Head-mounted display evaluation in anesthesia for rigid cystoscopy D. Liu, BEng(Hons)

1, S. Jenkins, BMBS FANZCA2, P.M. Sanderson, PhD FASSA

1, P. Fabian, MBBS2, W.J. Russell, MBBS DIC FANZCA FRCA

2

1 The University of Queensland, Brisbane, Australia 2 Royal Adelaide Hospital, Adelaide, Australia

Methods

Six attending anesthesiologists each provided anesthesia to six patients undergoing urology procedures at the Royal Adelaide Hospital. Each of the participant’s six cases were alternated between two experimental conditions:

• Control – standard monitoring (Philips IntelliVueTM MP70)• HMD – standard monitoring plus the HMD

The HMD displayed almost all of the vital signs available on the MP70. Tidal volumes were measured by the ventilator and not available on the HMD.

All cases were recorded on quad video (two field cameras,a head-mounted camera, MP70 display) for further data analysis.

Aims

We evaluated a head-mounted display (HMD) of vital signs in the clinical environment to determine whether the effects of HMDs found in prior simulator studies would:

a) generalize to clinical practiceb) be any different during crisis management

Background

Head-mounted displays (HMDs) can superimpose the patient’s vital signs over the anesthesiologist’s field of view.

Prior simulator studies indicate that anesthesiologists using a head-mounted display of vital patient signs:

• spent more time looking towards the patient• spent less time looking towards the anesthesia machine• detected vital signs changes faster than otherwise if they

were busy and physically constrained o except they detected a waveform change more slowly

• did not detect events faster during routine monitoring

Results

Cases ranged in duration from 17 to 75 minutes (median 31 mins). In total, 16,342 head turns were coded from 22 hours of video data.

Participants in cases where the HMD was available spent:

• less time looking towards the anes. machine (p=0.003)• more time looking toward the patient (p=0.014)

compared to their Control condition cases.

While managing a regurgitation episode, an anesthesiologistusing the HMD:

• spent less time looking at the anesthesia machine (9.9% vs 26.1%, p=0.035)

• looked towards the anesthesia machine less frequently (1.36 vs 3.61 looks per minute, p=0.009)

• looked at the patient for longer each time (16.212 vs 2.773 seconds, p<0.001)

compared to their own Control condition baseline.

The same variables for another regurgitation event that occurred during a Control condition were not significantly different from the participant’s own baseline.

Conclusions

A head-mounted display of patient vital signs lets anesthesiologists spend more time monitoring their patient’s clinical signs during normal anesthesia and especially during crisis management.

Acknowledgements

We thank the anesthesiologists, nurses, biomedical engineers, and surgeons at the Royal Adelaide Hospital who participated in the study and/or consented to being filmed.

This research is supported by Australian Research Council Discovery Project grant ARC DP0559504 to P. Sanderson, M. Watson, and W. J. Russell; and an Australian Postgraduate Award for D. Liu. Travel funding for D. Liu was provided by a Fulbright Postgraduate Scholarship, an Elizabeth Usher Memorial Travelling Scholarship, a Gregory Schwartz Enrichment Grant, and a Churchie Old Boys Overseas Study Scholarship.