COMPUTER ASSISTED DECISION MAKING, an illustration

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COMPUTER ASSISTED DECISION MAKING, an
illustration

• Molly Shek
• March 1, 1999

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Computer assisted decision making in
anesthesiology

• Optimal anesthesia in surgeryHypnosis and lack
  of recallAnalgesiaAreflexia (Reflex Movement)

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Cognitive Walkthrough of Standard Practice

• Goal Patient remained sedated during surgery
• Subgoal No free recall
• Subgoal Patient wake up in a timely fashion post
  surgery
• Related actions EEG monitor,
  Heart Rate monitor
  Respiration monitor
  Reflex monitor
• System response Multiple systems response and
  interpretation by anesthesiologist
• Potential problem Patient may have free recall
  

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Potential Problems of measuring the depth of
unconsciousness by patient response

• Patients react differently to ordinary doses of
  medicines
• Too little anesthetics, patient suffer pain or
  awareness during surgery
• Tendency to use more anesthetic then the average
  patient
• Measurements of heart rate and blood pressure
  could be askew by patients pathologies

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Development of BIS

• Relate changes in EEG to levels of sedation,
  anesthesia, loss of consciousness and recall
• Over 5000 cases studied using a wide variety of
  anesthetic agents
• Identified features within EEG that were
  associated with sedation
• Combined these features into an easy-to-use
  number called BIS

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MINIMIZING DRUG USE
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FACILITATING STAGE-1 PACU BYPASS IN O.P.
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COST ANALYSIS AND ANESTHETIC OUTCOME
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IMPROVED TITRATION OF INHALATION ANESTHESICS
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Cognitive Walkthrough using BIS Monitor

• Goal Patient remained sedated during surgery
• Subgoal No free recall
• Subgoal Patient wake up in a timely fashion post
  surgery
• Related actions Apply electrodes on patients
  foreheadInsert sensor tab into the patient
  interface cable

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Cognitive Walkthrough using BIS Monitor
(continued)

• System response Monitor converts to operating
  mode Bis monitor indicates ranges between 60 and
  70
• Potential problems Patients level of
  consciousness changes from moment to
  momentPotential for complacency of
  anesthesiologistNew technique
  

)
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CONCLUSION

• The above is an example of human computer
  interaction. It demonstrates ..With perpetual
  change being one of the few certainties, the
  challenge is to adapt to the constantly shifting
  balance between recognizing and promoting these
  technological changes and understanding the
  social consequences Vimla L. Patel, Ph.D.