Making Complex Simple

Could a new robot replace anesthesiologists?

Johnson & Johnson (J&J) soon will start selling a machine that automates the sedation of patients undergoing colonoscopies, but anesthesiologists warn that taking doctors out of sedative administration could prove perilous, the Wall Street Journal's Jonathan Rockoff reports. Is this just the beginning of how things are to be? Robots putting us to sleep?

Sedasys: The latest in colon cancer care
J&J's Sedasys is a computer-assisted system designed to administer propofol. The drug can result in sedation as deep as general anesthesia, but it can have dangerous side effects. For instance, the drug can cause patients to suddenly stop breathing or lose blood pressure.
FDA approved Sedasys for use on healthy adults who require mild-to-moderate levels of sedation during colonoscopies. However, given propofol's potential side effects, the agency required that a trained anesthesiologist be "immediately available" on site during the procedure.
J&J hopes the potential savings from the machine will appeal to hospitals. Sedasys would cost about $150 per procedure. By comparison, an anesthesiologist's involvement in a colonoscopy typically adds $600 to $2,000, according to a research letter in JAMA Internal Medicine.
Sedasys "is a great way to improve care and reduce costs," J&J CEO Alex Gorsky said in an interview. More than $1 billion a year is spent sedating patients undergoing colonoscopies, according to a RAND study paid for by J&J.
 
J&J plans to start selling the machines next year.
Anesthesiologists: Technology does not supplant physician-centered care
Anesthesiologists are sounding the alarm on the new technology, which they say could result in the improper use of propofol. Moreover, they worry that removing anesthesiologists from the process would make it difficult to prevent medical emergencies.
"Everyone is so hot on the technology, but you have to balance the fiduciary duties of the company with the physicians' interest in" ensuring high-quality, safe care for the patient, says Rebecca Twersky, chair of the American Society of Anesthesiologists' (ASA) committee on Sedasys.
The group lobbied FDA for years to block approval of the device. Now, the ASA is drafting recommendations for the "safest and most efficient" use of Sedasys, and it is urging its more than 50,000 members to keep track of the number of times the machine is used and the number of emergencies that arise.
 
A harbinger of things to come?
The Journal's Jonathan Rockoff writes that the dispute over Sedasys may be a sign that more health care battles are on the way. While efforts to curb health care spending have created an opportunity for medical device makers, some new technologies threaten to disrupt the status quo for physicians.  
 
Anesthesiologists are frequently the target of cost containment efforts, Rockoff writes. According to a survey by Payscale.com, a salary data and software firm, their median annual salary of $286,000 is the ninth-highest among all physicians and third among non-surgeons.
Anesthesiologists have proven to be formidable opponents against such efforts. In 2007, Aetna was forced to shelve a plan that would limit the use of anesthesiologists during routine colon-cancer screenings to only high-risk patients. Anesthesiologists argued that there is no substitute for four years in specialized training when it comes to a patient's health.
 
In the case of Sedasys, J&J has pledged to adopt a cautious approach, introducing the machine in a select number of hospitals and clinics in collaboration with anesthesiologists, nurse anesthetists, and other physicians. "This is truly a first-in-kind medical technology that has the potential to redefine the way sedation is administered," the company says (Rockoff, Journal, 9/25).
 
Original article from The Advisory Board Company here