Automation in Anesthesia — A Relief?: A Systematic Approach to Computers in Patient Monitoring

193 Pages·1987·8.91 MB·English

by  Dr. Annejet P. Meijler (auth.)

Annejet P. Meijler
Automation
in Anesthesia
A Relief?
A Systematic Approach to Computers
in Patient Monitoring
Foreword by J. E. W. Beneken
With 69 Figures and 22 Tables
Springer-Verlag
Berlin Heidelberg New York
London Paris Tokyo
Dr. Annejet P. Meijler
University of Technology, Den Dolech 2
P. O. Box 513, NL-5600 MB Eindhoven
ISBN-13:978-3-540-18204-7 e-ISBN-13:978-3-642-72913-3
DOl: 10.1007/978-3-642-72913-3
Library of Congress Cataloging-in· Publication Data
Meijler, A.P. (Annejet P.), 1954- . Automation in anesthesia.
Bibliography: p. Includes index. 1. Anesthesia - Data processing. 2. Patient monitoring -
Data processing. 3. Microcomputers. l. Title. [DNLM: 1. Anesthesia. 2. Monitoring, Phy
siologic - methods. 3. Signal Processing, Computer-Assisted. WO 200 M512al
RD80.95.M45 1987 617'.96'0285 87-24332
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To Whom I Love
It is as far as the bear knows,
the only way of coming downstairs .....
but sometimes he feels.
there is really another way .....
if only he could stop bumping
for a moment and think of it!!
(From: A. A. Milne, Winnie-the-Pooh)
Foreword
Anesthesia is a fascinating area because it deals with the patient as
a whole. The anesthesiologist takes full responsibility for the pat
ient and his physiological well-being during a period which may
become live-threatening if no proper surveillance were available.
This is the essence of the complexity of anesthesia. The providing
of the conditions for the surgeons to operate on the patient is, al
though originally the primary goal, probably no longer the most
difficult aspect. .
The anesthesiologist is faced with a growing number of variables
he needs to monitor. Not only the measurements are of his con
cern, the interpretation of the individual signals and, even more,
the assessment of the (cor)relation between the signals and their
variations require his full attention.
Many attempts have been made to place the individual instru
ments together which resulted in ergonomically better situations.
The advent of multichannel displays, some making use of as many
colors as possible, raised questions about the optimal display: what
is optimal, is that true for all situations, can we judge that objec
tively, how important is the subjective feeling of the user?
These questions are too general to permit a direct answer. With
this study we tried to answer many of these questions for a particu
lar case, cardioanesthesia, because we felt that this was probably
the most complex situation and that many of the results could be
applied in less complex patient monitoring situations.
This book gives a description of the development and function
of a data acquisition and display system on the basis of a thorough
problem analysis. It is, however, even more important that the
methodology that is developed is germane to many monitoring sit
uations, now and in the future.
Eindhoven, July 1987 Jan E. W. Beneken
Professor of
Medical Electrical Engineering
Preface
The work reported in this book, a revised version of my Ph. D. the
sis, was carried out within the Division of Medical Electrical En
gineering (head: Prof. J. E. W. Beneken) from the Eindhoven Uni
versity of Technology and at the Department of Anesthesiology
(head: Prof. Joh. Spierdijk) of the University Hospital Leyden. The
project was supported in part by the Netherlands Technology
Foundation (STW) and Honeywell Medical Electronics B. V. (cur
rently PPG Hellige).
Nowadays most research is not performed by one single person.
This is especially true for the multi-disciplinary subject described
in this book, in which we worked on the boundary between human
engineering and medical engineering. As a consequence I am in
debted to a great many people.
In the first place I would like to thank my first promotor, Profes
sor J. E. W. Beneken. He was the master-mind behind the servo
anesthesia project of which the research in this book is a part. In
spite of the fact that his clinic was invaded by technicians, my sec
ond promotor, Professor Joh. Spierdijk, gave all possible support
for the practical realization of the tests performed in the ORs. I am
very grateful to my friends and teachers from the Medical Physics
Lab in Amsterdam: Dr. T.J.T.P.van den Berg and Professor
L. H. van der Tweel for the stimulating discussions and the co-edit
ing of this work.
Without the contribution made by my colleagues H. van Kessel
and J. Blom this work could not have been realized. An essential
contribution in the development and clinical testing of the com
puterized monitoring system DADS came from the physicians
A. Nandorff, P. Hennis, R. Nelissen, J. R. de Jong and H. van Wezel.
P. Damman gave his immeasurable support in the form of text edit
ing and programming. J.Onink was very patient with my continu
ous updating of his professionally made figures. Furthermore, I
want to express my thanks to everybody, both in the University
Hospital of Leyden and at the Eindhoven University of Technolo
gy, who gave their invaluable support to this project.
X Preface
My parents gave me the education and love which are funda
mental to everything. Kees, I could not have managed without
your unwavering support and your trust both in me and in the
completion of this work.
Eindhoven, July 1987 Annejet P. Meijler
Contents
1 General Introduction . . . . 1
1.1 Introduction and Survey 1
1.2 Historical Developments in Monitoring .. 5
2 The Anesthesiologist's Work in the Operating Room . . . . .. 10
2.1 Introduction . . . . . . . . . . . . . . . . . 10
2.2 General Task Description . . . . . . . . . . 11
2.3 The Operating Room: Layout, Equipment,
and Information Presentation . ..... 17
2.4 Howcharting Anesthesia .. 20
2.5 Conclusions . . . . . . . . . . 28
3 The Data Acquisition and Display System (DADS) ...... 30
3.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . .. 30
3.2 Configuration ........................ . 33
3.3 Data How and Processing (Disturbance Detection) . . . . . 35
3.4 Data Presentation . . . . . ..... 39
3.5 Operation of the System. . . . . . . . . . . . . . . . . . . . 44
3.6 Data Storage . . . . . . . . . . . . . . . . . . . . . . . . . . 47
3.7 OfT-Line Graph and Report Facilities . . ..... . 49
3.8 Planned Facilities . . 50
3.9 Concluding Remarks . . . . . . . . . . 50
4 The Evaluation Method 52
4.1 Introduction . . . . . 52
4.2 Review of the Literature on Evaluation of Medical
Equipment. . . . . . . . . . . . . . . . . . . . . . . 52
4.3 Setup of the General Evaluation Method .......... 56
4.4 Setup of the Evaluation Method as Applicable to DADS.. 61
4.5 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . .. 65