Autonomous Systems in Anesthesia: Where Do We Stand in 2020? A Narrative Review

Abstract

BIS = bispectral index; CDS = clinical decision support system; EEG = electroencephalogram; HSS = hybrid sedation system; MIMO = multiple input multiple output; SISO = single input single output; TCI = target-controlled infusion BACKGROUND: THE RATIONALE FOR ROBOTS IN ANESTHESIA Robots now surround our daily activities, doing everything from cleaning our homes to flying airplanes, and they exist in fields ranging from industry to medicine.In science fiction, we tend to conceptualize "robots" as human-shaped automata, but in general, a "robot" generally refers to any mechanical system capable of interacting with the environment with directed interventions.In medicine, automation offers precision therapy in combination with a high level of reproducibility. These features make robots appealing in the medical fields, and they have been used in the field of anesthesia for several decades assisting clinicians. 1,2 However, many well-tested autonomous systems and known to be safe have not been adopted yet into clinical practice on a daily basis. When we consider that repetitive execution of trivial technical tasks is subject to vigilance decrement in humans, as well as the fact that human providers may suffer from fatigue, boredom, and bias, there is a strong rationale for the role such systems may play in clinical care. 3,4 Using robots to assist in the acquisition of patient data, simple decision-making, and manual tasks may leave physicians freer to focus efficiently on tasks requiring human intelligence and judgment. 5 As most of us are aware, almost every facet of our society is becoming, for better or worse, progressively more technology-dependent. Technological advancement has made autonomous systems, also known as robots, an integral part of our life in several fields, including medicine. The application of robots in anesthesia could be classified into 3 types of robots. The first ones are pharmacological robots. These robots are based on closed-loop systems that allow betterindividualized anesthetic drug titration for optimal homeostasis during general anesthesia and sedation. Recent evidence also demonstrates that autonomous systems could control hemodynamic parameters proficiently outperforming manual control in the operating room. The second type of robot is mechanical. They enable automated motorized reproduction of tasks requiring high manual dexterity level. Such robots have been advocated to be more accurate than humans and, thus, could be safer for the patient. The third type is a cognitive robot also known as decision support system. This type of robot is able to recognize crucial clinical situation that requires human intervention. When these events occur, the system notifies the attending clinician, describes relevant related clinical observations, proposes pertinent therapeutic options and, when allowed by the attending clinician, may even administer treatment. It seems that cognitive robots could increase patients' safety. Robots in anesthesia offer not only the possibility to free the attending cl...

Artificial Intelligence for Perioperative Medicine: Perioperative Intelligence

“…Using vast information, and with expert input, advanced AI application can help develop autonomous systems or robots that help in drug delivery, precision mechanical tasks, and decision support systems. 14 Autonomous systems are ever more important for patient safety, especially with an aging workforce. 15 For example, drug delivery closed-loop systems comprising sensors to monitor safe drug level, algorithms to assess needed change, and drug delivery systems to deliver drugs to patients can provide consistent anesthetic drug delivery, and finally sensors to monitor drug effect (Table ).…”

A Century of Technology in Anesthesia & Analgesia

“…205 In May 2020, Anesthesia & Analgesia published a special issue on "Anesthesia and Artificial Intelligence," which covered most of these topics. 196,200,[204][205][206][207][208][209][210][211][212][213][214][215] Robotic and closed-loop anesthesia systems have also been featured in several articles. Notable examples include the Kepler intubation system, which enabled robot-assisted tracheal intubation, and the Magellan system, which performed robot-assisted ultrasound-guided nerve blocks.…”

Experimental Results of an MPC Strategy for Total Intravenous Anesthesia

“…In particular, in Total Intravenous Anesthesia (TIVA), the required Depth-of-Hypnosis (DoH) is generally obtained by means of the hypnotic drug propofol, while the required analgesia is achieved by means of the analgesic drug remifentanil [1]. Feedback control of DoH has attracted the attention of many researchers since sensors to measure the level of hypnosis have become available [2], [3]. In fact, the use of a control system where the anesthesiologist acts only as a supervisor might provide significant advantages in terms of patient's safety [4], [5].…”