E.Flerov, I.Sablin, O.Broytmann, S.Batchayev, A.Bankov.

National Research Centre of Surgery named after B.V. Petrovsky, Russian Academy of Medical Sciences, Moscow, Russia

Goal: Development and clinical application of a system that allows continuous monitoring of the patient’s condition during surgery, as well as surgical and anesthetic actions in order to optimize work process, ensure quality and provide necessary informational support and administrative oversight.

Material and methods: In house developed systems of computer monitoring/ paperless anesthesia record keeping in 4 operating rooms with collection of data by central server and further proxy-server forwarding the information over the Internet. We use high resolution Web-cameras that can be controlled remotely over the Internet (Sony SNC-RZ30), four-channel video server Axis 241QA for high definition visualization of surgical and anesthetic manipulations as well as monitor displays, TEE and X ray screens. Videoconferencing is based on H323 protocol and on using Skype IP-video telephone. Database for over 5000 patients with 2400 operated on over last 4 years is accessible for review and statistical analysis from any computer connected to the Internet (standard security measures are implemented). Any conventional browser (Explorer, Mozilla, Firefox, Opera, Safari) installed either on desktop, laptop or mobile communicating devices (UMPC Samsung Q1, communicator E-Ten600, modern GSM smartphones with GPRS/EDGE / CDMA2000 and WAP connection) can be used for this purpose: please see site

Results: This technology allows accessing information used for anesthesia record in real time on line and off line analysis on any computer connected to the world wide web. It’s use facilitates following the protocols of computer monitoring, allows to detect and correct imperfections and errors in instrumental technique, earlier discovery of periods of suboptimal depth of anesthesia, timely response to alarms from the monitors. The chief of service can monitor situation in the operating room during meetings, conferences etc. using Wi-Fi access from mobile device and even from home for emergency procedures. Videoconferencing, in particular Voice over IP allows necessary interaction and instruction to operating room staff. We conducted a successful trial of remote monitoring of patient’s condition and evaluation of adequacy of anesthesia by colleague working as a Board Certified anesthesiologist in Philadelphia, USA.
Using this system the leading cardiac surgeon was able to oversee remotely the stages of the procedure before his involvement during the main stage, get results of transesophageal echocardiography and X ray images without being physically present in the room. The digital images of surgical filed are stored at predetermined stages and on as needed basis. The video clips of these images/ stages demonstrating surgical technique, details of anesthesia and intra-operative functional diagnostics are used as podcasts for remote postgraduate training/ continuous medical education (CME) for doctors of different specialties.

Conclusion: Developed technology provides reliable means of comprehensive monitoring of patients condition over the Internet, allows control over surgical and anesthetic actions and serves as informational basis for real time telemedicine approach in the operating room.

Опубликовано в материалах Annual Meeting of the European Society for Computing and Technology in Anaesthesia and Intensive Care (ESCTAIC). 01 - 04 October 2008, Goldegg, Austria.