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Handheld Devices and Informatics in Anesthesia Prasanna Vadhanan,MD1, Adinarayanan S., DNB2

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Handheld Devices and Informatics in Anesthesia Prasanna Vadhanan,MD1, Adinarayanan S., DNB2 COMMENTRY Handheld devices and informatics in anesthesia Prasanna Vadhanan,MD1, Adinarayanan S., DNB2 1Associate Professor, Department of Anaesthesiology, Vinayaka Missions Medical College & Hospital, Keezhakasakudimedu, Kottucherry Post, Karaikal, Puducherry 609609, (India) 2Associate Professor, Department of Anaesthesiology & Critical Care. The Jawaharlal Institute of Postgraduate Medical Education & Research, Dhanvantri Nagar, Gorimedu, Puducherry, 605006, (India) Correspondence: Dr. Prasanna Vadhanan, MD, No. 6, P&T Nagar, Mayiladuthurai 609001 (India); Phone: +919486489690; E-mail: [email protected] Received: 02 April 2016; Reviewed: 2 May 2016; Corrected: 02 June 2016; Accepted: 10 June 2016 ABSTRACT Handheld devices like smartphones, once viewed as a diversion and interference in the operating room have become an integral part of healthcare. In the era of evidence based medicine, the need to remain up to date with current practices is felt more than ever before. Medical informatics helps us by analysing complex data in making clinical decisions and knowing recent advances at the point of patient care. Handheld devices help in delivering such information at the point of care; however, too much reliance upon technology might be hazardous especially in an emergency situation. With the recent approval of robots to administer anesthesia, the question of whether technology can replace anesthesiologists from the operating room looms ahead. The anesthesia and critical care related applications of handheld devices and informatics along with its possible drawbacks are discussed. Key words: Informatics; Anesthesia informatics; Anesthesia; Critical care; Devices; Smart phones Citation: Vadhanan P, Adinarayanan S. Handheld devices and informatics in anesthesia. Anaesth Pain & Intensive Care 2016;20(2):209-213 Received: 25 April 2016; Reviewed: 15 May 2016; Accepted: 2 June 2016 INTRODUCTION Table 1: Sources of Information The integration of technology into medicine has made Sources of anesthesia related information the entire process of patient management more efficient, 1. Peer reviewed journals accurate and safer. Complex medical devices are becoming 2. Text books with new editions every few years smaller and robust, and hand held devices have an 3. Conferences and seminars increasing role to play in day to day patient management. 4. Association guidelines (American Society of Anesthesiologists, Hand held devices like smartphones, personal digital Difficult Airway Society etc.) assistants (PDA), informatic devices and handheld 5. National and institutional protocols 6. Pharmaceuticals monographs ultrasound are changing the ways in which anesthesia and 7. Expert opinions, best practice guidelines critical care is practiced. 8. Web based resources (websites of societies like WFSA, Information Overload NYSORA etc.) In this era of evidence based medicine litigation has According to Medline, since 2005 between 2000 to 4000 become an everyday happening. Anesthesiologists completed references are added each day .In 2013 this therefore, need to stay up to date with recent advances amounted to more than 700,000 articles.1 Even within a and practice guidelines. Searching for evidence, appraising specific speciality, it is impossible to keep up with all the and grading the evidence and determining their practical published medical reports.2 With the increasing number applicability needs time and resources. Before internet, the of medical publications, however narrow a speciality field only source of information was textbooks, few journals may be, it is impossible to keep up to date to become an and personal opinion of experts (the least possible level of expert. As of 2014 in anesthesiology and pain medicine evidence), but today the sources of information are vast nearly 118 anesthetic and 81 journals critical care journals and are shown in Table 1. are being published.3 gThe total number of articles published in these journals amounts to approximately ANAESTH, PAIN & INTENSIVE CARE; VOL 20(2) APR-JUN 2016 209 handheld devices and informatics in anesthesia 12,000 in anesthesiology and 10,000 in critical care 2. In making decisions based on patients’ clinical annually. This implies that even if a trainee manages to parameters and as a database of best practices from read and assimilate information from 40 articles per day reliable sources. This is called HDSS or Health for five days a week, he or she can only cover half the Decision Support Systems. Intelligent medical published articles that year and additional 22,000 articles informatics should be able to mimic the thought would have assimilated by that time. Literally we are process of an expert physician.10 living in an era of information overload. 3. In Telemedicine.Telemedicine is the ability to Information from Patients diagnose and treat diseases remotely. This is the basis of tele-ICU and tele surgery. Patient data can lead to information overload as well. As monitoring and laboratory parameters are increasing it Anesthesia related informatics systems are known as becomes difficult for the human mind to process them Anesthesia information management system or AIMS. and arrive at a clinically relevant diagnosis. Human mind Most of the features of the AIMS can be accessed by can adequately process four variables only at one time. hand held devices. Companies like McKesson, Stanford 4 A patient in an intensive care unit can generate up to Anesthesia informatics provide integration of the 236 variables,5 hence it is possible to miss relevant data informatics systems with hand held devices. Some of the that can help in diagnosis and management. On the other practical uses of AIMS are shown in Table 2. hand, such excess of information can lead to diagnostic errors and neglect of relevant data. Therefore instead Table 2. Use of informatics in Anesthesia of just raw data in the form of investigation reports Practical uses of AIMS and clinical parameters, we need computers to process • Storing patient data, automatic recording of intra operative them with appropriate algorithms and provide us with vitals and events clinically relevant hypothesis/diagnosis that best explains • Calculating drug dosages and infusion rates the raw data.6 • Predicting possible drug interactions based on patient’s Human Errors medications Fatigue and mood of the physicians had been shown to • Diagnosing light anesthesia and unstable blood pressures influence his/her decision making in patient management. • Reminders for drugs (e.g. insulin, DVT prophylaxis, Emotion can play a role in decision making, and studies antibiotics) in both psychology and economics have demonstrated • Scheduling surgeries and reserving post-operative beds 7 human fallibility in everyday decision making. A • Decision support involving multiple patient factors. stressed physician is more likely to deviate from standard protocols with or without his knowledge. Physicians tend to talk less, prescribe and refer more when they are Handheld Devices and Internet stressed and in a negative mood.8 Informatics can help in reducing such events by constantly alerting the physicians Another major application of handheld devices is whenever a deviation from protocol is noted and thereby accessing internet for information. Most AIMS devices preventing litigations.9 provide integrated internet access. Medical Informatics E Learning is a concept where computers and networks are used to provide online educational materials and Medical informatics can be defined as a complex science communication. Modules rich in multimedia teaching that integrates relevant theories, design methodologies, and files and discussions and feedback create a virtual knowledge of best practices drawn from various cognitive, classroom. It is also referred to by other terms: online computational, informational, organizational, and other learning, computer-assisted-learning, or Web-based expert knowledge domains.10 It involves synergistically learning. E Learners have demonstrated increased collecting, storing, organizing, manipulating, using, retention rates and better utilization of content.11 Other and disseminating clinical-based and health-related advantages are that the learner can control the pace, information. Handheld devices can be used to utilize the timeliness of content and sequence of learning. Interactive numerous benefits of medical informatics at point-of- learning enables users to manipulate variables and observe care. outcomes, for example drug kinetics. Several societies and There are three major areas where informatics is used in associations offer eLearning modules on various topics, anesthesia and critical care. which can be accessed from handheld computers as well. In a randomized trial, residents scored high on post 1. As a tool for electronic record keeping and retrieval. 210 ANAESTH, PAIN & INTENSIVE CARE; VOL 20(2) APR-JUN 2016 commentry module knowledge assessment after a regional anesthesia book are providing a platform where case discussions can E Learning module and all participants reported a be carried out with peers. Videos of procedures can be preference for web based learning.12 watched, and calculation of drug dosages and infusion rates can be done. Podcasts where digital media files can For the practicing anesthesiologist, the need to stay up to be downloaded and watched later helps in understanding date in current concepts and guidelines is being felt more complex concepts with ease. Podcasting uses RSS (Rich and more. The need
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