Thomas Hemmerling

• McGill University

The administration of propofol for sedation or general anesthesia presents challenges due to the complex relationship between patient factors and real-time physiological responses. This study explores the application of deep reinforcement learning (DRL) to automate propofol dosing, aiming to maintain multiple physiological parameters including bisp...

This study presents a comprehensive comparison of multiple time-series models applied to physiological metric predictions. It aims to explore the effectiveness of both statistical prediction models and pharmacokinetic-pharmacodynamic prediction model and modern deep learning approaches. Specifically, the study focuses on predicting the bispectral i...

BACKGROUND This study presents an analysis of machine-learning model performance in image analysis, with a specific focus on videolaryngoscopy procedures. The research aimed to explore how dataset diversity and size affect the performance of machine-learning models, an issue vital to the advancement of clinical artificial intelligence tools. METHO...

The potential benefits of epidural anesthesia on mortality, atrial fibrillation, and pulmonary complications must be weighed against the risk of epidural hematoma associated with intraoperative heparinization. This study aims to provide an updated assessment of the clinical risks of epidural anesthesia in cardiac surgery, focusing on the occurrence...

Background and Aims Rectus sheath block (RSB) is an effective postoperative pain control technique in abdominal surgical procedures. This systematic review evaluated the efficacy and outcome data of patients undergoing RSB compared to the standard of care in both laparoscopic and open surgical procedures. Methods This systematic review followed th...

This article explores the evolving role of ultrasound technology in anesthesia. Ultrasound emerged decades ago, offering clinicians noninvasive, economical, radiation-free, and real-time imaging capabilities. It might seem that such an old technology with apparent limitations might have had its day, but this review discusses both the current applic...

The last 2 decades have brought important developments in anesthetic technology, including robotic anesthesia. Anesthesiologists titrate the administration of pharmacological agents to the patients’ physiology and the needs of surgery, using a variety of sophisticated equipment (we use the term “pilots of the human biosphere”). In anesthesia, incre...

In this Pro-Con commentary article, we discuss whether all general anesthesia should be done using target-controlled propofol anesthesia guided by monitoring of depth of anesthesia. This is an ongoing debate since more than 25 years, representing a scientific, cultural as well as geographical divide in the anesthesia community. The Pro side argues...

Background: Fat manipulation procedures, such as liposuction, contain a degree of subjectivity primarily guided by the surgeon's visual or tactile perception of the underlying fat. Currently, there is no cost-effective and direct method to objectively measure fat depth and volume in real-time. Objectives: Using innovative ultrasound-based softwa...

Background: Medical technology is expanding at an alarming rate, with its integration into health care often reflected by the constant evolution of best practices. This rapid expansion of available treatment modalities, when coupled with progressively increasing amounts of consequential data for health care professionals to manage, creates an envi...

Ultrasound-guided nerve blocks are increasingly being used in perioperative care as a means of safely delivering analgesia. Unfortunately, identifying nerves in ultrasound images presents a challenging task for novice anesthesiologists. Here we attempted to address this issue by developing a deep-learning algorithm capable of automatically identify...

Unlabelled: There is no consensus regarding implant size as an independent risk factor for complications in primary breast augmentation. Choosing appropriate implant volume is an integral part of the preoperative planning process. The current study aims to assess the relationship between implant size and the development of complications following...

Background: Pre-operative planning for liposuction is vital to ensure safe practice and patient satisfaction. However, current standards of fat assessment before surgery are guided by subjective methods such as visual inspection, skin-pinch tests, and waist circumference measurements. Objectives: This study aimed to develop an inexpensive softwa...

Bariatric surgery presents a specific challenge in surgical education; simulators need to take into account the specific technical difficulties related to the patient population but also to various types of surgery. We interviewed several leaders in the fields of bariatric and general surgery with experience in laparoscopic surgery and developed a...

Introduction: Aesthetic liposuction represents one of the most commonly performed cosmetic procedures worldwide. The purpose of this article is to examine and synthesize reported complication rates and explore the analytical prospect of possible patient or procedure-related predictive factors associated with specific complications. Methods: A syste...

Background: Brachioplasty procedures have experienced a surge in popularity over the past decade, mirroring the rise in bariatric procedures and growing population of massive weight loss patients. The authors estimated the incidence of associated complications and identify possible patient- or procedure-related predictive factors. Methods: A sys...

Healthcare systems are belligerently responding to the new Coronavirus Disease 2019 (COVID-19). The severe acute respiratory syndrome (SARS co-V2) is a specific condition, whose distinctive features are severe hypoxemia associated with (>50% of cases) normal respiratory system compliance. When a patient requires intubation and invasive ventilation...

GLOSSARY BIS = bispectral index; CDS = clinical decision support system; EEG = electroencephalogram; HSS = hybrid sedation system; MIMO = multiple input multiple output; SISO = single input single output; TCI = target-controlled infusion BACKGROUND: THE RATIONALE FOR ROBOTS IN ANESTHESIA Robots now surround our daily activities, doing everything fr...

Objective Simulation training of endotracheal intubation (ETI) has proven to be an effective training tool. We used an adjustable airway mannequin that allows the achievement of various difficulty levels of laryngoscopy to train inexperienced medical students. The purpose of this study was to evaluate the effect of training using this novel airway...

Background Abdominal surgery has undergone major changes during the last two decades with a general shift from open, invasive surgery to closed minimally invasive surgery. Accordingly, pain management strategies have also changed, especially with the introduction of ultrasound-guided abdominal wall blocks. Despite laparoscopic abdominal surgery cla...

There are currently several reported techniques of sonographic subcutaneous adipose tissue (SAT) measurement described in the literature. This systematic review aims to report techniques of SAT measurement using ultrasonography. A systematic literature search was performed and identified 39 relevant articles using ultrasonography to quantify abdomi...

A modified Delphi technique was used to survey plastics surgeons with an expertise in breast reconstruction from 6 university centers with plastic surgery residency programs across Canada. A list of the most challenging steps in teaching alloplastic breast reconstruction was obtained. From the survey results, a benchtop post-mastectomy breast recon...

Background: The utility and efficacy of 3-dimensional representation have been proven in bony reconstruction; however, its role in soft-tissue reconstruction remains limited. There is currently no reliable gold standard to objectively measure flap volume. This systematic review aims to summarize the available techniques used to objectively measure...

Objective: To identify new tools capable of predicting surgical performance of novices on an augmentation mammoplasty simulator. The pace of technical skills acquisition varies between residents and may necessitate more time than that allotted by residency training before reaching competence. Identifying applicants with superior innate technical a...

Background Surgical residents’ exposure to aesthetic procedures remains limited in residency training. The development of the Montreal Augmentation Mammoplasty Operation (MAMO) simulator aims to provide an adjunctive training method and assessment tool to complement the evolving competency-based surgical curriculum. Objectives To perform face, con...

Background Surgical residents’ exposure to aesthetic procedures remains limited in residency training. The development of the Montreal Augmentation Mammoplasty Operation (MAMO) simulator aims to provide an adjunctive training method and assessment tool to complement the evolving competency-based surgical curriculum. Objectives To perform face, con...

Background: In acute compartment syndrome (ACS), clinicians have difficulty diagnosing muscle ischemia provoked by increased intra-compartmental pressure in a timely and non-invasive manner. Phonomyography records the acoustic signal produced by muscle contraction. We hypothesize that alterations in muscle contraction caused by muscle ischemia can...

Closed-loop systems for propofol have been demonstrated to be safe and reliable for general anesthesia. However, no study has been conducted using a closed-loop system specifically designed for sedation in patients under spinal anesthesia. We developed an automatic anesthesia sedation system that allows for closed-loop delivery of propofol for seda...

Alongside the ongoing evolution of surgical training toward a competency-based paradigm has come the need to reevaluate the role of surgical simulation in residency. Simulators offer the ability for trainees to acquire specific skills and for educators to objectively assess the progressive development of these skills. In this article, the authors d...

Background: Recently, several trials have shown that closed-loop sedation is feasible. No study has used automated sedation in extremely frail patients, such as those scheduled for transcatheter aortic valve implantation (TAVI). We developed and tested a novel automated sedation system for this kind of population and surgery. The system integrates...

The international anaesthesia community is getting older, in line with trends worldwide, and as men and women age there is the risk that psychophysiological decline could have an impact on clinical practice. Impairment of technical and nontechnical skills could have a negative impact on patients' safety and outcomes. The ageing process may not nece...

Background: Automated systems can improve the stability of controlled variables and reduce the workload in clinical practice without increasing the risks to patients. We conducted this review and meta-analysis to assess the clinical performance of closed-loop systems compared with manual control. Our primary outcome was the accuracy of closed-loop...

Purpose The transversus abdominal plane (TAP) block has been described as an effective pain control technique after abdominal surgery. We performed a systematic review and meta-analysis of randomized-controlled trials (RCTs) to account for the increasing number of TAP block studies appearing in the literature. The primary outcome we examined was th...

Introduction: Since the introduction of competency-based education and the restriction of residents' working hours, simulator-aided training has obtained increasing attention for its role in teaching and assessing resident surgical skills. Within plastic surgery training, such simulators would be particularly useful for aesthetic surgery procedure...

Introduction Phonomyography (PMG) is a noninvasive acoustic technique by which microphones placed on the skin surface detect the low-frequency sounds emitted by muscle upon contraction. Presently, there is no reliable noninvasive continuous monitoring technique for the detection of acute compartment syndrome (ACS), a traumatic condition seen in mil...

Robots in the acute care environment can be divided into telepresence, pharmacological, and manual robots. Telepresence robots are mobile audio-video-equipped communication stations which allow physicians to communicate with health-care personnel and patients remotely including access to digital patient data. They make access to specialist care pos...

Peripheral regional nerve blockade (nerve block) is used in anesthesia to administer anesthesia to certain regions of the body. During nerve block the anesthetic is injected directly into or around the area surrounding the nerve. One of the most critical components of ultrasound-guided nerve blocks is the detection of the nerve within the ultrasoun...

Implication for health policy/practice/research/medical education: Robots are about to revolutionize anesthesia practice as they have manufacturing. This article explores the changes that are about to happen, and how anesthesiologists can best adapt to these changes and improve patient care.

/st>This study focuses on a recently developed robotic nerve block system and its impact on learning regional anaesthesia skills. We compared success rates, learning curves, performance times, and inter-subject performance variability of robot-assisted vs manual ultrasound (US)-guided nerve block needle guidance. The hypothesis of this study is tha...

Advances in surgery and anesthesia yield bariatric surgery as a short-stay procedure. Short-stay bariatric surgery can be successfully performed applying an ultra fast-track pathway, which consists in a multidisciplinary perioperative management focused on the patient, with the aim to enhance recovery and improve outcome. Many components are involv...

Aims and objectives: The risk assessment of epidural hematoma due to catheter placement in patients undergoing cardiac surgery is essential since its benefits have to be weighed against risks, such as the risk of paraplegia. We determined the risk of the catheter-related epidural hematoma in cardiac surgery based on the cases reported in the liter...

To control the three components of general anesthesia (hypnosis, analgesia, and neuromuscular blockade), an automated closed-loop, anesthesia-drug delivery system (McSleepy) was developed. Bispectral index was used as the control variable for hypnosis, the analgoscore for analgesia, and phonomyography for neuromuscular blockade. McSleepy can be use...

Nerve blocks are common procedures used to remove sensation from a specific region of the body via injection of local anesthetic. Ultrasound-guided nerve blocks are common-place in anesthesia, but require specialized training and advanced bi-manual dexterity. This paper de-scribes a system designed to robotically assist in ultrasound-guided nerve b...

Decision support systems (DSSs) have been successfully implemented into clinical practice offering clinical suggestions and treatment options with excellent results in various clinical settings. Although their results appeared promising, showing that DSSs can increase anesthesiologists’ vigilance and patient safety during surgery, DSSs have never b...

Telemedicine is defined as the delivery of health care and the share of medical knowledge over distance using telecommunications systems. One of the main purposes of telemedicine is to improve accessibility to specialty consultation in remote areas and to reduce the costs of traditional health practices. Telemedicine is used in preoperative assessm...

Background: Although telemedicine is one of the key initiatives of the World Health Organization, no study has explored the feasibility and efficacy of teleanaesthesia. This bi-centre pilot study investigates the feasibility of transcontinental anaesthesia. Methods: Twenty patients aged ≥ 18 yr undergoing elective thyroid surgery for ≥ 30 min we...

Background: We have developed an automatic anaesthesia system for closed-loop administration of anaesthesia drugs. The control variables used were bispectral index (BIS) and Analgoscore for hypnosis and antinociception, respectively. Methods: One hundred and eighty-six patients were randomly enrolled in two groups. Propofol, remifentanil, and ro...

Background: Ultrasound-guided nerve blocks are becoming a standard of modern anesthesia. We developed a robotic system, Magellan, to perform nerve blocks using a remote control center. Methods: Thirteen patients were enrolled in this pilot study. The Magellan system consists of 3 main components: a joystick, a robotic arm, and a software control...

The evolution of techniques and knowledge of beating heart surgery has led anesthesia toward the development of new procedures and innovations to promote patient safety and ensure high standards of care. Off-pump coronary artery bypass (OPCAB) surgery has shown to have some advantages compared to on-pump cardiac surgery, particularly the reduction...

Purpose of review: Robots are present in surgery, to a much lesser extent in the field of anesthesia. The purpose of this review is to show the latest and most important findings in robotic anesthesia. Moreover, this review argues the importance and utility of robots in anesthesia. Recent findings: Over the years, many closed-loop systems have b...

Editor—I enjoyed reading the study by Hemmerling and colleagues. 1 A robotic technique would fill a gadget loving, coffee drinking anaesthetist with enthusiasm, but I would like to understand the fundamental point of what are we trying to achieve by using this technique of tracheal intub-ation. I wonder whether the development of this technique is...

Anesthesia consists of three components: unconsciousness, analgesia and neuromuscular blockade (NMB). A specific drug is administered by the anesthesiologist to control these different components. In this paper we propose a new system for monitoring the neuromuscular blockade in anesthesized patients during surgery. Neuromuscular blockade drugs are...

Intubation is one of the most important anaesthetic skills. We developed a robotic intubation system (Kepler intubation system, KIS) for oral tracheal intubation. In this pilot study, 12 patients were enrolled after approval of the local Ethics board and written informed consent. The KIS consists of four main components: a ThrustMaster T.Flight Hot...

The objective of this prospective study is to determine cognitive dysfunction after thoracic surgery. Seventy-six patients undergoing thoracic surgery with single-lung ventilation (SLV) of an expected duration of >45 min were enrolled. Monitoring consisted of standard clinical parameters and absolute oximetry (S(ct)O(2)). The Mini-Mental State Exam...

We assessed the effectiveness of a continuous local anaesthesia block of the articular branches of the femoral nerve (ABFN) for the treatment of early postoperative pain in 74 patients undergoing total hip anthroplasty (THA). Postoperative analgesia was provided by patient-controlled analgesia (PCA) in 20 patients (PCA group), or by continuous bloc...

Our goal in this study was to develop a robotic intubation system and to conduct a feasibility pilot study on the use of a robotic intubation system for endotracheal intubations. The Kepler Intubation System was developed, consisting of a remote control center (joystick and intubation cockpit) linked to a standard videolaryngoscope via a robotic ar...

This narrative review describes a rationale for robotic anesthesia. It offers a first classification of robotic anesthesia by separating it into pharmacological robots and robots for aiding or replacing manual gestures. Developments in closed loop anesthesia are outlined. First attempts to perform manual tasks using robots are described. A critical...

Fast-track programs have been developed with the aim to reduce perioperative surgical stress and facilitate patient's recovery after surgery. Potentially, regional anesthesia and analgesia techniques may offer physiological advantages to support fast-track methodologies in different type of surgeries. The aim of this article was to identify and dis...

This review outlines the basic pharmacodynamic and pharmacokinetic properties of sugammadex for the cardiac anesthesiologist. It describes the different clinical scenarios when sugammadex can be used during cardiac surgery and gives clinical recommendations. Sugammadex is a unique reversal drug that binds a chemical complex with rocuronium and vecu...

The purpose of this randomized control trial was to determine the performance of a novel rule-based adaptive closed-loop system for propofol administration using the bispectral index (BIS(R)) and to compare the system's performance with manual administration. The effectiveness of the closed-loop system to maintain BIS close to a target of 45 was de...

Volatile anesthetics provide myocardial protection during cardiac surgery. Sevoflurane and desflurane are both efficient agents that allow immediate extubation after off-pump coronary artery bypass grafting (OPCABG). This study compared the incidence of arrhythmias after OPCABG with the two agents. Forty patients undergoing OPCABG with immediate ex...

Background: We present a novel continuous block of the articular branches of the femoral nerve (ABFN) for analgesia after hip arthroplasty. Methods: In this prospective audit, twenty-five patients underwent hip arthroplasty performed by the same surgeon (MT) under spinal anaesthesia performed by the same anaesthesiologist (TH) using 10 to 15 mg of...

Regional cerebral oxygen saturation (S(ct)O(2)) has recently been shown to decrease significantly during thoracic surgery. The present study investigates whether these desaturations are related to postoperative complications. Fifty patients undergoing thoracic surgery with a single-lung ventilation (SLV) of >45 min duration were enrolled. Regional...

Anesthesiologists are overloaded with information and multitasking necessities in an extremely complex work environment. The purpose of this review is to present recent developments toward automated anesthesia and present future technologies for everyday clinical practice. Decision support systems integrate different parameters, clinical scenarios...

A novel monitoring system (integrated monitor of anaesthesia, IMA) which integrates three components of general anaesthesia on one single display was developed. The focus of this study was to evaluate the performance and user-friendliness of four different display designs. Four interface displays of the IMA were developed, including one numerical,...