Dr. Howard Rollins, EHRtv AIMS specialist and medical consultant, interviews Lloyd Olson of Medbotics Inc.
Dr. Howard Rollins:This is Dr. Howard Rollins with EHRtv. Today we’re in EHR studios with Dr. Lloyd Olson; President and CEO of Medbotics Inc. Dr. Olson and I will be discussing new and exciting technology developed by Medbotics. Hello Dr. Olson.
Dr. Lloyd Olson:Hello.
Dr. Howard Rollins:Nice to have you here.
Dr. Lloyd Olson:Nice to be here, thank you.
Dr. Howard Rollins:I understand that you are an anesthesiologist and an emergency department physician.
Dr. Lloyd Olson:That’s right.
Dr. Howard Rollins:Is it okay if I call you Lloyd?
Dr. Lloyd Olson:Please do.
Dr. Howard Rollins:Okay. Lloyd, why don’t we just jump right into this; tell me about the product – I understand the product is called Rescue Bot which implies to me that there’s some robotic technology here that we’re going to speak about.
Dr. Lloyd Olson:That’s right. The Rescue Bot has been conceived to automatically respond to respiratory depression in patients getting narcotics after surgery.
Dr. Howard Rollins:Now, are we talking about PCA narcotics?
Dr. Lloyd Olson:Mostly patients who are receiving PCA narcotics, although it does have other potential uses perhaps even at home.
Dr. Howard Rollins:I know this is – this has been a hot topic for a while because I believe that respiratory depression post-operatively especially in patients that are using PCA pumps has been a problem intermittently in hospitals where they – patients have had serious complications.
Dr. Lloyd Olson:That’s right.
Dr. Howard Rollins:So why is this technology important? Why does it – some people would say, “Well that’s what the nursing staff is for.” Why is this technology important in this arena?
Dr. Lloyd Olson:Well the problem is; nurses on post-op floors take care of from four to eight patients each. Patients are never really as safe in hospital as they are in the operating room. Of course they have the benefit of full monitoring; the latest and best monitoring and you know, a physician who’s an expert in airway control and critical care – in fact, anesthesiologists were the ones who invented critical care, so you’re never better off than you are in the O.R.
Dr. Howard Rollins:And?
Dr. Lloyd Olson:And – well, the further away you get from the O.R., for example; recovery after the O.R., there will be one highly trained nurse taking care of you – often they are ICU nurses, but you know, they’re taking care of two patients.
Dr. Howard Rollins:So let’s assume that the patient is using a PCA pump and they are becoming depressed. Your technology is going to notice that how?
Dr. Lloyd Olson:Well, as I mentioned, monitoring would be required in the best case scenario in all post-op patients; some form of respiratory monitoring whether it be breathing rate, heart rate, pulse oximetry, capnography, an acoustic monitor of the breathing over the trachea, there are numerous forms of monitoring. Unfortunately, all these forms of monitoring require some response – some human response in order to be worth anything.
Dr. Howard Rollins:Some kind of depression would be picked up by the monitors, and then how will Rescue Bot respond to that?
Dr. Lloyd Olson:The Rescue Bot uses an alarm condition to deliver a small amount of an agent that reverses narcotic. This agent is given every day in emergency departments in very large doses in patients who are in coma or full respiratory arrest because some of them have overdosed on narcotics. And the medicine itself Naloxone is one of the safest medicines around actually.
Dr. Howard Rollins:It has been around for a long time.
Dr. Lloyd Olson:1970 approved by the FDA for the treatment of respiratory depression. It’s well known to be extremely safe.
Dr. Howard Rollins:So I assume we’re giving a low dose of Naloxone maybe 40 to 80 micrograms, is that right?
Dr. Lloyd Olson:That’s right. Naloxone does nothing unless a patient is under the influence of narcotics.
Dr. Howard Rollins:Right.
Dr. Lloyd Olson:Theoretically of course, if you reverse the effects of narcotics, you’re going to reverse some of the pain control – the analgesia. Although there are several papers that I’ve seen – there is literature to support the position that you can reverse respiratory depression without analgesia.
Dr. Howard Rollins:So you get the Narcan and then that is in some way recorded?
Dr. Lloyd Olson:Yes, all these events would be recorded along with the Rescue Bot delivering the first small amount of reversal agent. There would be an audible and video prompt for the patient to replace their monitors if for example they’d come detached. And the idea is that we don’t want false alarms to proceed to prompt the Rescue Bot to deliver more reversal agent. So we’re increasing the safety margin, we’re avoiding severe episodes of full-on respiratory arrest. We don’t need to alert the nurse; the Rescue Bot is pretty much trying to keep – is in a cruise control mode. We’re trying to keep that patient comfortable and safe at the same time without requiring a lot – any human intervention or making more work for nurses who are already overworked.
Dr. Howard Rollins:So, now this product – this is not really a product yet; it has not been approved, is that right?
Dr. Lloyd Olson:That’s correct.
Dr. Howard Rollins:So tell me a little about the approval process and where you are at that.
Dr. Lloyd Olson:Well, it’s in prototype form now. The approval process can be a long one as you know. It will soon be bench tested, and I hope to start clinical trials as soon as possible. There are several centers interested in doing this. I’m hoping that the fact that numerous patients’ safety organizations are focusing on respiratory depression will speed approval. For example, the American Society of Anesthesiologists’ president Mark Warner made post-operative respiratory depression his number one priority this last year. As I mentioned before, the APSF had a major conference this year and recommended all post-op patients be monitored. I was just at the Society for Technology in Anesthesia meeting last week; where we met.
Dr. Howard Rollins:That’s right. And why did you choose the STA for your exhibition?
Dr. Lloyd Olson:It really is the premiere meeting of physicians, engineers, and makers of medical devices.
Dr. Howard Rollins:How is the concept received at the meeting?
Dr. Lloyd Olson:I thought very well. Everyone knows the seriousness of the issue. And as a matter of fact, I think the accumulation of more and more data regarding post-op surgical outcomes which will come out instituting EMR is going to make it apparent that this really is even more of an issue than we’ve been aware up to this point.
Dr. Howard Rollins:I would think that the people that are going to be most excited about this are the risk managers and the CEOs of hospitals because nobody in risk management or the administration wants to hear when they come in the morning, that they had a fatality or a significant complication on the floor the night before.
Dr. Lloyd Olson:Absolutely! It is called in a rude way – even in the literature, Dead-in-Bed Syndrome; nobody wants this. Surgeons have a tremendous responsibility to restore their patients to normal functionality but they’d been put in impossible situations – we’ve all been put in a very difficult situation by regulatory agencies that want patients to be perfectly comfortable.
Dr. Howard Rollins:Right, let’s hear some examples.
Dr. Lloyd Olson:Well, in the emergency department; they’re very busy places. Many people come on with injuries and they’re in pain. And they can’t be watched every second. Almost always they’re put on some sort of monitoring but that doesn’t mean that the monitor is going to be heard. It’s a very chaotic place at times. There may not be enough nursing personnel to watch these people afterwards, or maybe even the physician conducting the procedure wants to have an extra measure of safety while they’re involved in trying to make a diagnosis. In addition, outside of the hospital itself, there is the potential for patients – either chronic pain patients or patients being sent home from hospital but still require significant pain medicine needing an extra measure of safety. I’ve developed a nasal cannula while it delivers oxygen; can also deliver a small bolus of Naloxone which will be effective almost as fast intra-nasally as intravenously.
Dr. Howard Rollins:So is this vaporized or is this put in mist form? How is delivered?
Dr. Lloyd Olson:You know it really doesn’t matter. It can go in a concentrated form; paramedics have been using it for years in patients that don’t have accessible veins in the field. It’s not approved for this use yet by the FDA, but it’s effective.
Dr. Howard Rollins:It will be absorbed thru the nasal mucosa.
Dr. Lloyd Olson:Absolutely.
Dr. Howard Rollins:As anything is.
Dr. Lloyd Olson:Well, imagine Neosynephrine…
Dr. Howard Rollins:Right.
Dr. Lloyd Olson:You know and there is a medication that can cause extreme high blood pressure in those who are susceptible whereas Naloxone really doesn’t have that downside.
Dr. Howard Rollins:Right.
Dr. Lloyd Olson:So I think it’s justifiable to consider it for approval.
Dr. Howard Rollins:Very interesting. Lloyd, I’d like to thank you for coming to our studio today. This is an exciting technology and I look forward to hearing more about it in the future as you make your way through this maze of approval, and I hope that it works out.
Dr. Lloyd Olson:So do I. I’ll be happy to update you whenever we reach another milestone.
Dr. Howard Rollins:Please do. Thank you.
Dr. Lloyd Olson:You’re welcome.
Dr. Howard Rollins:This has been Dr. Howard Ross with EHRtv with Dr. Lloyd Olson of Medbotics Inc. Thank You.