First Reported Remote Anesthesia Monitoring Program over the Internet with NASA/MedITac

Virginia Commonwealth University (VCU) based Medical Informatics and Technology Applications Consortium (MedITAC), a unique National Aeronautics and Space Administration (NASA) Research Partnership Center (RPC) , partnered with TeleVital and used TeleVital’s  low bandwidth real-time telemedicine software for monitoring remote surgeries in remote locations in 2001 and 2002 as part of a NASA-funded research program.  During the December 2001 trip to Ecuador, surgeries were performed in the Cinterandes Foundation Mobile Surgical Facility in Sucúa. The first surgery, an open cholecystectomy, saw the first known transmission of real-time physiologic parameters for distant anesthetic monitoring. Dr. Lynne Gehr, a faculty anesthesiologist at MCV/VCU in Richmond, Virginia monitored the transmitted data in the MedITAC laboratory, while Dr. Patricio Escandon, a member of the faculty of Yale University's Anesthesiology Department, was the local attending anesthesiologist.  

TeleVital's browser-based telemedicine software allowed physicians to transmit in real-time, audio, video, EKG, Sp02 , pulse, respiration rate, and ETC02 . All these signals were simultaneously transmitted from MedITAC's Rapidly Deployable Telemedicine Unit with a standard laptop to Virginia more than 3000 miles away utilizing a single 64Kbps satellite connection while archiving all the physiological data in a data center in San Jose, California. Dr. Lynne Gehr, the anesthesiologist at the remote end, was able to monitor, supervise, and verbally communicate details about the patient's condition during surgery performed by MedITAC Director Dr. Ronald Merrell, Chairman of Surgery at Virginia Commonwealth University's School of Medicine.

The quality of the video and audio was absolutely amazing considering the 64Kbps bandwidth although at the same time the vital signs were also being sent.  Almost nine hours of live anesthesia monitoring was performed on one day, and another 3 hours of Urology monitoring was on the second day, without the slightest hiccup in performance.  In one of surgeries, when a young woman was undergoing gall bladder operation, Dr. Lynne Gehr  even detected an anomaly in the patient's heart rhythm remotely and was able to notify the surgeon on the scene--Dr. Ronald C. Merrell,  who was able to correct the problem.

"The experience of sitting at my desktop computer in Virginia monitoring a patient's vital signs during an operation in Ecuador was quite remarkable," said Dr. Gehr. "TeleVital’s  VitalWeb link provided the same information I would have received if l had been physically in the operating room.  VitalWeb represents a significant advance in telemedicine with far-reaching benefits for both healthcare professionals and their patients."

VitalWeb also enables electronic storage of all the medical information on its secure database for easy retrieval or forwarding. Additionally, the software supports a variety of off-the-shelf wired and wireless EKG, EMG, EEG, blood pressure, spirometry and oximetry, and multi-parameter vital sign monitoring devices.

Seven cases were successfully completed and transmitted using the protocol described during two surgical missions to Ecuador in 2002. In June of 2002, four cases were transmitted, consisting of two general anesthesia and two spinal anesthesia. Three general anesthesia cases were added in December. Operations consisted of cholecystectomies, herniorrhaphies, and lipoma resections.

The following Figure illustrates the screen and information available to observers on both ends of the connection.

The development of TeleVital's low bandwidth telemedicine technology brings the ability to reach out to medically and economically disadvantaged countries that lack medical goods and services.  The development of the low bandwidth technology compared with the more traditional high bandwidth enables the use of telemedicine facilities even in areas with poor telecommunication facilities. While low bandwidth operates on a normal telephone line, high bandwidth needs broadband lines that are extremely hard to come by in rural areas and also in developing countries.

Even in the United States many rural communities lack extensive financial resources and high bandwidth digital transmission capabilities. Today almost one fourth of the entire US population lives in rural areas, while only 9% of US physicians are actually practicing in these locations.

A white paper on the success of remote anesthesia monitoring program was written and published by the NASA/MediTAC surgeons and anesthesia specialists and is available at

Remote Anesthetic Monitoring Using Satellite Telecommunications and the Internet

Additional information on this project are available at the links given below.

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