VCU conducts first-known anesthesiology via internet

By Mike Frontiero
VCU School of Education

RICHMOND, Va. – Under normal circumstances, surgeons and anesthesiologists work side by side in the operating room, but recently – for the first time known – they worked half a world apart to help an ailing patient in one of the most remote areas of South America.

Using a well-equipped mobile operating room housed inside a converted delivery truck, a medical team led by Ronald C. Merrell, M.D., chairman of surgery at Virginia Commonwealth University’s School of Medicine, removed a young woman’s gall bladder in Sucua, Ecuador, on Dec. 4. His anesthesiologist, meanwhile, monitored her breathing and heart rhythms on a desktop computer 3,000 miles away in Richmond.

"Traditionally, the operating room has been a place to expect dedication and accuracy," Merrell said after returning from Ecuador. "I think in the future it should also be a place where we can summon outside help when we need it."

The real-time Internet link allowed VCU anesthesiologist Lynne C. Gehr, M.D., to notice a potentially life-threatening anomaly in the patient’s heart rhythm and notify her counterpart in the surgical truck, who corrected the problem. "It was helpful and exhilarating to participate in the procedure from such a great distance," Gehr said.

In addition to chairing VCU’s Department of Surgery, Merrell is director of the VCU-based Medical Informatics and Technology Applications Consortium (MITAC), a unique Commercial Space Center sponsored by the National Aeronautics and Space Administration (NASA) to conduct telemedicine and medical informatics research. CSCs leverage technology through partnerships with industrial affiliates and other government agencies to benefit both human space flight and the commercial sector. The goal of MITAC (www.meditac.com) is to explore portable technologies and telecommunications that will allow medical care to be delivered away from hospitals and at remote facilities – in space and around the earth. VCU is the lead U.S. clinical site for NASA’s telemedicine activities.

The objective of Merrell’s latest trip to Ecuador was the addition of patient monitoring to the MITAC-developed Rapidly Deployable Telemedicine Unit (RDTU) for the possibilities of remote anesthesia monitoring. The RDTU was outfitted with software developed by TeleVital of Milpitas, Ca., for monitoring patients via the Web. The success of the procedure is one of a series of successes that can be claimed by MITAC, which has been conducting telemedicine test beds and research around the globe for the past two years – in the Caribbean, Egypt, Kosovo, Greece, Turkey, Arctic Circle, Russia and on Mt. Everest.

"The goal is to transport as much information about a patient as possible, so doctors can understand what’s going on as if they were actually in the operating room and send solutions back that will work," said Merrell. "International test beds offer a wide variety of opportunities for understanding the cultural diversity of the practice of medicine, as well as evaluating models in remote environments."

Merrell’s team hopes telemedicine research eventually will allow doctors to mechanically interact with patients in remote locations during surgeries and dispense medication.