ROME (ITALPRESS) – The introduction of patient hemodynamic parameter monitoring systems powered by artificial intelligence algorithms is a breakthrough in the operating room, both for general surgery and especially vascular surgery, which is more at risk for hemodynamic instability.
Anesthesiologists, in addition to checking the patient’s parameter trends on the monitor, are alerted by Artificial Intelligence (AI) and guided in the strategy aimed at correcting any problems that may arise during aortic aneurysm or carotid artery disruption surgery.
“In the field of monitoring in the operating room,” recalls Dr. Andrea Russo, adjunct professor of anesthesiology at the Catholic University of the Sacred Heart, head of the UOS of Anesthesia in Pancreatic Surgery at Fondazione Policlinico GEMELLI IRCCS, in the UOC Anesthesia of General Surgery and Transplantation directed by Professor Paola Aceto, afferent to the Department of Emergency, Anesthesiology and Resuscitation Sciences, directed by Professor Massimo Antonelli, “new technologies based on artificial intelligence have been introduced a few years ago. These are intelligent software, capable of intercepting a possible incoming problem and creating decision paths, based on the acquisition of certain data, regarding hemodynamics. These AI-enhanced monitoring tools, for example, are able to recognize in advance the changes in blood pressure that are related to most of the adverse events that can occur both in the operating room and in the immediate postoperative period. The introduction of these machines in the operating room allows anesthesiologists to be more adequate in the management of some potentially risky situations, which can occur during major surgery, such as in vascular surgery, such as for aortic aneurysm and carotid artery disruption.”
The risks of hemodynamic instability are mainly hypoperfusion of the noble organs (brain, heart, kidney), with even very serious consequences both during surgery and postoperatively. “In some vascular surgeries,” explains Professor Yamume Tshomba, Ordinary Professor of Vascular Surgery at the Catholic University of the Sacred Heart and director of the UOC of Vascular Surgery, Fondazione Policlinico GEMELLI IRCCS, “the sudden lowering of pressure can be critical. This is the case, for example, in surgeries requiring clamping of the aorta, such as those for an aortic aneurysm. But the benefits also extend to carotid artery unclamping surgeries. Thanks to the use of these monitoring systems, we have begun to do, with the anesthesiological assistance of Dr. Russo, very complex surgeries without resorting to extracorporeal circulation, but using the patient’s own heart as a ‘pump’ to bring blood distally to the clamping of the aorta through a temporary bypass. In such a situation, these artificial intelligence software are crucial. This smart monitoring of the patient’s hemodynamic condition allows us to do these procedures safely, without extracorporeal circulation. In fact, the software alerts a few minutes before a severe hypotension episode occurs, giving the anesthesiologist a way to intervene promptly by expanding blood volume (administering fluids), reducing peripheral resistance with specific drugs, or improving the contractility of the heart. In short, using his entire therapeutic armamentarium to stabilize the patient’s hemodynamics by acting early.” “Specifically,” Dr. Russo continues, “AI is able to tell us precisely which components to work on (resistances, contractility, volume) to keep the patient’s hemodynamics stable, thus putting the anesthesiologist in a position to choose the most appropriate strategy, the so-called ‘tailored therapy.’
The device that assists the anesthesiologist during the procedure has a 14-inch screen on which changes in the patient’s pressure wave are drawn and is connected to a cannula, placed in an artery in the patient’s hand. “Arterial pressure,” Dr. Russo explains, “is drawn with a wave, behind which is all the cardiac mechanics (how the heart fills, how it contracts, and what kind of resistance it encounters in the periphery). The AI algorithm is able, by analyzing changes in the pressure wave, to assess the trend of change in these three basic parameters.” “AI in the operating room,” Professor Tshomba continues, “has also entered vascular surgery (abdominal aortic aneurysm and carotid artery surgeries) a couple of years ago, which particularly benefits from this technology because complex fluid redistributions (such as supra- or sub-renal aortic clamping and passive shunts) can occur during the course of these surgeries, and this makes it much more difficult for the human mind, without this support, to be able to predict and understand in advance what is happening and how to fix the situation. It’s very sophisticated monitoring, which allows us to anticipate what might happen a few minutes from now and act accordingly, that is, in a ‘proactive’ rather than ‘retroactive’ way.”
And the benefits of these new technologies are well described by the numbers: in the GEMELLI Polyclinic case series, hemodynamic instability during aneurysm surgery was reduced by more than 65 percent.
On the carotid artery surgery side, the benefits have been even greater. “We have seen a marked reduction in the use of the shunt. When you close the carotid artery,” Professor Professor Tshomba explains, “to free it from the atherosclerotic plaque obstructing it with a carotid endarterectomy (EAC) surgery, if you don’t ensure adequate blood flow to the brain through natural bypasses, you can have a reduction in cerebral perfusion, which can lead to serious neurological damage. Therefore, in some cases we have to do additional maneuvers to ensure cerebral perfusion by inserting a shunt, but this makes surgery much more complex. Thanks to such sophisticated monitoring, we have realized that often resorting to this procedure is unnecessary, because there is already good cerebral compensation that anesthesiologists can highlight by going to analyze, in addition to hemodynamic aspects, cerebral oxygen saturation and other parameters. Very often in short, it is not necessary at all to go and insert a shunt, which makes the surgery much more complex and the carotid artery reconstruction more difficult. And this monitoring is very useful to tell us when putting in the shunt is really necessary. From an initial analysis of our case history, since we introduced this monitoring in the operating room, we have reduced the use of the shunt in carotid surgery by 15 percent.”
-Photo press office Policlinico Gemelli-.
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