Optimization of Post-Surgery Wake Up Time Providing Adequate Analgesia

What is the best drug concentration during anesthesia? We are creating algorithms to minimize pain and shorten wake up time after surgery. This will be used by anesthesiologist during surgery to continuously provide optimal drug cocktails with surgery and patient specificity

Simulating Gas Exchange in the Human Lung and Body

We have implemented a real-time simulator of gas exchange in the human body and lung. The system realistically mimics respiratory gas uptake and production as a function of pulmonary, cardiovascular, and metabolic parameters. The implementation consists of hardware and software to control the flow of gases entering and leaving a ventilated test lung. Such a device could serve as a bench-top resource for testing newly developed anesthesia, hemo-dynamic, and patient monitors. Preliminary tests have been performed for validation of a non-invasive cardiac monitor. The results, while promising, expose the need for more sophisticated models of the human respiratory and circulatory physiology

Optimization Methods to Minimize Emergence Time While Maintaining Adequate Post-Operative Analgesia

A rapid emergence from anesthesia combined with an extended duration of adequate analgesia is desired. Difficulties arise when trying to achieve a rapid emergence and provide adequate analgesia for procedures associated with moderate post operative pain. We propose to use pharmacokinetic (PK) and pharmacodynamic (PD) models with optimization techniques to determine anesthetic drugs ratios to improve post-anesthetic outcomes of emergence and analgesia. We hypothesize that optimized propofol, remifentanil, and fentanyl administrations will shorten emergence time and extend the period of adequate analgesia during patient recovery. Anesthesiologists administered a general anesthetic to 21 patients for laparoscopic procedures with propofol, remifentanil, and fentanyl according to their standard practice. The theoretical improvement provided by the optimization was measured by comparing the time differences between the control predictions and the optimized prediction of the TROR time and TRON time. In the control group the TROR was 10.2+-5.8 minutes (mean +- SD) and TRON was 3.5+-5.0 minutes after emergence. In the optimized group the TROR was 7.5+-2.2 minutes or 26% faster (p \u3c .001, paired t-test) and the TRON was 7.4 +-2.4 minutes or 88% longer (p \u3c .00001, t-test). Optimized administrations of propofol, remifentanil, and fentanyl resulted in a theoretically shorter emergence time and a longer period of adequate postoperative analgesia. The optimization algorithm shows potential for real-time clinical guidance in drug management

Evaluation of a Graphical Anesthesia Drug Display for Space Travel

As the frequency and duration of space travel increase, the potential need for emergency medical care in space grows, and with it the need for patient monitoring devices supporting therapeutic treatment. Providing emergency care to an injured astronaut may necessitate immediate surgery. During such events, the timely administration of anesthetic agents will need to be performed by someone who is not a formally trained anesthesiologist. The availability of usable real-time displays of intravenous anesthetic concentrations and effects could significantly enhance intraoperative clinical decision-making both in space and on earth. The effectiveness of the real-time anesthesia display on the management of total intravenous anesthesia was determined by 31 anesthesiologists participating in a simulation study. In the presence of the anesthesia drug display, clinicians maintained physiologic indicators such as blood pressure and heart rate closer to baseline levels. Participants also reported an increase in perceived performance when using the drug display. The results indicate that surgeries on earth and in orbit would benefit from the implementation of this display

Pulmonary Metaphor Design and Anesthesia Simulation Testing

Medical decision making is a crucial process to successfully treat a critical medical emergency. During an unexpected medical event, astronauts, like anesthesiologists, must react quickly in a complex environment. Tools, such as the pulmonary metaphor display, were created to aid the medical caregiver\u27s decision making process. The pulmonary metaphor display is designed to help the caregiver collect and integrate pulmonary data to provide a more accurate, quicker diagnosis and treatment. The following outline anesthesiology simulation study will provide the data to prove that the pulmonary metaphor display is beneficial to medical decision making

Faster clinical response to the onset of adverse events: A wearable metacognitive attention aid for nurse triage of clinical alarms

<div><p>Objective</p><p>This study evaluates the potential for improving patient safety by introducing a metacognitive attention aid that enables clinicians to more easily access and use existing alarm/alert information. It is hypothesized that this introduction will enable clinicians to easily triage alarm/alert events and quickly recognize emergent opportunities to adapt care delivery. The resulting faster response to clinically important alarms/alerts has the potential to prevent adverse events and reduce healthcare costs.</p><p>Materials and methods</p><p>A randomized within-subjects single-factor clinical experiment was conducted in a high-fidelity 20-bed simulated acute care hospital unit. Sixteen registered nurses, four at a time, cared for five simulated patients each. A two-part highly realistic clinical scenario was used that included representative: tasking; information; and alarms/alerts. The treatment condition introduced an integrated wearable attention aid that leveraged metacognition methods from proven military systems. The primary metric was time for nurses to respond to important alarms/alerts.</p><p>Results</p><p>Use of the wearable attention aid resulted in a median relative within-subject improvement for individual nurses of 118% (W = 183, p = 0.006). The top quarter of relative improvement was 3,303% faster (mean; 17.76 minutes reduced to 1.33). For all unit sessions, there was an overall 148% median faster response time to important alarms (8.12 minutes reduced to 3.27; U = 2.401, p = 0.016), with 153% median improvement in consistency across nurses (F = 11.670, p = 0.001).</p><p>Discussion and conclusion</p><p>Existing device-centric alarm/alert notification solutions can require too much time and effort for nurses to access and understand. As a result, nurses may ignore alarms/alerts as they focus on other important work. There has been extensive research on reducing alarm frequency in healthcare. However, alarm safety remains a top problem. Empirical observations reported here highlight the potential of improving patient safety by supporting the meta-work of checking alarms.</p></div

Nurses’ subjective opinions comparing their performance with and without HAIL-CAT.

<p>Nurses’ subjective opinions comparing their performance with and without HAIL-CAT.</p

Trial condition metrics for analysis of potential secondary effects.

<p>Trial condition metrics for analysis of potential secondary effects.</p