Artificial intelligence has several applications in anaesthesia including decision support systems, automated assist devices, and virtual reality training. Closed loop anaesthesia systems can precisely maintain drug levels and patient vitals within target ranges using feedback control of drug infusion pumps. While AI has benefits like reduced costs and time, and more consistent care, limitations include potential errors during learning, lack of emotional intelligence, and safety issues. Future areas of research include large datasets to improve AI and automated difficult airway assessment using facial recognition.

1. Artificial Intelligence
&
Anaesthesia
How far have we come!
Faiza Buhari
Birmingham Heartlands Hospita

2. Aim
• Definition
• How A.I. works?
• Evolution
• Applications in Anaesthesia
• Merits
• Downsides
• Future prospects

3. What is A.I. ?
Artificial intelligence is the capability of computers
to respond in a manner resembling human
intelligence.

4. How A.I. works?
• Artificial Neural Network
• Fuzzy logic

5. Evolution

6. Applications in Anaesthesia
• Decision Support Systems
- smart monitors
• Automated Assist Devices: Semi-Automated Anesthesia
- Closed loop system
- Mc Sleepy
• Procedure training by Virtual Reality

7. Closed Loop Anaesthesia Delivery
A closed-loop system can be defined as an automated control system
using the feedback principle.
• Pharmacological robots.
• Integrates expert systems.
• Determines right drug /right dose/right time
• Feedback principle

8. A Basic C.L.A.D model

9. McSleepy

10. ...McSleepy
• Controlling parameter: BIS+ ANALGOSCORE+ TOF
• 3 phases (induction/maintenance/emergence)
• 3 infusion pumps connected to a controlling unit
• Safety measures
A technical description of a novel pharmacological anaesthesia robot
Thomas M . Hemmerling et al
J Clin Monit Comput (2014) 28:27 – 34

11. Sedasys
• A computer-assisted personalized sedation system
• Mild-to-moderate Propofol sedation to be delivered by non-
anaesthesiologists.
• Consists of a full monitoring array ..
• Multi-centre study comparing SEDASYS® to
benzodiazepine/opioid : less oxygen desaturation, greater
patient satisfaction, and faster recovery
BJA: British Journal of Anaesthesia, Volume 113, Issue suppl_2, 1 December 2014, Pages ii37-ii47 https://doi.org/10.1093/bja/aeu378

12. Automated Anesthesiologist Suffers a Painful Defeat
A machine that makes anesthesiologists unnecessary for some
medical procedures has failed amid poor sales and resistance
from doctors and nurses
ASA Responds to FDA's Rejection of Johnson & Johnson's Computer-Assisted Anesthesia Device
April 22, 2010

14. • Significant reduction in Propofol dose
• Precisely maintained pre-established target BIS values with higher
performance scores
• Significantly lower BIS
Meta-analysis on Closed loop Delivery System
Closed-Loop Delivery Systems Versus Manually Controlled Administration of Total IV Anesthesia: A Meta-analysis of
Randomized Clinical Trials
Pasin, Laura MD et al
Anesthesia & Analgesia: February 2017 - Volume 124 - Issue 2 - p 456–464

15. ..Meta-analysis
• Time that the system was able to maintain a given variable in a
desired target range.
• Episodes of system undershoots or overshoots its target value.
Clinical Performance and Safety of Closed-Loop Systems: A Systematic Review and Meta-analysis of
Randomized Controlled Trials
Brogi, Etrusca MD; Cyr, Shantale PhD; Kazan, Roy MD, MSc; Giunta, Francesco MD; Hemmerling, Thomas M.
Anesthesia & Analgesia: February 2017 - Volume 124 - Issue 2 - p 446–455

16. KEPLER intubating system
British Journal of Anaesthesia 108 (6): 1011–16 (2012) Advance Access publication 28 March 2012 . doi:10.1093/bja/aes034
RESPIRATION AND THE AIRWAY First robotic tracheal intubations in humans using the Kepler intubation system
T. M. Hemmerling*, R. Taddei, M. Wehbe, C. Zaouter, S. Cyr and J. Morse
1. Robotic Arm
2. Joy stick
3.Pentax AWS video-laryngoscope
4. Software control system

17. Regional Anaesthesia

19. Other uses
• The use of automated anesthesia carts reduced the drug
recording errors in medication administrations of anesthesia.
J Clin Anesth. 2017 Aug;40:11-15. doi: 10.1016/j.jclinane.2017.03.051. Epub 2017 Apr 13

20. Benefits
• Cost reduction
MIT journal (sedation with the Sedasys machine cost $150 to $200 for
each procedure, compared to $2,000 for an anesthesiologist)
• Time reduction
A robot to reduce the time and number of steps to deliver
intravenous medication during anaesthesia
Yan E. Anaesthesia and Analgesia 2012;115(2)
• No Inter-individual difference

21. Is A.I a threat? (the spooky bit)
• Learns by itself
• Deep learning programmes-
(the Tensor Flow by Google 2018)
(unpredictable therefore uncontrollable)

22. Downsides
• Errors with huge learning curve
• Absent emotional intelligence
• Morality
• Problem solving limited
• Safety

23. Future Prospects:
 Database of Expected sample size of 50k
 Estimated to be finished by 2022
 University of Zhejiang - China
Automated Assessment of Difficult Airway with
Facial Recognition Techniques

24. Take home message…

25. ….Thank you !