health Center (MUHC) recently performed the world's first totally automated administration of an anesthetic, using a "humanoid anesthesiologist" apparatus that thinks like an anesthesiologist, analyzes biological information, and constantly adapts its own behavior, even recognizing monitoring malfunction.

"We have been working on closed-loop systems, where drugs are administered, their effect continuously monitored, and the doses adjusted accordingly for the past five years," says Dr. Thomas Hemmerling, member of McGill's Anesthesia Department, Montreal General Hospital, and head of the Intelligent Technology in Anesthesia Research Group. ITAG's team of anesthesiologists, biomedical scientists and engineers have playfully named their automated system "McSleepy," in honor of the handsome albeit fictional medical hunk on the television hit "Grey's Anatomy" known as "McDreamy."
McGill's innovative system administers appropriate drugs using conventional infusion pumps controlled by a laptop computer on which "McSleepy" software is installed.

So far, the system has been used during seven operations. To manipulate the various components of general anesthesia, the automated system measures three separate parameters displayed on a new Integrated monitor of anesthesia (IMATM): depth of hypnosis via EEG analysis, pain via a new pain score known as AnalgoscoreTM, and muscle relaxation via phonomygraphy TM, all developed by the ITAG team.

Using these three separate parameters and complex algorithms, the automated system calculates faster and more precisely than a human can the appropriate drug doses for any given moment. Anesthesiologists can then focus more on other aspects of direct patient care during any given surgical procedure. An additional feature is that the system can communicate with personal digital assistants, making off-site monitoring and anesthetic control possible.

Dr. Hemmerling suggests it will take two years to perfect the system. "In designing McSleepy," he adds, "We put considerable research on the design of an interface which is clear, easy to read, resembles displays of our everyday practice but still provides a detailed clinical picture of what is going on and what has happened."

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