uses of smartphone in present and future anesthesia practice

1. Smartphone
The Future of Anesthesia Practice
Dr. Tushar Chokshi
M.D. (Anesthesia)
1TMC

2. Questions
1) How many of you are using smartphone in your
anesthesia practice ? Yes / No
2) Will use of smartphone benefit in anesthesia
practice ? Yes / No
3) If you want to learn new things in anesthesiology
then, will you use your smartphone ? Yes / No
2TMC

3. Lecture Outline
Definition of Smartphone
History of Smartphone
Features of Smartphone
Future Smartphone & Modular Smartphone
Uses of Smartphone in Medicine
Uses of Smartphone in Anesthesiology
Different Anesthesia Apps for Smartphone
Future Uses of Smartphone in Anesthesia
Take home Message
References
3TMC

4. A mobile phone that performs many of the functions of
a computer, typically having a touch screen interface,
internet access and an operating system capable of
running downloaded apps.
4TMC

5. History
Anaesthesia
The first documented general
anaesthetics was performed
by Crawford W. Long in 1842
The first public demonstration of
general anaesthesia was in 1846
by a Boston dentist
named William T.G. Morton at
the Massachusetts General
Hospital.
Smartphone
Devices that combined telephony
and computing were first
conceptualized by Theodore
Paraskevakos in 1971 and
patented in 1974, and were
offered for sale beginning in 1993
The term "smart phone" first
appeared in print in 1995, for
describing AT&T's "Phone Writer
Communicator" as a "smart
phone"
5TMC

6. IBM Simon: The
world's first
smartphone in
November 23rd 1992
$ 899 (Rs. 55,000)
Latest available
smartphones in market
$ 899 ( Rs. 55,000/ ) 6TMC

7. Features of Smartphone
Basic Features
Advance Features
Future Features
7TMC

8. Basic features of Smartphone
Smartphone act as a communication device, multimedia
device, and mini application operating platform
8TMC

9. Smartphone
WiFi/NFC/BLUETOOTH
Micro or Nano SIM card
High mAH Battery Wireless Print & Fax
Rear/Front Camera with Flash
Fingerprint Scanner
Screen Mirroring3G / 4G
Advance Operating System
Extended RAM Memory Advance Sensors
In all Latest available smartphones in market
these features are there 9TMC

10. 10TMC

11. Future feature Smartphone will be called as
Super Smartphone
11TMC

12. • Augmented Reality (AR)
( Live search of places
through GPS without
internet)
• Flexible Screens ( paper
thin and able to provide
large screen for viewing)
• In-Built Projector
( Integrated, No need for
TV screen, only Flat Surface)
• Seamless Voice Control
( No Sound wave
recognition, only natural
language user interface)
• Transflexive LCD displays
(Change the screen light
according to sun light)
• Future NFC making keys
to everything & no credit
debit card required
• IPS (Indoor Positioning
System)
• Waterproof and Break
proof
• Sixth Sense Technology
12TMC

13. Continued…..
• Seamless Wi-Fi
(Uninterrupted and all
across globe), WiFi
Passpoint (also known as
Hotspot 2.0)
• 3D Screens & Holograms
( Retina Display, image will
be sharper than what
human eye see)
• Prediction (through
sensors)
• Ocular scanning or eye vein
biometrics
• 5 G (Fastest Speed up to 50
mbps)
• Designer Smartphone
• Endless Battery Life (Solar,
advance lithium ion and
endless)
• Wireless recharging
• Smartphone advance
sensors ( Bluetooth and
others)
• Universal Battery Charging
from Audio Jack Point
13TMC

14. Flexible Smartphone
Wearable Smartphone
3 D Holographic Smartphone Projector Smartphone
14TMC

15. 15TMC

16. Micro electro-mechanical systems
(MEMS) sensors, that enable
smartphones to hear, see, touch, feel
and smell will create opportunities
for new smartphones that
profoundly affect the way we live.
16TMC

17. Google is Developing
( Project Era )
Modular
Smartphone
17TMC

18. A Modular Smartphone is a Smartphone made using
different components (alternatively called blocks) that can
be independently upgraded or replaced. 18TMC

19. In
My Opinion
19TMC

20. Smartphone acts like Anesthesiologist
and
Anesthesiologist acts like Smartphone
( Vigilant, Smart, Quick , Multitasking & Ever Demanding)
Use of Smartphone is Universal
Anesthesia is essential in Medical Practice
20TMC

21. Uses of Smartphone
in Medicine
(Through different apps, usb attachment, sensors & Modules)
21TMC

22. Smartphone Stethoscope As Ophthalmoscope
22TMC

23. As Thermometer As Pulse Oximeter
23TMC

24. As Otoscope AliveCor as Portable ECG
24TMC

25. As a Microscope As Glucometer IBGStar
25TMC

26. As Dermatoscope The Smartphone
Ultrasound
26TMC

27. As Video Laryngoscope To Measure BLOOD
PRESSURE
27TMC

28. As Spiro meter
28TMC

29. SMARTPHONE AS A
BRAIN SCANNER
As SPECTROMETER
29TMC

30. Smartphone as Neuromuscular Junction Monitor
30TMC

31. Colorimetric Smartphone Capnography
(CSC)
31TMC

32. http://www.vitadock.com
ThermoDock CardioDockGlucoDock
Each attachment cost Rs. 2500/-
32TMC

33. LifeWatch Technologies a first Medical Smartphone that
renders independently measure seven medical indexes:
ECG, Heart Rate, Body Temperature, Blood Sugar
levels, Body Fat Percentages, Blood Oxygen Saturation
and an Index Measuring Stress 33TMC

34. Seven components in all
> Air quality sensor
> CO2 monitor
> Light sensor
> EKG node that measures
heart activity
> Glucometer for glucose
tracking
> Breathalyzer
> Soul module
Lapka x Project Ara Medical Modular Smartphone
34TMC

35. Uses of Smartphone in Anesthesia Practice
• As Pulse Meter
• As Stethoscope
• As Pulse Oxymeter
• As ECG Monitor
• As Glucometer
• As USG Machine
• As Thermometer
• As Multi Para Monitor
Screen
• As light source in failure
of laryngoscope light
• As Spiro meter
• As Capnograph
• As Monitor for Video
Laryngoscope and Fiber
Optic Scope
• As Wireless Monitor Via
Bluetooth, NFC, Wi-Fi
• As Wireless alarms during
Anesthesia
• As Neuromuscular Junction
Monitor
(Through USB port, Sensors and Different Apps) 35TMC

36. Use of Smartphone As a Whole
(Through Different Apps)
• For Pre Assessment of Patient (paperless
anesthesia records)
• To Refer Different Anesthesia Textbooks
• Instant reference for Journal Articles
• To Refer Anesthesia Drugs Online ( Everything)
• For Information about Conferences, Seminars and
different Anesthesia Departments
• To refer Videos of New Anesthesia Gazettes and
Techniques
• For Anesthesia residency programme
36TMC

37. Continued….
• Online Shopping of Anesthesia Products and
Textbooks
• To Create Global Friendship with Anesthesia
Consultants and Departments
• Instant Ready Information in Crisis Management
• Use as Dictaphone, as Voice Recorder, For
Shooting Videos, To Click Photos ( in different
situation during anesthesia for CME and
References)
• Practically from Pre assessment to Transfer in
Anesthesia Practice
• Lastly free time in OT, to play dedicated
anesthesia games, puzzles and quiz
37TMC

38. Different Anesthesia Apps
• Pre Assessment
• Emergency
• Journals Reference
• Pediatric Anesthesia
• Geriatric Anesthesia
• Logbook and Records
• Guidelines
• Anesthesia Drug Refere.
• Anae. Gazettes Software
• Different Score & Scale
• Regional Anesthesia
• Anesthesia Books
• Ready Dose of Drugs
• For Infusion Rate in
OT/ICU
• Flashcards, Quiz & Games
• Social Apps e.g. Google,
Whatsapp, Twitter, Face
book, You Tube etc.
38TMC

39. 39TMC

40. 40TMC

41. 41TMC

42. 42TMC

43. Future Use of Smartphone in Anesthesia
(Will connect anesthesia machine via different sensors, USB attachment & Modular Smartphone)
• Oxygen, Nitrous and Air Flow Meter Monitoring
• As Anesthetic drugs & Inhalation agents dose
Monitoring
• Multipara Monitoring
• Ventilator Monitoring
• Drug Delivery Monitoring
• Light and Deep Anesthesia Control
• Drug selection and Exact Dose delivery time to time
• Any Mishaps during anesthesia Alarms in phone
• Machine Malfunction Alarms in phone
43TMC

44. Modular Smartphone for Anesthesiologist
In future different
anesthesia modules
will be available with
specific requirement
of anesthesiologist in
the market
e.g. gas monitoring,
drug monitoring, vital
signs monitoring etc.
44TMC

45. 45TMC

46. Smart Anesthesia Manager (SAM)
A Real-time Decision Support System for Anesthesia Care during Surgery
Anaesthesia information management systems (AIMS) are being
increasingly used in the operating room to document anaesthesia care.
We developed a system, Smart Anaesthesia Manager TM (SAM) that
works in conjunction with an AIMS to provide clinical and billing
decision support. SAM interrogates AIMS database in near real time,
detects issues related to clinical care, billing and compliance, and
material waste. Issues and the steps for their resolution are brought to
the attention of the anaesthesia provider in real time through “pop-
up” messages overlaid on top of AIMS screens or text pages. SAM
improved compliance to antibiotic initial dose and redoes. SAM was
also able to reduce wastage of inhalation anaesthetic agents.
IEEE Trans Biomed Eng. 2013 Jan;60(1):207-10
Nair BG Newman SF, Peterson GN, Schwid HA
Dept. of Anaesthesiology & Pain Med., Univ. of Washington, Seattle, WA, USA 46TMC

47. Anesthesia Machine with 2 USB Port 47TMC

48. Digital Anesthesia Work Station
Virtual flow
tubes with
high resolution
TFT display
48TMC

49. Dr. Staton
Digital Anesthesia machine
https://www.youtube.com/
watch?v=rB0Lj6k27fs
49TMC

50. Control on Anesthesia Work Station with
touch interface or screen display or digital
can
be controlled by Smartphone in future
with
newer sensors and modules
50TMC

51. Totally Smartphone controlled Anesthesia
Machine in Future
0 ! ! 0
No Control From Machine
All Control From Smartphone
By Four Different Ways
1) Through Micro USB Drive
2) Wireless through Bluetooth or NFC or
Wi-Fi compatible Anesthesia Machine
3) Through Sixth sense Technology
4) Through Medical Modules 51TMC

52. This robotic system named The Kepler Intubation System (KIS), developed by Dr.
Thomas M. Hemmerling, McGill University Health Centre (MUHC) specialist and
McGill University Professor of Anesthesia and his team, may facilitate the
intubation procedure and reduce some complications associated with airway
management. The world’s first robotic intubation in a patient was performed at
the Montreal General Hospital
https://www.youtube.com/watch?v=Z4PK7NYXGmM
52TMC

53. Pharmacological Robots: (McSleepy Anaesthesia Robot)
> Developed at McGill University by Dr Hemmerling and his team
> Three components of anaesthesia – Hypnosis, Analgesia and Muscle relaxation
automatically controlled from induction to emergence
> Patient data of height, weight, age, ASA classification, type of surgery, any specific drugs like
beta blocker which can interfere with the system and additional information like concomitant
neuro-axial blockade is uploaded to the computer system
> The system will use the pharmacodynamics results to categorize the patient’s pharmacological
“personality” and adapt doses accordingly
> Maintenance of anaesthesia is provided through integrated closed loop control of hypnosis,
analgesia and muscle relaxant using BIS score, Analgoscore and muscle twitch monitor
> Drugs used are propofol, remifentanil and rocuronium or cisatracurium
> McSleepy needs to know the stage of surgery , so there three options like prepping , incision
and 20 minutes to end , accordingly the doses will be adjusted or stopped 53TMC

54. Robotic ultrasound-guided nerve blocks
( The Magellan system)
> Developed at McGill University by Dr Hemmerling and his team
> A robotic system, Magellan, to perform nerve blocks using a remote control centre
> The Magellan system consists of 3 main components: a joystick, a robotic arm, and a
software control system
> The success rate was 100%
> The total performance time was approximately 3 minutes to 4 minutes
54TMC

55. SmartBot: Smartphone Robot
SmartBot is a programmable
Smartphone robot for
entertainment, education
and health that uses your
Smartphone (Android,
iPhone, or Windows Phone )
or a programmable
development board as its
brain, sensors and interfaces
Useful in future Anaesthesia Practice 55TMC

56. So Smartphone in Anesthesia
• Offers a computing device,
power source and display to
which we can attach wide
variety of physiological sensors.
• This can include noninvasive
ECG, EEG, Oxygen Saturation,
Hemoglobin, glucose, blood
pressure, spirometry,
temperature, energy
expenditure, height and weight.
• In built sensors used to measure
vital signs e.g. accelerometer for
respiratory activity, camera for
Heart rate, and RR
• In general Smartphone is
used for information
resource to guide care, for
patient assessment, deliver
e-learning, as a logbook, for
tele- consultation and
remote support.
• In future as true friend of
anesthesiologist for
complete monitoring of
patient during
Peri-Operative period
56TMC

57. 1) Pre Assessment of patient with all details including Personal history, Medical history,
Physical examination, Lab. Investigations etc. will be recorded in dedicated apps in
Smartphone
2) Smartphone will be attached to anesthesia machine by usb, sensors, modules and apps
3) From induction, monitoring, drug selection with doses and intra operative decision will be
taken by Smartphone according to patient’s history and operation
4) Fluid management will be decided by Smartphone according to NBM and Blood Loss
5) Practically Smartphone will act as an anesthesiologist and only intubation and extubation
will be in hand of anesthetist
6) Even Intubation and extubation will also done by robotic assisted anesthesia in future
Anesthesiologist will only Monitor Smartphone
57TMC

58. Practical uses of Smartphone in jj private practice
• For discussion of cases in
whatsapp forum in our
academic groups
• In OT, during free time to
refer anesthesia textbooks
and journal articles
• For dose calculation of
different drugs
• To take photos and videos of
good cases for reference and
discussion
• To take instant help of other
colleagues by phone, social
medias or by video chat
• Most important use of
Smartphone is for virtual
pre anesthesia checkup by
phone calls or videos and
seeing all investigation on
Smartphone
• Post operative follow up of
patient
• For paperless record of all
my cases in log book app
• Lastly in crisis management
Smartphone is most useful
for me for everything to
manage the patient 58TMC

59. Take Home Message
In near future Smartphone will help and act as
good companion to Anesthesiologist
Smartphone will reduce morbidity and mortality
rates due to precise and meticulous planning of
each case through advanced technology and
dedicated anesthesia apps
All anesthesiologist will monitor patient through
their Smartness and Smartphone
59TMC

60. Increasingly future Smartphone technology and
sophisticated anesthetic delivery with monitoring
systems are inevitable
They are great when everything works well, but
understanding enough about those technology and
systems to know what to do when things go wrong is
a significant challenge
Anesthesiologist should ensure that they are familiar
with this before they first time use them
It is not a magic in future 60TMC

61. Finally, I will say that
Surgeon saves the life of patient
Anesthesiologist saves the lives of patient and surgeon
But, Smartphone will save the lives of patient, surgeon and anesthesiologist
61TMC

62. References
• http://m.youtube.com/watc
h?v=Zhtx59tgBNU
• http://m.youtube.com/watc
h?v=J5ztKKjNPd
• http://m.youtube.com/watc
h?v=jt7Wf-KLSwM
• https://m.youtube.com/wat
ch?v=O8UGYcX1RkA
• http://mobihealthnews.co
m/22674/timeline-
smartphone-enabled-
health-devices/
• https://m.youtube.com/wat
ch?v=YY3d4dyFRog
• https://m.youtube.com/wat
ch?v=WRE1310f05s
• http://internetmedicine.co
m/2012/12/14/top-ten-
medical-uses-of-the-
iphone
• https://www.youtube.com/
watch?v=DJPGM9LbxCs
• https://www.youtube.com/
watch?v=Z4PK7NYXGmM
62TMC

63. What is your self judgment of using Smartphone in your practice ?
63TMC

64. 64TMC