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Reinforcement learning based automated anesthesia system for gastrointestinal endoscopy with a multicenter randomized

Hai-Long Bing1,2, Yan Wang1, Shi-Ying Li1

  • 1Department of Anesthesiology and Perioperative Medicine, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan, China.

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An intelligent automation system for anesthesia in gastrointestinal endoscopy showed comparable safety to clinician management. This automated anesthesia system (AAS-GE) also reduced induction time, potentially improving efficiency.

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Area of Science:

  • Anesthesiology and Artificial Intelligence
  • Medical Device Technology
  • Clinical Trial Research

Background:

  • Growing demand for gastrointestinal endoscopy and anesthesiologist shortages necessitate automated anesthesia solutions.
  • Reinforcement learning (RL) shows promise for autonomous anesthesia control, but clinical data is limited.
  • Development of an RL-based automated anesthesia system for gastrointestinal endoscopy (AAS-GE) for ciprofol delivery.

Purpose of the Study:

  • To evaluate the safety and efficacy of the AAS-GE compared to clinician-managed anesthesia.
  • To assess primary outcome of hypoxemia incidence and secondary outcomes including induction time, drug use, recovery, and adverse events.

Main Methods:

  • Prospective, multicenter, randomized controlled trial involving 418 adult patients (ASA physical status I-II) undergoing gastrointestinal endoscopy.
  • Patients were randomized 1:1 to receive anesthesia managed by AAS-GE or by clinicians.
  • Primary outcome: incidence of hypoxemia (SpO2 < 92%); secondary outcomes: hypoxemia severity, induction time, drug use, recovery, adverse events.

Main Results:

  • Hypoxemia incidence was similar between AAS-GE and clinician groups (14.42% vs. 14.29%, P=0.968).
  • AAS-GE demonstrated significantly shorter induction times (1.55 vs. 1.90 min, P<0.001) without compromising drug dose or recovery.
  • Increased intraoperative body movement in the AAS-GE group indicated lighter anesthesia depth, with no significant differences in other safety outcomes.

Conclusions:

  • AAS-GE is non-inferior in safety and efficacy to clinician-managed anesthesia for gastrointestinal endoscopy.
  • The system offers potential for improved efficiency and standardized sedation care.
  • Further research may explore optimizing anesthesia depth control for AAS-GE.