New machine could one day replace anesthesiologists

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TOLEDO — The new machine that could one day replace anesthesiologists sat quietly next to a hospital gurney occupied by Nancy Youssef-Ringle. She was nervous. In a few minutes, a machine — not a doctor — would sedate the 59-year-old for a colon cancer screening called a colonoscopy.

But she had done her research. She had even asked a family friend, an anesthesiologist, what he thought of the device. He was blunt: “That’s going to replace me.”

By Todd C. Frankel

Lisa McLaughlin, 49, receives anesthesia from the Sedasys system, a computer-assisted personalized sedation machine, before her colonoscopy at the ProMedica Toledo Hospital in Toledo. (Dustin Franz for The Washington Post)

One day, maybe. For now, the Sedasys anesthesiology machine is only getting started, the leading lip of an automation wave that could transform hospitals just as technology changed automobile factories. But this machine doesn’t seek to replace only hospital shift workers. It’s targeting one of the best-paid medical specialties, making it all the more intriguing — or alarming, depending on your point of view.

Today, just four U.S. hospitals are using the machines, including here at ProMedica Toledo Hospital. Device maker Johnson & Johnson only recently deployed the first-of-its-kind machine despite winning U.S. Food and Drug Administration approval in 2013. The rollout has been deliberately cautious for a device that hints at the future of health care, when machines take on tasks once assumed beyond their reach.

Everyone is watching to see how this goes.

“We’ve had a lot of anesthesiologists who’ve been dropping by to get a look,” said Michael Basista, the gastroenterologist who was about to work on Youssef-Ringle.

Then Sedasys did its job. And his patient was out cold.

Anesthesiologists tried to stop Sedasys.

They lobbied against it for years, arguing no machine could possibly replicate their skills or handle an emergency if something went wrong. Putting someone to sleep is an art, they said. Too little sedation, and the patient feels pain. Too much, and the patient dies. Anesthesiology requires four years of training after medical school, meaning careers might not launch until the doctors are in their 30s. It’s one reason the profession’s median salary is $277,000 a year, according to research firm Payscale.

Resident nurse Rachen Roudebush checks Lisa McLaughlin’s breathing after her colonoscopy at the ProMedica Toledo Hospital. (Dustin Franz for The Washington Post)

At first, the FDA rejected Sedasys over safety concerns. That was in 2010. But Johnson & Johnson, which began work on the device in 2000, won approval by agreeing to have an anesthesiology doctor or nurse on-call in case of emergencies and to limit use to simple screenings such as colonoscopies and endoscopies in healthy patients.

“The indication is very narrow, which is comforting to anesthesiologists,” Paul Bruggeman, Sedasys general manager for Johnson & Johnson, said in an interview.

But that comfort might be short-lived. More advanced machines are in the works. Researchers at the University of British Columbia, in Vancouver, are testing a device that can fully automate anesthesia for complicated brain and heart surgeries, even in children. Hospital administrators imagine the day when Sedasys or another device is used throughout their facilities for sedation.

“I dream about using it in bigger areas than endoscopy units,” said Joseph Sferra, vice president of surgical services at ProMedica Toledo Hospital, who had to overcome staff objections to get Sedasys into his medical center. “I’m sure this is very disconcerting to anesthesiologists.”

It is. But many have changed tactics. The American College of Anesthesiologists dropped its steadfast opposition as it became apparent Sedasys was going to get approved. The group instead pushed for restrictive guidelines.

Jeffrey Apfelbaum at the University of Chicago, co-chair of the professional group’s Sedasys committee, said he has doubts “about how it will pan out.”

“But is this a threat to a specialty?” he said. “Boy, I just don’t see it.”

Rebecca Twersky at SUNY Downstate Medical Center, the other committee co-chair, agreed.

“Clearly this is an example of disruptive innovation,” Twersky said.

“But,” she added, “we’re not going away.”

Even boxed into its corner, Sedasys could have a major impact.

Colonoscopies are among the most common medical procedures, with about 14 million done annually. The screenings are often uncomfortable and sometimes painful. Many patients would prefer to be knocked out, and in recent years anesthesia has grown more common for these procedures. In 2009, an estimated $1.1 billion was spent on traditional anesthesia services for colonoscopies, according to one research study.

Read more at the WashingtonPost.com