Wireless sedation

The Daily talks with the world's first tele-anesthesiologist

Researchers in McGill’s Department of Anesthesia and at the University of Pisa recently teamed up to perform the world’s first application of remote-controlled anesthesia, or tele-anesthesia. A team in Montreal, led by tele-anesthesiologist Thomas Hemmerling, administered the procedure to patients more than 6,000 kilometres away in Pisa. The procedure is shaping up to be an important application of telemedicine — a new wave of medical treatments that harness modern communication technology to transcend geographical distance in providing medical care. The Daily recently got the chance to talk with Hemmerling about his medical first.

McGill Daily: Can you describe how this procedure was carried out?
Thomas Hemmerling: We have installed what we call an anesthesia cockpit. In that anesthesia cockpit you have two basic connections. One is an automated system here in Montreal that connects to an automated system in Pisa, Italy. [From Montreal], we control an automated system in Italy that controls all three components of anesthesia. So it makes your patient sleepy, takes the pain away and relaxes the muscles… The second part of the cockpit controls several webcams in the operating room and has an audio communication with the local team in Italy. [One camera] looks at the vital signs monitor, one camera looks at the surgical side, one looks at the anesthesia machine and one is a so-called free floating webcam which we can use for whatever I want to see. And we do the pre-operative assessment of the patient via a normal video link.

MD: What brought McGill and the research team at Pisa University together?
TH: I have a longstanding scientific relationship with the University of Pisa…so Pisa was an obvious choice to do this as a ‘proof of concept.’ And that’s exactly what it is. Don’t forget that there was always an anesthesia team in Italy as a backup. And obviously the anesthesia team in Italy doesn’t need my help…but let’s say you have a remote location. In most of the countries in Africa, anesthesia is actually provided not by specialists but by nurses. And you could imagine that these nurses, if they have something like this tele-anesthesia, might definitely benefit from it and the safety and the quality of anesthesia might be improved.

MD: Can you describe what it was like to work with another team through video communication?
TH: We’ve noticed that the advantage of having a remote team is that we sometimes recognize certain things earlier than the local team because they are focused on other issues and we are standing back, controlling things on different monitors.

MD: Did you run into any problems during the surgeries?
TH: [First] we needed to establish the connections. But once everything was set up, throughout that proof of concept period of 20 patients we did not have any problems at all. Obviously, we were looking at problems of what happens if the internet goes down. The risk of interruption is very big [in remote areas]. The beauty of our tele-anesthesia is that two remote anesthesia automates are communicating with each other. That means that if for some reason we had lost contact, the local anesthesia automate would still provide anesthesia until we reestablished a connection…so that is basically a safety net.

MD: What other applications do you see in the future of tele-medicine?
TH: There are two directions which I see here. One is the pre-op evaluation: if I could ask you questions before surgery through a video link and do certain measurements of the airways…then I don’t think you have to come in for a pre-operative visit… It saves costs, it saves trouble, and it’s more comfortable for the patient.

The second thing is that I think in general medicine needs to think globally. We have all these programs together with Africa and we are trying to get the specialists there. But as a matter of fact if you look at countries like Rwanda, there are [about] less than ten specialists for the whole country. And that’s not going to change overnight. All over the Third World, anesthesia is provided not necessarily by specialists, but very often by less skilled generalists or very often by nurses. If you have a system like that then in selected cases you could actually use [tele-anesthia]…it’s a backup, it increases safety and it increases the quality of anesthesia… By using these combinations of video communication, audio communication and automated systems, I absolutely believe that you can increase the safety and quality of anesthesia in the Third World.