How apps like Google Translate make lifesaving interventions possible — 3 Qs with Dr. Linda J Mason

Linda J. Mason, MD, president of the American Society of Anesthesiologists, told Becker's ASC Review how AI and virtual reality tools could affect the field of anesthesia.

Note: Responses were lightly edited for style and clarity.

Question: Do you think AI and virtual reality will revolutionize anesthesia, or are the benefits of these technologies exaggerated? Why?

Dr. Linda Mason: AI and virtual reality are separate technologies. Of the two, AI is the truly revolutionary technology, and it is already profoundly changing almost every aspect of our lives. You don't have to look any further than your cellphone to see AI in action. Physician anesthesiologists work in a polylingual environment by virtue of our diverse population. Additionally, patients travel from all corners of the globe to receive care at American hospitals. How do we communicate? Increasingly, my colleagues and I use Google Translate on our phones. With seemingly little effort, Google Translate converts spoken English to English text, translates English text into another language, and then speaks the other language in a natural voice. Each step involves massive AI but is completely invisible to the user. It won't be long before similar algorithms replace keyboards in the operating room, populating our charts based on spoken instructions. Additionally, many investigators are working on AI algorithms to monitor vital signs. In tests, these algorithms predict cardiovascular collapse 20 to 30 minutes before a vigilant physician anesthesiologist sees the warning signs. This can make the difference between life and death by enabling lifesaving interventions such as preventing arrhythmia or transfusing the patients earlier. Just like Google Translate, these apps and smart devices will simply appear and fit right into our workflow.

Anesthesia has been at the forefront of bringing VR into clinical practice. For example, ASA's Anesthesia SimSTAT uses virtual simulation for training regarding anesthesia, patient-monitoring and managing anesthesia-related emergencies and can be used for CME by completing any of four available modules (trauma, robotic surgery, appendectomy and post-anesthesia care unit). We are continuing to invest in VR — a labor and delivery module is coming soon. The next level, augmented reality, superimposes computer-generated images over your view of the world around you. For example, with AR, the physician anesthesiologist could look at the patient and "see" into the chest to watch the heart beating, enhancing the ability to assess and diagnose beyond the vital signs. Indeed, such systems might combine AI algorithms, which draw very subtle inferences about cardiac status from vital signs, with AR to display the cardiovascular status as clearly as possible. That sort of technology is probably five to 10 years off, and will have to prove itself useful and not a distracting toy.

Am I worried that AI will replace physician anesthesiologists? Not a bit. The AI we use every day enhances what we do. Cardiologists weren't replaced by stethoscopes or catheterization labs, and we aren't being replaced by video laryngoscopes and smart monitors. These technologies are really algorithms. What we bring to clinical care isn't just our experience and judgment, but also our skills and dexterity. There is no such thing as general purpose robotic dexterity. Specialized machines such as the da Vinci robot can do one thing well, but they can't open a bottle, make a sandwich or plug themselves into the wall.

Q: What are some innovations that have changed the way physician anesthesiologists perform their jobs, in a positive or negative way?

LM: Video laryngoscopy has made an enormous difference in the ability to successfully intubate patients with difficult airways, making anesthesia safer. Widespread adoption of ultrasound helps in starting IVs, evaluating a patient's airway, performing nerve blocks and looking directly at the heart. Portable ultrasound devices — attached to cellphones — have made it even easier. And while it's easy to forget, the adoption of cellphones into care has been huge. They were once banned in the ICU and OR, but now we use them to enable timely discussions, look up an unfamiliar procedure on YouTube or access a medical record.

Q: What trends or innovations have the most potential to effectively reduce administrative burden and/or lower healthcare costs?

LM: AI could really help in lowering administrative burden and should lower healthcare costs as well. AI isn't going to replace physicians, but it could replace entire tiers of administrators. The challenge in making positive change is to overcome entrenched interests that demand preservation of the status quo. From patients to physicians, hospitals to the government, everyone has a stake in maintaining the status quo. We have to all be on board to recognize the value of these advancements and implement them, rather than putting up roadblocks. That will only happen when everyone agrees that patients come first.

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