A team from Montreal's McGill University has pioneered a medical first by administering anesthesia via remote teleconferencing for surgery that was taking place in Pisa, Italy.
On Aug. 30, Dr. Thomas Hemmerling and his team from McGill's anesthesia department treated patients undergoing thyroid gland surgery in Italy, putting them to sleep remotely from a control room in Montreal.
"The practice has obvious applications in countries with a significant number of people living in remote areas, like Canada, where specialists may not be available on site," Hemmerling said in an interview Friday.
"Up north, you might have a GP (general practitioner) or anesthesiologist all on his own. Now, if you have the video, you can have an expert team." Hemmerling said the ability of medical professionals to use a team of experts from another centre had implications for the military and for countries such as Rwanda, where there are fewer than 10 anesthesiologists serving the entire country.
"The idea is if they have difficult cases, they definitely benefit to have some kind of remote control and monitoring." The approach is part of technological advancements, known as "teleanesthesia," and involves a team of engineers, researchers and anesthesiologists.
Medical staff on site start an intravenous line and then the dosage is controlled remotely through an automated system.
The procedure followed ongoing scientific collaboration between Hemmerling's team and Dr. Cedrick Zaouter and Professor Francesco Giuntathe of Pisa University's anesthesia department.
Using four video cameras, the medical team in Montreal was able to monitor every aspect of patient care in Italy in real time.
Live images of the surgery, along with the patient's breathing rate and vital signs are monitored by each camera.
In Montreal, a remote computer station known as the "anesthesia cockpit" is used in conjunction with a workstation that handles the audio-video link between the two centres.
Before the operation, an assessment of the patient's airway and medical history is also performed via video-conferencing.
At one time, Hemmerling said, invasive blood tests or other tests were required in preparation for many surgeries, but that's no longer the case. Still, many patients take long journeys and often wait hours to see an anesthesiologist who will ask them specific questions. Video-conferencing, however, could eliminate that and reduce the stress of in-patients, before surgery.
"The next steps will be to confirm the results of this pilot experience with further studies," Hemmerling said.
He said the project had received funding for three years to develop standards and protocols for remote anesthesia.
"This is just a proof of concept," he said. "The second step is to standardize all the different parts of what we are doing, lighting, camera placement, to compare the performance of remote anesthesia to local anesthesia." "It could also be used for teaching purposes, allowing the resident to perform tasks without the physical presence of a tutor, thus increasing his or her confidence level," Hemmerling said.
The Montreal-Pisa experiment furthers the knowledge learned from telemedicine, which uses interactive audiovisuals for diagnosing, examining and consulting with patients in remote areas.
The idea of remote medicine goes back at least to the early 1900s, when radios were used to help people communicate with the Royal Flying Doctor Service, an emergency and primary health-care service for those living in rural, far-flung areas of Australia.
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Autor(en)/Author(s): Glenn Johnson
Quelle/Source: The Ottawa Citizen, 11.09.2010
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