Interview with Anesthetist Dr.Raj Sethuraman on Digital Healthcare Solutions


5 min read

Hi guys, we have a good news. We just kick started a series of webinars on Digital Healthcare solutions, a new unit under our company, Spritle Software.

As a start, we conducted a webinar which was a very fun and informative interview with Dr. Rangaraj Sethuraman, a Consultant Anesthetist at the Nottingham University Hospitals NHS Trust, England, UK. The discussion I would rather say was focused on how Digital Healthcare is related with Anesthesiology, the difficulties, advantages and drawbacks of not having digital healthcare as well as having it in his field.

So, hosting is a part that I haven’t done before ever in my life but was forced to do here😂. I had to jump a little out of my comfort zone but it was nice to be honest. I had to host, ask questions, listen to the speaker and keep a smiling face too which was a little difficult.

I can see you all waiting to get into the actual part of the webinar. Okay fine, let’s go, with me stopping my blabbering here😅..!

Starting with the interview, firstly,

“So, Dr.Raj, how do you monitor the patient’s status when the anesthetic is injected into their body?”

He started, “That is a fantastic question. You see the fundamental of anesthetic practice is monitoring the patient’s status. Their details like Name, Age, Gender, Height, Weight must be mentioned before injecting the anesthetic.

So it can be done in two ways: Basic Monitoring and Advanced Monitoring. Where do you start off with monitoring the status of the patient you ask, let me say it would be the brain.

Brain’s electrical activity is measured usually with EEG (Electroencephalography), where it gives many waveform representing the activity of different parts of the brain, which are difficult for an anesthetist to keep track on. So, there are two different types of monitoring at our hospital to reduce the risk and difficulty for us.


Two different monitors to keep track of brain activity, both with complex algorithms and software updates every few years to have increased levels of monitoring. The commonly used monitor in UK, might well as be used in India,

1.) Bispectral Index Monitor (BIS):

Measures brain activity using EEG and gives a processed single waveform for easy monitoring. An important factor in BIS Monitoring System is the ‘BIS Number’. For a fully awake person it can be around 99 or even 100 and for a person under anesthesia it would drop down between 40 and 60.

If BIS Number drops down 40, it indicates that the anesthetic level has crossed the limits for the patient and it can be titrated and bought back to the normal level.

2.) Norco Trend:

It is the other type of brain monitoring with EEG as its base gaining popularity in the recent years. It also monitors the patient’s brain activity using processed EEG waves.

“Next monitoring would be,

The second question was, “the kind of technologies that are currently used in anesthesiology and does the anesthetic injecting level vary with pediatrics and geriatrics?”

“At Nottingham Hospital nearly 80 percent of the anesthetic is injected with the help of a technology called the Target Controlled Infusion. Instead of me having to inject the anesthetic into the patient’s body, there will be syringes loaded with anesthetic, controlled by a Syringe driver, driven by a microchip. One end would be this target controlled infusion and the other end would be the brain monitoring.

The patient who is coming in for a surgery will undergo three stages,

  • Pre-Operative Period: time where the patient takes up the pre-anesthetic assessment which is to make sure the patient is fit to take up a surgery.
  • Operating Period: time where the patient gets the anesthesia shot & goes into a full unconscious state or only a certain area gets numbed. The anesthetic injection is controlled by syringe driver and the vitals are monitored. Ultrasound techniques are also used here in my hospital for performing a lot of procedures.
  • Post-Operative Period: the time where the patient after surgery, under the recovery period, their vitals are continuously monitored and recorded in an application. If any abnormalities detected, the doctors will get an alert even if they are not around the patient (called as Early Warning Score [EWS] )”

That is how our second question came to an end. Jumping to the third question,

“What are the pain points in your profession that you think can be fixed using a software?”

1.) Assessing a patient before a surgery: during the pre-operative period, the person in charge of a patient has to ask his/her patient with a set of questions like around 60 to make sure that they can undergo that particular surgery. This really takes up a lot of time and energy.

So, here to save the time of the busy people in the hospitals, an application can be developed where all the questions can be answered by the patient themself with the person in charge guiding them only once.

2.) Breathing under control: Under anesthesia, the breathing of the patient is completely taken over by the anesthetist. A breathing tube must be inserted into their mouth. But it is not that easy as it seems because the anatomy of patients varies depending upon age, height, Body Mass Index (BMI) etc.

Here is where the technologies can be of a great help. Airway Recognition Applications using facial recognition and artificial intelligence can be built to reduce the human intervention in the process.

3.) Teaching trainee doctors: Traditionally, the trainee doctors watch few procedures in the OT, perform few procedures with my direct supervision.

This way of training them can be changed. Building Virtual Reality software systems replicating real anatomical structures, where the trainee doctors can practice by themselves without making their presence in the OTs. The system can be designed so that the anatomies can be changed like, of a sixty year old patient or of a five year old child.

4.) Human Errors: Human errors are inevitable. Drug error (i.e.) giving the wrong drug or incorrect dose of drug, writing the wrong name of the drug or even forgetting to mention the drug used in the medical records are the common human errors that are caused in our industry.

So you see, you guys can come up with an automated drug cart system. The drugs would be under lock. You have to enter the patient’s details and medical conditions so that the correct drug cart only will open for that patient. Other drug carts will remain locked avoiding the anesthetist taking the wrong drug.

We doctors want to make our lives easy with these automation technologies and machines, but I wouldn’t advice replacing an anesthetist. Still initiatives have been taken in parts of the world like Canada and America but it has not really paid off”, he concluded.

Seems like we have reached the end of the webinar as I ask the last question,

In what ways should the anesthesiologists and the software industry work together to come up with new ideas?

“One of the areas where we really strive to excel is the Risk Prediction, as in to see how the patient is doing before, during and after the surgery; are they really fit for the operation, will they be able to cope up with it and what will be rate of recovery things like that.

There are quite a few Risk Prediction Models, will mention about the two types, 1.) Pre-operative Risk Prediction Model and 2.) Post-operative Outcome Prediction Model.

The pre-operative prediction model learns from thousands of patient data from the past & if it gives the percentage of risks like getting a heart attack, or the percentage of survival is low etc., the patient can decide for themselves if they really want to undergo the surgery or not. And for doctors it will be helpful to come up with solutions to reduce those risks.

The post-operative prediction model has an eye on the patient’s parameters like oxygen level, blood pressure level etc., & keep them in track even before the patient comes out of the OT. It can be built in way to learn and train inform about the after surgery effects like getting a stroke or an organ failure.

To summarize, the important points that a software developer must take into consideration before building any application related to healthcare are,

  • Firstly, understand the needs of the hospitals and ensure the safety of the patient
  • Regarding anesthesiology, it always comes along with patients’ safety, where a software might not give the perfect solution for the cause but shouldn’t compromise on the safety aspects

He emphasizes on the point that even with the development of anesthesiology with AI, nothing can replace a human anesthetist in the operating room. There might be many AI systems but those never really took off and need improvement to be more accurate & precise.

After the interview, we had a very interactive Q&A session with the speaker. It showed that our participants were really into the webinar👏.

Finally, to my favorite part of the blog, the ending. How you end is as important as how you start. It takes a lot of efforts to write a good and interesting blog and at the same time it takes a lot of effort to give content for that blog, an informative and to the point webinar on how to bridge the gap between anesthesiology and digital healthcare.

I hope this blog would have given you at least some knowledge that we tried to convey. This initiative by Spritle Software really shows our interest as in how much we want to step into Digital Healthcare.

We will be conducting another webinar like this with another Doctor specialized in a different domain on the 11th of February, 2021. Until then, stay safe & happy and keep expecting more from us…..

Thank you!!

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