Medically induced comas may be better off on autopilot

A computer-controlled system developed by Massachusetts General Hospital holds the promise to be more precise than humans at keeping a patient in a medically induced coma, sometimes is used to reduce brain swelling after a traumatic injury or to treat uncontrolled seizures. It requires a nurse or doctor to monitor the patient's brain activity and adjust the rate of anesthetic delivery around the clock, sometimes for several days.

In an article at PLOS Computational Biology, including researchers from Massachusetts Institute of Technology, reports successfully using an automated system on mice.

"To use an analogy that compares giving anesthesia to flying a plane, the way it's been done is like flying a direct course for hours or even days without using an autopilot. This is really something that we should have a computer doing," senior author Emery Brown, Ph.D., of the MGH Department of Anesthesia, Critical Care and Pain Medicine, said in an announcement.

Although anesthesiologists have used computer-assisted technologies for years, the U.S. Food and Drug Administration has not approved any completely automated system.

Brown's team developed algorithms to read and analyze an EEG pattern in real time to determine a target level of brain activity, then automated flow of an anesthetic drug to achieve it, with real-time feedback sent back into the system. The system met its targets in mice almost exactly, according to the announcement.

The system promises the ability to maintain the coma at a more precise, consistent level and to use less anesthetic. It also could free up an ICU nurse devoted each shift to continuous monitoring of the anesthesia.

Mark Newman, anesthesiologist at Duke University, told Technology Review that computerized sedation would fully automate care, however, since heart and kidney function must be monitored as well.

However, technology mishaps--most often misconfiguration or improper settings--were cited as the cause of almost one-fourth of operating room errors, according to a study published at BMJ Quality & Safety.

Preoperative checklists and anesthesia checklists are among 10 patient safety strategies hospitals are "strongly encouraged" to adopt, according to research headed by RAND Corp

In another example of medicine taking a page from the airline industry play book, an idea from anesthesiologist David Brown, M.D., of Cleveland Clinic ranked among the clinic's top 10 medical innovations of 2014. His idea: Why not have a system in the operating room sending out alerts and offering advice about performance measures the same way pilots receive information from his airplane computers and air traffic controllers?

To learn more:
- find the research
- read the announcement
- here's the Technology Review story