|Year : 2008 | Volume
| Issue : 1 | Page : 93
Use of Multimedia Message Service Technology in the Operation Theatre: A Case Report
Anurag Tewari1, Ripul Oberoi2, Shuchita Garg3, Harpreet Kaur4, Dinesh Sood5, Sunil Katyal6
1 Assistant Professor, Anaesthesiology & Resuscitation, Institute: Dayanand Medical College & Hospital, Ludhiana, Punjab, India
2 P. G Student, Anaesthesiology & Resuscitation, Institute: Dayanand Medical College & Hospital, Ludhiana, Punjab, India
3 Senior Resident, Anaesthesiology & Resuscitation, Institute: Dayanand Medical College & Hospital, Ludhiana, Punjab, India
4 P. G. Student, Anaesthesiology & Resuscitation, Institute: Dayanand Medical College & Hospital, Ludhiana, Punjab, India
5 Associate Professor, Anaesthesiology & Resuscitation, Institute: Dayanand Medical College & Hospital, Ludhiana, Punjab, India
6 Professor & Head Department:Anaesthesiology & Resuscitation, Institute: Dayanand Medical College & Hospital, Ludhiana, Punjab, India
|Date of Acceptance||02-Dec-2007|
|Date of Web Publication||19-Mar-2010|
Dayanand Medical College & Hospital, Ludhiana, Punjab
The use of mobile phones has long been controversial in the operation theatres citing various incidences wherein aberration of the electronic equipments has occurred due to their use. We hereby report a case where we used mobile phone to capture a dysrrhythmia occurring intra-operatively in a patient via multimedia messaging service (MMS) technology, and sending it to the consultant in charge and a cardiologist via multimedia messaging service(MMS technology) and taking immediate remedial action.
Keywords: Electromagnetic interference, Mobile phones, Multimedia message service, Operation theatre.
|How to cite this article:|
Tewari A, Oberoi R, Garg S, Kaur H, Sood D, Katyal S. Use of Multimedia Message Service Technology in the Operation Theatre: A Case Report. Indian J Anaesth 2008;52:93
|How to cite this URL:|
Tewari A, Oberoi R, Garg S, Kaur H, Sood D, Katyal S. Use of Multimedia Message Service Technology in the Operation Theatre: A Case Report. Indian J Anaesth [serial online] 2008 [cited 2013 May 20];52:93. Available from: http://www.ijaweb.org/text.asp?2008/52/1/93/60608
| Introduction|| |
The modern mobile phones have the potential to become an inseparable and trusted companion of the anaesthesiologists. The use of mobile phones is restricted in operation theatres and intensive care units due to its interference with medical electrical equipment, but for an anaesthesiologist it might be the most valuable friend at the time of crisis. The ability to contact and seek advice from an appropriate professional member of a team (due to the immense memory of a mobile phone directory) instantaneously is very pertinent in our multidisciplinary care for many sick and critical patients. This often obviates the prolonged and frustrating delays due to painfully slow hospital intercoms and usually defunct paging system. The Medicine and Healthcare Product Regulatory Agency (MHRA) recommends that a balanced approach is necessary to ensure that the benefits of mobile wireless technology can be made to all organizations  . If mobile phones are used sensibly and after taking due precautions like in our case, the benefits to patient care may far outweigh the limited risk of interfering with equipments, particularly in an emergency situation.
| Case report|| |
A 35-year-old lady (weight 58kg) had developed esophageal and gastric strictures due to accidental ingestion of acid two days ago, was to be taken up for emergency laparotomy. Preoperatively, the patient had a compromised haemodynamic status. Her heart rate was in the range of 116-124/min, non invasive blood pressure(NIBP) 86/54mmHg, on inotropic support (dopamineinfusion 5mcg.kg-1.min-1) with a central venous pressureof 3 cm of saline and respiratory rate of 20 breaths per minute. Her ECG, chest X-ray, and ABG were within normal limits. Blood analysis showed signs of haemoconcentration (Hb 18gm%, haematocrit 47%).She also had dyselectrolytemia with serum potassium being 2.4mEq.L-1, sodium 130mEq.L-1 and chloride 98mEq.l-1. In view of the sick condition of the patient, gastro-jejunostomy was planned under general anaesthesia.
Continuous ECG, NIBP, SpO2, temperature, EtCO2,and CVP monitoring was instituted. A rapid sequence induction technique was used with ketamine followed by suxamethonium. She was maintained on 66.67% nitrousoxide in oxygen with fentanyl as an analgesic andatracurium for neuromuscular blockade.
The patient developed tall T-waves on her ECG accompanied with fluctuations in her blood pressure 20 minutes after surgery had started. The ECG pattern was suggestive of hyperkalemia. An urgent sample for evaluation of serum electrolytes was sent. It was a matter of confusion for the present team of residents to take any decision regarding the treatment since her morning serum potassium was below the normal range. The senior resident recorded the dysrrhythmia displayed on Excel20E LCD monitor on his cell phone[Figure 1] and [Figure 2]. Using MMS technology, he sent it to the consultant who was inducing a patient in another operation theatre. It was ensured that while MMS data transfer, a safe distance of more than 2 meters between the phone and the anaesthetic equipment and monitors (ECG, SpO2, HR monitors) was maintained. Upon receiving the MMS, the consultant immediately reached the OT. The repeat serum potassium levels showed a value of 5.8mEq.L. -1 Immediately 10 ml of 10% calcium gluconate over 10 minutes was administered. This was followed by 100ml of 25% dextrose with 10 units of insulin. The patient's ECG reverted to near normal. The MMS was also simultaneously sent to a cardiologist and he endorsed the diagnosis and the treatment undertaken.
We could prevent morbidity in our patient by timely detecting and executing the required intervention. During the recording and transferring of the multimedia data we observed no change in the functioning of the medical electronic devices used in the operation theatre. The exact cause of intra operative hyperkalemia could not be ascertained as thereafter there were no similar episodes. The surgery concluded without any further event and patient was transferred to the ICU. She was eventually discharged on the 10 th day from the ward.
| Discussion|| |
Mobile phones have become an inseparable companion of doctors worldwide but there are no standard rules for the use of mobiles in the hospitals. There is no restriction of mobile phones in our institute as such, except there remains an unwritten rule that they should not interfere or compromise patient care. Ours being a tertiary care hospital (like in most of the developing countries), because of the workload it is not possible for the consultant to give personal attention to all the patients at the same time. The quick thinking by the residents saved the day for us.
In state of Victoria in Australia, the hospitals have set their own restrictions while in New South Wales the hospitals follow the 2003 Health directions restricting their use in clinical areas  . Two studies involved the monitoring of the use of mobile phones in the hospital by the clinical staff for up to 6 months found no adverse clinical effects , . Hence at the moment there is a need for formulating a definition of clinically relevant electromagnetic interference (EMI).
Irnich & Tobisch described clinically relevant EMI as that potentially causing "realistic danger" with individual event explanation  . Clinically relevant EMI was observed in 45 of 479 devices tested at 900MHz, and 14 of 457 devices tested at 1800MHz when the mobile phones were used within 2 meters of these devices. It appears that at least 4% of medical devices could experience clinically relevant EMI when a mobile phone is within 2 meters. However, when the mobile phone (devices tested at 900MHz) was used more than 1 meter away from the medical equipment, the numbers of events was negligible (0.01%), showing clinically irrelevant EMI at this range , . Mobile phones using 1800MHz appear to cause even lesser EMI than mobile phones using 900MHz when these are kept at a distance of more than 1 meter from the monitoring equipment. In a study published in the Mayo Clinic Proceedings,  it was found that any serious malfunction of monitoring equipment would be unlikely if a cellular phone was used at a reasonable distance of 5 feet or greater from the equipment.
In another study mobile phones were used in 27 cases of hand trauma for correspondence between the registrar and consultant in the emergency department over a period of 2 months.  The study investigated the use of mobile phone photo-messaging into clinical practice, in order to explore its potential advantages and limitations in the context of communication between the registrar and consultant for the assessment of hand trauma. Two Nokia 7650 mobile phones were used for correspondence between the registrar and the consultant for all hand traumas seen in the emergency department over a 2-month period. They approved of the use of mobile phones with photo-messaging capabilities for the purpose of enhancing communication in a clinical setting. Low cost and ease of use make the phones easily incorporated into clinical practice  .
Short messaging services have been used especially by surgeons and anaesthesiologists in the operation theatres and intensive care  . MMS technology could be useful for the anaesthesiologists to transfer visual data to the concerned supervising senior regarding threatening ECG changes, anticipated difficult intubation, cardiopulmonary cerebral resuscitation etc. We would like to reinforce the "1 meter rule" proposed by Irnich and Tobisch  . We hope that hospital managers and clinical directors will reconsider the issue and will adopt a more flexible policy towards use of mobile phones in the operation theatres. A practical approach would help remove the aggressive over reaction of some staff and public to their use in the hospitals. With the advent of advanced mobile phone technology that might prove very beneficial in future, appropriate measures must be taken to design the anaesthetic & monitoring equipment in a way so as to resist EMI from mobile phones.
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[Figure 1], [Figure 2]