Critiquing anesthetic management: the "ATTENDING" computer system

ATTENDING, a computer system under development using Artificial Intelligence techniques, is designed to critique an anesthetist's preoperative plan for anesthetic management. The system receives as input: 1) a list of a patient's medical problems; 2) a planned surgical procedure; and 3) an anesthetic plan outlining the agents and techniques to be used for premedication, induction, intubation, and maintenance of general or regional anesthesia. ATTENDING critiques this plan, discussing the risks and benefits of the proposed approach and of other reasonable approaches. To critique a physician's plan, the ATTENDING system must be able to 1) explore alternative approaches to a patient's management in a flexible fashion; 2) assess the relative risks and benefits of these alternatives; and 3) produce a readable, easily understood analysis written in English prose. This article describes how these design issues are addressed in ATTENDING's current implementation. The ATTENDING system is presently being used in a tutorial mode which allows self-evaluation by an anesthetist.