Patients to control their own sedation during operations

NTU works with Nottingham University Hospitals NHS Trust to allow patients to control their own sedation during operations

Prof Philip Breedon (left) and Dr James Sprinks
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Prof Philip Breedon (left) and Dr James Sprinks
Two of the NTU researchers behind the technology

Patients undergoing operations while awake will control their own levels of anxiety thanks to new research.

At the touch of a button, patients will administer doses of intravenous sedation whenever they feel nervous on the operating table.

The aim is to allow patients to individualise their experience of surgery by putting them in control of how awake or sleepy they want to be.  The technology may also allow for swifter recovery times by reducing exposure to the drug’s side effects.

The technology would make it impossible for patients to under or overdose themselves as minimum and maximum limits are set. An anaesthetist would remain in the operating theatre observing the patient at all times.

The project is led by Nottingham University Hospitals NHS Trust in collaboration with product design researchers at Nottingham Trent University (NTU). NTU was awarded more than £376,000 by National Institute for Health Research (NIHR) to develop the hardware and software for the project.

Professor Philip Breedon, who leads Nottingham Trent’s Medical Design Research Group, said: “Undergoing surgery can be a worrying experience so patients are sedated. Propofol is very effective but, like many drugs, it has side effects that can prolong recovery.

“By putting the control of drug delivery directly into a patient’s hand, less propofol can be used without compromising the patient’s comfort, which we expect will lead to swifter recovery times.”

It could make a huge difference to the experience patients receive while also creating efficiencies for the NHS.

Dr David Hewson, Anaesthetic Registrar at Nottingham University Hospitals NHS Trust.

Nottingham Trent research fellow Dr James Sprinks, who is developing the technology, said: “Because there’s no real way of knowing how anxious a person feels, anaesthetists often err on the side of caution and have to administer larger doses to ensure that operations run smoothly.

“But this technology will help ensure that patients receive more suitable doses. It will also make patients feel more in control and anaesthetists will be provided with live data on how much the patient is taking.”

Ahead of the development of the technology, 25 patients at Nottingham University Hospitals NHS Trust took part in an initial study of the technique. Results showed these patients were able to choose how awake or sleepy to be for surgery and needed less propofol than if an anaesthetist alone had been in control of the sedation.

Different patients also took the drug at different points of their operation. People who felt anxious before the operation tended to use more at the start. Those who felt relaxed at the beginning tended to ask for more propofol later on, say the researchers.

Principal investigator Dr Nigel Bedforth, consultant anaesthetist at Nottingham University Hospitals NHS Trust, said: “This is a pioneering project which could have a huge impact on the way operations involving conscious patients are undertaken around the world.

“It shows that by working in collaboration can we develop new technologies and introduce new anaesthetic techniques which help improve the experience of patients undergoing surgery.”

The research has focussed on orthopaedic operations, such as for knee and hip replacements.

Dr David Hewson, Anaesthetic Registrar at Nottingham University Hospitals NHS Trust, said: “In the future this technology could be widened out to other forms of medical or surgical procedure which require patients to be awake.

“It could make a huge difference to the experience patients receive while also creating efficiencies for the NHS.”

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    About Nottingham Trent University

    Nottingham Trent University was named University of the Year 2017 at The Times Higher Education Awards and Modern University of the Year in The Times and Sunday Times Good University Guide 2018. The award recognises NTU for its strong student satisfaction, quality of teaching, overall student experience and engagement with employers.

    Nottingham Trent University (NTU) has been awarded the highest, gold, rating in the Government’s Teaching Excellence Framework for its outstanding teaching and learning.

    NTU is one of the largest UK universities with nearly 28,000 students and more than 3,500 staff across four campuses, contributing £496m to the UK economy every year. It is one of the most environmentally-friendly universities, containing some of the country’s most inspiring and efficient award-winning buildings.

    The University is passionate about creating opportunities and its extensive outreach programme is designed to enable Nottingham Trent to be a vehicle for social mobility. NTU is the sixth biggest recruiter of students from disadvantaged backgrounds in the country and 95.6% of its graduates go on to employment or further education within six months of leaving.

    NTU is home to world-class research, winning The Queen’s Anniversary Prize in 2015 - the highest national honour for a UK university. It recognised the University’s pioneering projects to improve weapons and explosives detection in luggage, enable safer production of powdered infant formula and combat food fraud.

    With an international student population of approximately 2,600 from around 100 countries, the University prides itself on its global outlook.

    About the National Institute for Health Research

    This research has been funded by an award from the National Institute for Health Research (NIHR) Invention for Innovation (i4i) Programme, which supports the preclinical and clinical development of innovative medical technologies.

    The NIHR: improving the health and wealth of the nation through research.

    Established by the Department of Health and Social Care, the NIHR:

    • funds high quality research to improve health
    • trains and supports health researchers
    • provides world-class research facilities
    • works with the life sciences industry and charities to benefit all
    • involves patients and the public at every step.

    For further information, visit the NIHR website www.nihr.ac.uk.

    About Nottingham University Hospitals NHS Trust

    Nottingham University Hospitals NHS Trust is one of the biggest and busiest acute hospitals in England, employing 15,000 staff. We provide care to over 2.5million residents of Nottingham and its surrounding communities and specialist services to a further 3-4million people from neighbouring counties.

    The Trust has three main sites:

    • Queen’s Medical Centre (QMC) – where our Emergency Department (A&E) major trauma centre and Nottingham Children’s Hospital are located. The QMC is also home to The University of Nottingham’s School of Nursing and Medical School
    • Nottingham City Hospital – where our cancer centre, heart centre and stroke services are based, and where we focus on planned care and the care of patients with long-term conditions
    • Ropewalk House – where we provide a range of outpatient services, including hearing services

    We have national and international reputations for specialist services such as stroke, renal, spinal, breast, neurosciences, cancer services and trauma.

    The Trust’s annual turnover is £940 million. We have approximately 1,700 beds (87 wards).

    We are at the forefront of many research programmes and new surgical procedures.

    In partnership with The University of Nottingham we host a Biomedical Research Centre carrying out vital research into hearing, digestive diseases, respiratory, musculoskeletal disease, mental health and imaging.

    As a teaching trust we have a strong relationship with The University of Nottingham and other universities across the East Midlands, playing an important role in the education and training of doctors, nurses other healthcare professionals.

    We are part of the London 2012 Olympic legacy and offer services at the National Centre for Sport and Exercise Medicine - East Midlands, based at Loughborough University.

    To find out more about our hospitals, please visit our website www.nuh.nhs.uk. You can also follow @nottmhospitals on Twitter.

Patients to control their own sedation during operations

Published on 22 February 2018

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