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Smartphone

The Future of Anesthesia Practice

Dr. Tushar Chokshi

M.D. (Anesthesia)

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Questions

1) How many of you are using smartphone in your anesthesia practice ? Yes / No2) Will use of smartphone benefit in anesthesia practice ? Yes / No3) If you want to learn new things in anesthesiology then, will you use your smartphone ? Yes / No

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Lecture Outline

Definition of SmartphoneHistory of SmartphoneFeatures of SmartphoneFuture Smartphone & Modular SmartphoneUses of Smartphone in MedicineUses of Smartphone in AnesthesiologyDifferent Anesthesia Apps for SmartphoneFuture Uses of Smartphone in AnesthesiaTake home MessageReferences

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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.

Smartphone

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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"

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IBM Simon: The world's first

smartphone in November 23rd 1992

$ 899 (Rs. 55,000)

Latest available smartphones in market

$ 899 ( Rs. 55,000/ )

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Features of Smartphone

Basic Features

Advance Features

Future Features

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Basic features of Smartphone

Smartphone act as a communication device, multimedia device, and mini application operating platform

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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

Advance

features

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Future feature Smartphone will be called as

Super Smartphone

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Future Features of Smartphone• 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

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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

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Flexible SmartphoneWearable Smartphone

3 D Holographic Smartphone Projector Smartphone

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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.

Future Sensors in Smartphone

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Google is Developing( Project Era )

Modular Smartphone

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A Modular Smartphone is a Smartphone made using different components (alternatively called blocks) that can

be independently upgraded or replaced.

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In My Opinion

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Smartphone acts like Anesthesiologistand

Anesthesiologist acts like Smartphone

( Vigilant, Smart, Quick , Multitasking & Ever Demanding)

Use of Smartphone is Universal Anesthesia is essential in Medical Practice

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Uses of Smartphone in Medicine

(Through different apps, usb attachment, sensors & Modules)

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Smartphone Stethoscope As Ophthalmoscope

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As Thermometer As Pulse Oximeter

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As Otoscope AliveCor as Portable ECG

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As a Microscope As Glucometer IBGStar

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As Dermatoscope The Smartphone Ultrasound

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As Video Laryngoscope To Measure BLOOD PRESSURE

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As Spiro meter

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SMARTPHONE AS A BRAIN SCANNER

As SPECTROMETER

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Smartphone as Neuromuscular Junction Monitor

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Colorimetric Smartphone Capnography (CSC)

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http://www.vitadock.com

ThermoDock CardioDockGlucoDock

Each attachment cost Rs. 2500/-

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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

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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

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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)

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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

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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

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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.

Free and Paid

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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

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Modular Smartphone for Anesthesiologist

In future different anesthesia modules

will be available withspecific requirement

of anesthesiologist in the market

e.g. gas monitoring, drug monitoring, vital signs monitoring etc.

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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

TMC 47Anesthesia Machine with 2 USB Port

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Digital Anesthesia Work Station

Virtual flow tubes with

high resolution TFT display

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Dr. Staton Digital Anesthesia machine

https://www.youtube.com/watch?

v=rB0Lj6k27fs

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Control on Anesthesia Work Station with touch interface or screen display or digitalcan

be controlled by Smartphone in future with

newer sensors and modules

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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 Drive2) Wireless through Bluetooth or NFC or

Wi-Fi compatible Anesthesia Machine3) Through Sixth sense Technology4) Through Medical Modules

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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

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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

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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

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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

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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

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Practical Anesthesia Case by Smartphone in Future

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

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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

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Take Home MessageIn 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

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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

But

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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

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References• http://

m.youtube.com/watch?v=Zhtx59tgBNU

• http://m.youtube.com/watch?v=J5ztKKjNPd

• http://m.youtube.com/watch?v=jt7Wf-KLSwM

• https://m.youtube.com/watch?v=O8UGYcX1RkA

• http://mobihealthnews.com/22674/timeline-smartphone-enabled-health-devices/

• https://m.youtube.com/watch?v=YY3d4dyFRog

• https://m.youtube.com/watch?v=WRE1310f05s

• http://internetmedicine.com/2012/12/14/top-ten-medical-uses-of-the-iphone

• https://www.youtube.com/watch?v=DJPGM9LbxCs

• https://www.youtube.com/watch?v=Z4PK7NYXGmM

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What is your self judgment of using Smartphone in your practice ?

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