BME Senior Undergraduate - Neural Engineering Concentration
Department of Anesthesiology
Week 1: Good Design vs. Bad Design Heading link
Fish out of Water
Before the Clinical Immersion Program (CIP), my experience in medicine consisted of my nurse aide training and working as a research assistant in a psychiatric research center when I was exploring pre-med as a career track. Now exploring careers in medicine more aligned with engineering, the anesthesiology group was thrusted into a new environment of the operating room (OR). Within the first week, we experienced a wide array of surgeries such as a jaw restructuring procedure, an open-chest surgery, and an organ transplant. To be honest, it was quite a jolt to transition from summer break to witnessing patients at their most vulnerable during surgery. A fish out of water feeling so to speak.
Keeping the “fly on the wall” analogy taught to us to ease our transition, our group took this week to prioritize observing and understanding the workflow of the OR without interfering with the doctors and nurses involved. Being able to witness the OR environment so intimately gave a renewed respect of the work healthcare workers do for their patients. Not only that, but during slower portions of the operations, circulating nurses and the Anesthesiologist were kind enough to reach out to us and answer the many questions we had about the procedure and equipment they used.
Good Design: When speaking with one of the nurses, a feature of the equipment we noted was how modular everything was. You will almost always find tools and modules on lockable wheels, such as the patient’s bed, vitals screens, the Anesthesiologist’s carts, and IV bag hangers. This in turn allows ORs to be transformed to accommodate the specific surgery they will perform.
Bad Design: An unfortunate consequence of modularity is tidiness. While it is by no means messy, the OR will have certain situations where different equipment will get in the way of each other, making navigating the OR and certain stages of surgery cumbersome. A notable example I noticed was a wire of an electrical surgical tool. When connected to the wall outlet, it ran across the floor, giving a potential trip hazard. While this was mitigated with an adhesive wire cover and coiling the wire around the stand for the surgical tool, this solution in turn didn’t give the surgeon enough wire slack to maneuver around his patient and operate properly. This was a pain point that was continually addressed throughout surgery to accommodate for both the equipment going over the wire and the surgeon.
Week 2 pt. 2 Heading link
In Brian Driver’s clinical trial, he aimed to test whether a bougie or a stylet was more effective in producing a successful intubation. This was done by having an observer collect data from the randomized surgery. The results of the 1106 randomized participants in this clinical trial was that a bougie or a stylet was not significantly significant to producing a successful intubation over the other. While avoiding a failed intubation is important to the anesthesiologist, avoiding these situations are done by predetermining what kind of intubation is right for the patient and evaluating the risk factors. In extreme cases, anesthesiologists have ways to reverse the anesthesia effect if deemed necessary.
Referenced research article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8655668/
Week 3 pt. 3 Heading link
Iteration 3: Anesthesiologists working in surgical settings on patients with complicated medical histories may run into organizational issues handling medication, IV bags, and blood bags during procedures and need a systemic approach to making their workflow more efficient.
- Population: Anesthesiologists in surgery working on patients with a complicated medical history
- Opportunity: Organizational issues handling medication, IV bags, and blood bags
- Outcome: a systemic approach to making their workflow more efficient
The goal of iteration three was to refine the scoping of iteration two. Speaking with Dr. Nishioka shed light on how exactly the anesthesiologist’s workflow like. He showed us that a patient’s medical and surgical history is often the factor that complicates the material anesthesiologists need for that procedure. He also shed light that there is no “one way” to do the anesthesiologist work and the organization largely depends on each physician. It is these two facts that refined the population and outcome statements of this iteration of the needs statement
Overall, iteration three is an improvement on scope. While an argument can be made that the scope is still too broad, I believe that the large scope of this needs statement opens the floor to innovative solutions that answers to an organizational problem of a wide array of materials.
Week 4 pt. 2 Heading link
Based on my personal observations and the anecdotes of the anesthesia physicians we interviewed, the Aisys CS2 works reliably for the amount of uses it goes through and rarely does it fail to the point where intervention was needed. To be frank, the manual ventilation is usually used out of preference during certain situations. Based on previous MAUDE reports and Dr. Nishioka’s previous experiences, the errors the Aisys CS2 that causes it to malfunction are overheating and condensation from exhalation reaching the circuitry of the device.
Aisys CS2 Patent: EP0904794A2 – Automatic bellows refill – Google Patents
Week 5: Market Heading link
Intubations of Difficult Airways
Now that the final weeks of CIP are upon us, we’re closing in on the final project proposal we plan to present for our final presentation. Intubation is a part of every anesthesiologist’s workflow, and difficult airways was a common issue brought up in workflow processes to improve. So, for our final needs statement, we decided to go with “Medical professionals in emergent settings who intubate patients in an emergent setting experience difficulty visualizing the airway due to contamination and need to increase first-time intubation success rate”. We wanted to focus on emergent settings because they don’t have any control in the patients they treat and the settings they give medical care in when treating difficult airways.
In the ED, we learned that compactness, reliability, and versatility of the tools they use are of paramount importance, especially in difficult intubations. All three are important because the emergency airway bags they carry only has a limited amount of space, so a value proposition comes up to take up that precious space. One of the tools they use are suctions in order to deal with aspiration from potential blood or stomach contents they deal with during intubation.
The tool we looked at as a group was video laryngoscopes, an important tool for intubations as it visualizes the airway and leads the endotracheal tube to the entrance of the trachea for ventilation. The blades for the video laryngoscopes are single use to maintain sterility in an efficient manner. Given that about 413,000 intubations happen yearly and the typical single use laryngoscope blade costs $18, the total addressable market would be about $7.4 million.
Week 6: We're Finished! Heading link
A Look Back
It’s hard to believe that these past six weeks have flown by. It honestly felt like yesterday when I was struggling to find a place to stand in the OR. Now, I have used my experience in both the clinic and lectures to create a project proposal that a BME senior design team will take up in the upcoming school semester.
If I were to give advice to a newcoming CIP student, I would say to keep an open mind and be vigilant. A lot of the immersion aspect of CIP will be self-motivated and you won’t always have a clear idea of what exactly you should be taking away. So be a sponge and take in whatever experience you can and don’t be afraid to step in and ask questions! Even a question as simple as “where can I stand to observe?” helps with getting to know the medical providers you’ll be getting acquainted with throughout your time in CIP. I wish you luck!