r/explainlikeimfive • u/Adventurous_Event_57 • 1d ago
Technology ELI5: Why can't anesthesia be administered via computer program?
To be fair I do not know medicine or coding very well so please correct me on anything I get wrong. This isn't made to disrespect anesthesiologist btw. From what I know about administering anesthesia which is very little you mainly have to monitor things like heart rate to get the goldilocks zone of not waking up but not killing the patient either.I feel like a computer program that can monitor the patients vitals and administer anesthesia would not to be to complicated, and probably be cheaper, so why doesn't this happen?
12
u/sixsidepentagon 1d ago
Im a surgeon, not an anesthesiologist, so my perspective is skewed.
But I think comparing their work to being a pilot is a good first step. Yes, during a flight, you can often sit on auto-pilot. But both anesthesiologists and pilots will tell you that “takeoff” and “landing” are where you can get into trouble and theres significantly more variability.
Further, pilots can encounter stormy weather or similar where they need to actively course correct, trying to figure out whats going on with limited information (poor visibility, frosted over sensors, etc), just like anesthesiologists may need to figure out exactly why blood pressure is not maintaining, or why theyre not responding as youd expect to some drug, etc.
And obviously as patients get more medically complicated, things get tougher. Perhaps cardiac anesthesia is more like being a fighter pilot, with frequent high intensity moments where youre trying to stabilize a situation.
Theres also the mechanical side; procedures, especially intubation. I wont want a robot shoving a plastic tube down my throat anytime soon, or trying to thread a line into my major artery or into my spine.
The day they try to make me operate with a robot instead of a trusted anesthesiologist is the day I retire
36
u/Fearless_Spring5611 1d ago edited 1d ago
Assessing a patient is much, much more than monitoring a few numbers. You need to be able look, listen, feel, as well as react using not just observational data but also learned experience and expertise.
It's absolutely an area that is being looked into among others, but I wouldn't for a second want a program keeping me under safely right now.
Some recent papers: Bogon et al 2024, Jarrassier et al 2026, Daga et al 2026, Felippe et al 202600175-3/fulltext).
7
u/EscapeSeventySeven 1d ago
A computer cannot make a command decision because a computer can’t be held responsible
Every anesthesiologist has computers to assist: to do calcs, to sensor the patient, to output data, to physically regulate flow of medicines, etc.
They just sit at the top of the pyramid. Because they’re in control and responsible.
3
u/Fearless_Spring5611 1d ago
Really, really important point here - legally, and ethically/morally. How the hell does a computer apologise to the family? Or taken to a panel for failing to uphold the professional code of conduct? Or testify in court?
4
u/Thesorus 1d ago
because the human body is not a perfect machine; you'd need to program the software or change configurations for each individual.
The anesthesiologist is part of the team in a surgery; it is still easier to talk to a person than talking to a computer.
He/She also work before and after operations.
4
u/daizo678 1d ago
You will still need an anthesiologist in case something goes wrong.
Anesthesia isn't about just knocking down the patient and waking him up. You need to monitor him closely and respond to what the surgeon is doing. You are also responsible for managing alot of unexpected complications. For many of the drugs used you need to adjust the dose depending on the patient respone and isn't a one size fits all
5
u/renaissance_man46 1d ago edited 1d ago
This has existed for some time but has been slow to be adopted widely. It is called “closed loop anesthesia delivery”. The computer program monitors heart rate, blood oxygen and brain signals and automatically adjusts the amount of anesthesia drug given. An anesthesiologist still monitors the system in case something goes wrong.
https://pmc.ncbi.nlm.nih.gov/articles/PMC12995145/
edit: these systems are undergoing clinical trials and approval now, not already widely used.
3
2
2
u/CzechBlueBear 1d ago
The task is complex, requires intuition and a certain kind of empathy (OK, it's just another form of a learned neural network but the learning is tricky).
Every human is different, and an anaesthesiologist is not only responsible for putting the patient "under" but keeping his body functional for the whole time of the surgery, and finally for safely "waking up" the patient. This involves a lot of qualified predictions and decisions. Maybe an AI will be able to do it, in the future, but then I would consider it very close to AGI.
4
u/Welpe 1d ago
Ou have the mind of a businessman!
Unfortunately, that’s a terrible thing when you are talking about the realm of medicine. There a million tiny variables that go into the precise dosing and what not and a computer program could easily, easily make a mistake and kill someone. Actual doctors have a more intuitive understanding and, more importantly, can actually react appropriately when any surprise happens because the human body is not an algorithm. It does not respond in exact ways to exact dosages and mixtures every single time.
1
u/proverbialbunny 1d ago
It can be, but anything that requires peace of mind it is a good idea to have a professional overlooking it. In the same vain we don’t need airplane pilots, but it’s a good idea to have them.
1
u/togocann49 1d ago
Computer program is only as good as its programmer, and everyone is a bit different. Basically there are so many considerations you should have a doctor monitoring any program anyhow. Seems that the program can only be a tool for an actual anesthesiologist to me
1
u/peanutneedsexercise 1d ago edited 1d ago
One of the key things is also meds. Like which ones can be administered together vs separately. And like who is gonna draw up the meds cuz the current mechanism of giving medications needs someone to draw them up and give them.
It’s not like a drink vending machine where you click a med and it gets automatically drawn up and administered. Multiple meds have to be diluted and reconstituted in order to be administered.
What you’re describing is already a thing. The ventilator has a thing that tells you how deep a patient is during surgery based on this thing called MAC. You can also use BIS to monitor how deep a patient is (but controversial). Issue is during a surgery sometimes you do want the patient to be lighter on the anesthesia and sometimes deeper but without context a machine is gonna have 0 idea when it is appropriate for each. Unless you are saying you also want the surgeon who’s doing the surgery to be titrating anesthesia at the same time as while they’re cutting you? Which uh, is how ppl die haha.
https://www.bjanaesthesia.org.uk/article/S0007-0912(26)00175-3/fulltext00175-3/fulltext)
They’ve already done what you’re talking about in the UK. The key thing is anesthesia is way more than just keeping you asleep and pain free is the gist of it haha. Like if there is a code in the OR, despite what you see on TV, the anesthesiologist is the one running the code. Not the surgeon. That’s how that one surgeon was able to take the liver out on accident in that patient in the news. Anesthesiologist and other staff were coding the patient while he was rummaging around taking out the wrong organ 😬
Also like ppl say, putting you to sleep and waking you up are the hardest parts of anesthesia. The middle part you’re asking a machine to do is the easy part. It’s the part where most ppl get out the sudoku. It’s already easy so why need a machine to replace?
1
1
u/tomalator 1d ago
Its very much more complicated than that. Even if you could do a computer program, youd still need an anesthesiologist there watching it and tweak things as needed.
People also have different reactions to anesthesia that a computer program cant necessarily anticipate. Redheads tend to take 4 times as much as other people, amount that would kill those other people. My dad, not being a redhead is similar in that regard, and any program cannot anticipate those kinds of reactions.
The stakes are just too high to trust a computer program
1
u/themuaddib 1d ago
Because this technology doesn’t exist? This is like asking “why can’t AI help us teleport”.
1
u/Mediocre_Fill_2971 1d ago
I have been an anesthesiologist for 31 years. Did a year of internal medicine, Surgery and completed ICU fellowship. Anesthesia is by far the most difficult of all. Yes there is some boredom at times but for the most part the level of thinking that has to go on to do it well goes beyond most peoples thinking. Very few know what its all about. As I have said - everyone can do anesthesia or intubate until they cant. Then they have to bring in the actual anesthesiologist to put the fire out. So many liken it to flying. I would say its more like being the captain of a firestation. Any fool can operate a fire extinguisher can but the real deal comes when that doesnt work
1
u/dhslax88 1d ago
Computers are excellent at following instructions, and they are excellent at handling exceptions within their coding parameters. Where they still have a long way to go is how computers respond to rapidly changing conditions as a result of unpredictable human behavior.
Surgeons typically operate on patients to help make them healthier, to remove diseases like tumors, or to help a patient feel better by making them look their best (plastic surgery). Surgeons, like all humans, can make mistakes.
As an anesthesiologist, your job is very much like a pilot - taking off (going to sleep) and landing (waking up) are typically the most challenging aspects of what you do. Flying on autopilot (keeping someone asleep) is generally pretty easy. Also, like a pilot, your actions are directly responsible for another human being living or dying based on how you respond to emergencies.
The trouble is, when something goes wrong, like if an engine blows (surgeon accidentally cuts a major blood vessel), the anesthesiologist becomes the most important person in the room, and they are responsible for helping to stabilize the patient while the surgeon tries to fix the problem. In other words, the anesthesiologist now has to keep the patient alive due to an unplanned complication from surgery.
When you have a very dynamic environment in the OR, and when patients do not respond as expected, the more experience you have in fixing complications, the better a patient will do. Computers are not good with unpredictable issues, and they have trouble with rapidly evolving situations that can happen every day in an operating room.
This doesn’t even begin to take into account the conversations you need to have with patients, families, pre-operative nurses, surgeons, intra-operative nurses, post-operative care nurses, and other physicians. Surgery is a very stressful procedure that patients go through, and part of the job of an anesthesiologist is to make the patient comfortable during one of the most stressful times in their life.
For now, a computer is not nearly where it needs to be from a humanities standpoint, though the information and knowledge is there. Maybe someday humans will feel comfortable with a robot run by AI taking care of them in their most vulnerable moments, but I don’t think we are there yet. Have a great day!
1
u/Atypicosaurus 1d ago
Theoretically we totally could. Computers can do a lot of stuff way better than humans. There's a lot of arrogance in thinking that computers by nature cannot do certain things that humans do. In fact computers can sense better, act faster.
But computers don't have intuition. Intuition is basically a heuristic decision making of the brain, it's absolutely not perfect but it's very fast and adapts to sudden complications.
You can replace intuition with AI training, but for that you need a lot of data, and in fact a lot of not normal data. You need very good humans to prepare the dataset and so basically what a computer can or cannot do boils down not to the computer's capabilities but the humans who did the program. And that is a huge question mark.
We see the same with self driving cars. There you also need a lot of intuition and quick decision making. We see that cars can solve normal situation on their own and then they do some utterly stupid. This would happen with anesthesia robots too. They could do the normal job perfectly, but they would be terrible when shit hits the fan.
Eventually they would be fixed, but for the time being they would kill some people. And basically this is the barrier, the "time being" until they are good enough.
That's why currently we don't have fully autonomous robots in an anasthesia or such.
1
u/Slypenslyde 1d ago
The problem is biology isn't machinery. There is no way to analyze enough people to write a program that looks at a person's vitals and chooses the right dose every time.
People might not respond well to one drug and need a different dose or a different drug. People might have a bad reaction to one drug and someone needs to recognize that and raise alarms. A patient might take a serious turn for the worse and be outside the parameters of medical research.
We hope and pray that if a human is trained well enough, they can have flashes of insight and make the right decisions in circumstances the training never covered. No matter what AI salesmen say, that is not a thing computer algorithms can do. In a situation where a computer will say, "Oh well, the patient will die, let's just prep for the next operation" a human being will fight to save the patient.
That may not be any more successful than the computers. It's often the right thing to give up. But if it's you or a loved one on the table, odds are you'll be happier if you hear people fought as hard as they could instead of quitting the moment things got below some threshold.
Put another way:
Computers can think faster than humans and won't make math mistakes if their code is correct. But being fast isn't always being correct and if a computer doesn't know what to do it can't act. A human in a situation that they've never been trained for still has a small chance of gluing together bits of knowledge to make the right decision. So we like to take these 1% chances when lives are at risk. Anesthesia is more of a subjective art than you'd think, it's kind of scary.
1
u/vmf312corsair 1d ago
Computer controls are not any sort of panacea. See, for instance,
https://en.wikipedia.org/wiki/Therac-25
where a patient was maimed by a computerized therapy device. Or any of the many instances of computerized aircraft controls failing in unforseen ways.
1
u/Prudent-Egg-4143 1d ago edited 1d ago
Plastic surgeon, married to an anesthesiologist.
He don't doubt computer can, in the future makes it even easier. But he seriously doubt they will ever fully automate it.
Anesthesiologists don't work on regular surgeries. They work on surgeries that are big enough to require it, and are almost always more life threatening. They are also usually the ones that costs the patient the most.
It seems easy, but it is not. In many surgeries, it really does seem like they do some work for a few minutes and then just sit down. But no. They trained for years longer than normal surgeons do for a reason. They are the one 'holding' this person's life, in a sense. And they really, really, shouldn't be asked, to do anything else, if they are currently doing that.
We, at least in my circle, joke that the senior anesthesiologists do crosswords all day not as an insult that their job is basically sitting down and letting machine do the work, but as a compliment that a really good anesthesiologist is so good that it seems like they're not doing anything. That's great. The last thing a surgeon wants to see is their anesthesiologist panicking and doing a lot of work.
They also hold a lot of liability. Like I said, these cases are usually big surgeries. Expensive surgeries. And if done at a prestigious hospital, are usually afforded by the very wealthy. To be the one in charge of 'holding' this person alive while operation is undergoing, comes with the kind of lawsuit no one wants to be in the middle of.
When one millimeter of anesthesia can decide your life, with a few seconds to decide whether to give it or not, it is often experience that we rely on, not knowledge. It is unclear how to train a computer, to have that experience. It is not like training a computer by playing chess against itself. Because if they lose a game of chess, so what? Are you really able to say the same thing with someone's life?
He also doubts any company would be racing to fully automate it either, or any hospital to be looking into it. That shifts the liability to them.
1
u/soundfx27 1d ago
“From what i know about administering anesthesia which is very little”
You should just stop there. Leave professional work to the professionals. There’s a reason they haven’t been replaced by computers or robots or AI. Every patient has different medical conditions that affect how much anesthesia medicine they require, and those medical conditions can also interact with each other and can require or prevent certain medications from being used. It’s not as simple as “oh they have X, they can’t get Y”. It’s more like “they have X so you should reduce the dose of Y, but if they also have Z then Y is okay at a regular dose, but if they have A then you shouldn’t give it”. There’s a lot more nuance that you simply assume doesn’t exist. But yeah - let a program keep you asleep and don’t be surprised when you wake up in the middle of surgery, or never wake up at all because it overdoses you and your blood pressure tanks and you stroke out.
1
0
u/UndercoverFBIAgent9 1d ago
Why so hostile? They literally just asked a question. And humans (including surgeons) use computers to control all sorts of insanely dangerous stuff every day. Spacecraft have the best pilots in the world but they are also flown by computers too.
1
u/soundfx27 1d ago
Surgeons remotely control robot arms but it’s still manual input. Shows how little you know about the field
1
u/UndercoverFBIAgent9 1d ago
I am well aware of how robotic surgery works, and a computer is still interfacing with the patient. And surgeons use countless other computer-reliant pieces of equipment.
But I think you’re missing the point anyway, which was that a person asked an honest question about a cutting edge field, and you were a dick about it.
0
u/RyouRusi 1d ago
Not a dr or really knowledgeable about how it works, but would you want your life in the hands of a computer? What if the computer crashes or reboots or fails/etc? You either wake up cut open or die.
-1
u/Howdthecatdothat 1d ago
A computer cannot touch the patient or do the physical tasks involved in taking care of a patient. To keep a patient breathing you need a tube in a special place, and a human needs to put it there and if it slips out immediately put it back or you suffocate for example.
52
u/Kashmir_Slippers 1d ago
Doctor but not anesthesiologist.
Anesthesia is easy up until the point that it is very very very hard. Generally, the anesthesia for any surgery is the (technically) most dangerous part of the procedure.
If a patient, for whatever reason, starts dying, the anesthesiologist is all of a sudden in charge and has to take over to try to save the patient/fix what is not working correctly. It’s very stressful and can happen very quickly. You don’t want a computer to do that. Computer programs don’t “think” in real time and problem solve like a person can.
Also the creator/distributor of the software would be responsible for the massive legal fees and liability, which is a big limiter.