Bridging the 300,000-Anesthesiologist Shortage: How Automated Anesthesia Robots Offer a Critical Solution

There is a saying that “surgeons treat diseases, while anesthesiologists save lives,” which underscores the critical importance of anesthesiologists. However, China currently faces a significant shortage of anesthesiologists. According to data from the 2017 China Health and Family Planning Statistical Yearbook, there were approximately 98,000 licensed (assistant) anesthesiologists in China in 2016, translating to only 0.5 anesthesiologists per 10,000 people. In contrast, the United States and the United Kingdom had 2.5 and 2.8 anesthesiologists per 10,000 people, respectively.

If China were to adopt the staffing ratios standard in Europe and the United States, there would be a shortage of approximately 300,000 anesthesiologists. This shortfall has limited the availability of procedures such as labor analgesia and painless gastroscopy.

Anesthesiologists in China are overworked under high-intensity pressure. Taking large tertiary hospitals as an example, a single anesthesiologist is responsible for overseeing thousands of surgeries annually. A survey conducted from 2008 to 2015 revealed that anesthesiologists had the highest number of sudden cardiac deaths among all physician specialties.

To address the current shortage of anesthesiologists, anesthesia surgical robots may offer a more immediate solution than the lengthy process required to train new specialists.

VCBeat (WeChat ID: vcbeat) has learned that in Beijing, a company named Easymonitor has developed an automated anesthesia robot based on more than 30 years of research in electroencephalography (EEG) and anesthesia. This innovation helps alleviate the workload of anesthesiologists, improve their work efficiency, enhance the level of anesthesia care in primary healthcare institutions, reduce human errors during anesthesia procedures, and help address the shortage of anesthesiologists.

Precise Monitoring and Assessment of Anesthetic Depth During Surgery Have Become a Critical Challenge Requiring Urgent Attention from Clinical Anesthesiologists. General anesthesia is a specialized and complex state encompassing multiple components, including sedation-hypnosis, amnesia, analgesia, stress suppression, and muscle relaxation. It spans the entire process of induction, maintenance, and emergence, all of which are controlled through the administration of anesthetic agents.

Responsiveness to anesthetic agents varies with different surgical procedures, patient populations, and degrees of intraoperative stimulation.

Insufficient anesthetic dosage leads to inadequate depth of anesthesia, which can easily cause adverse reactions such as hemodynamic fluctuations, intraoperative awareness, and body movements, thereby hindering the smooth progression of surgery. Conversely, excessive anesthetic dosage results in overly deep anesthesia, causing severe suppression of vital organ functions, including the respiratory and circulatory systems, leading to ischemia and hypoxia; in severe cases, this may result in brain function impairment and endanger the patient’s life. Therefore, intraoperative monitoring of anesthesia depth not only helps control the quality of anesthesia but also enables achieving optimal anesthetic effects with minimal anesthetic agents, thereby shortening postoperative recovery time.

In anesthesia monitoring, three critical indicators are indispensable: the depth of sedation, analgesia, and muscle relaxation. Sedation indices primarily assess whether the patient remains conscious, while analgesia assessment determines whether pain perception has been effectively blocked. During surgery, monitors evaluate the patient’s anesthetic depth by analyzing changes in electroencephalogram (EEG) signals. As the patient’s brain emits electrical signals, the monitor “interprets” these signals to inform the anesthesiologist of the specific anesthetic state the body has entered.

The advantage of Easymonitor devices lies in their ability to objectively and quantitatively assess brain states, such as sedation and analgesia, thereby providing a decision-making basis for precision anesthesia.

Beijing Easymonitor Technology Co.,Ltd. is no newcomer to the development of anesthesia surgical robots. Since 2002, the company has developed a range of products in the field of anesthesia, including Anesthesia Information Management Systems (AIMS), Intensive Care Unit Information Management Systems (ICU-IMS), anesthesia depth monitors, neuromuscular transmission monitors, and cerebral function state monitors.

Over the nearly 20 years since its establishment, Easymonitor has never halted its R&D efforts, consistently reinvesting its profits into research and development. Building on more than 30 years of R&D expertise and accumulation, Easymonitor has launched the Automated Anesthesia Robot (Closed-Loop Feedback Target-Controlled Infusion System).

Beijing Easymonitor Technology Co., Ltd. utilizes a two-compartment model to acquire electroencephalogram (EEG) signals from both the cerebral cortex and subcortical regions. By employing various advanced algorithms, it deciphers and extracts indices for depth of sedation (WLi) and depth of analgesia (PTi) from the acquired EEG signals. Building on this foundation, its independently developed automatic anesthesia robot operates under the control of Target-Controlled Infusion (TCI) algorithms. Using the sedation index, analgesia index, and systolic blood pressure as target parameters for closed-loop feedback, the system automatically controls infusion pumps to administer sedatives, analgesics, and vasoactive drugs. Coupled with audio-visual voice alerts, this ensures that the depth of sedation and analgesia, as well as blood pressure, remain within safe ranges during surgery.

Anesthesia surgical robots can continuously monitor the depth of anesthesia sedation, pain index, degree of muscle relaxation, and blood flow status, provide feedback on drug administration rates, and assist anesthesiologists in performing general anesthesia.

Ms. Xu Wenyue, head of Beijing Easymonitor Technology Co., Ltd., told VCBeat that the company is not the first to develop automated anesthesia robots. However, compared with traditional devices capable only of monitoring sedation indices, Easymonitor’s automated anesthesia robot achieves real-time monitoring and feedback of electroencephalogram (EEG) data, enabling objective quantitative measurement of sedation, analgesia, and pain. In terms of drug administration, it realizes dual-channel delivery for both sedation and analgesia.

Beijing Easymonitor Technology Co.,Ltd.’s ability to achieve this breakthrough is underpinned by its extensive repository of over 300,000 EEG cases, a vast standardized database built upon more than three decades of EEG research accumulation.

Professor Wu Yibing, Chief Scientist and Founder of Easymonitor, has been engaged in EEG research since graduating from Harbin Institute of Technology. Professor Wu formerly served as a Senior Engineer in the Department of Biophysics at Peking University Health Science Center and currently holds an adjunct professorship at the School of Astronautics, Harbin Institute of Technology. He has over 30 years of experience in clinical EEG application research and practice.

The absence of large-scale data is one of the key factors contributing to the bottleneck in the research and development of automated anesthesia robots. Although the number of patients undergoing surgery is substantial, the collection of effective and objective clinical data remains incomplete, with a lack of clinical observational data on the impact of anesthesia and surgery on patients’ long-term outcomes. The scarcity of data precludes the automated assessment and diagnosis of patients’ anesthesia status.

It can be said that the 300,000 EEG data points and the unique wavelet algorithm constitute the core competitive barrier of Beijing Easymonitor Technology Co., Ltd.

Ms. Xu Wenyue from Beijing Easymonitor Technology Co., Ltd. stated, “Automated anesthesia robots are primarily composed of two parts: one is real-time monitoring that includes EEG indices, and the other is infusion pumps for automated drug administration.”

In the field of infusion pump technology, Beijing Easymonitor Technology Co., Ltd. initiated clinical research on target-controlled infusion (TCI) based on pharmacokinetic modules as early as 1999. Furthermore, Easymonitor has exclusively achieved dual-channel control for the administration of sedation and analgesia.

Although automated anesthesia robots can perform automatic injections, they are not intended to replace anesthesiologists.

Ms. Xu stated, “The automated anesthesia robot can effectively reduce the workload of anesthesiologists and improve the quality of anesthesia. Easymonitor’s anesthesia robot monitors changes in patients’ sedation, analgesia, blood pressure, and other indicators, alerting physicians to patient status and the appropriateness of medication use. In cases of excessively deep or shallow anesthesia, the device provides voice alerts to inform doctors of potential issues.”

Currently, Easymonitor's automated anesthesia robot has entered the clinical trial phase.

In terms of market size, Beijing Easymonitor Technology Co., Ltd. estimates that, assuming a 10% market share with most hospitals purchasing 3–10 anesthesia robots each, the market for automated anesthesia robots is projected to reach nearly RMB 30 billion.

In addition to anesthesia surgical robots, years of technological accumulation have also enabled Beijing Easymonitor Technology Co., Ltd.'s products to be applied in other areas, such as the development of brain functional state monitors.

With the development of electroencephalogram (EEG) monitoring technology in recent years, the Bispectral Index (BIS) has been recognized as an effective method for monitoring the functional status and changes of the cerebral cortex, and it is currently one of the commonly used clinical methods for monitoring anesthesia depth. It is reported that the modules adopted by domestic anesthesia depth monitors are basically BIS modules.

BIS has both advantages and limitations in the clinical monitoring of anesthesia depth. As a quantitative index that does not affect anesthesia depth (requiring no stimulation), BIS can effectively reflect the degree of sedative drug effects. However, it is insensitive to analgesic components and lacks effective monitoring capability for patients’ responses to noxious stimuli under anesthesia [1].

Currently, experimental comparisons between the Easymonitor WLi EEG monitoring module and the BIS module have demonstrated that the WLi offers higher sensitivity and superior anti-interference capabilities, making it suitable for monitoring anesthetic awareness.

Unlike other manufacturers, Beijing Easymonitor Technology Co., Ltd. holds independent intellectual property rights for EEG monitoring. Ms. Xu stated, “After acquiring the EEG signals, we process them using our proprietary wavelet analysis algorithm to extract information related to brain states. Our algorithm is based on large-scale, multivariate EEG data, which includes not only healthy individuals but also infants, patients with depression, and other diverse populations.”

Easymonitor also extracts more critical quantitative indices of brain states from EEG signals, including pain, analgesia, delirium, memory, anxiety, emotion, and sleep, significantly expanding the significance and capabilities of brain function monitoring.

“Easymonitor is a research-oriented company. We have been studying EEG monitoring since 1996. Compared with existing BIS modules, our algorithms are optimized and updated based on the latest data, rather than being developed on outdated and singular datasets. In the past, we could only perform sedation monitoring; however, through continuous research, we are now capable of monitoring analgesia and cognition, enabling multi-parameter monitoring,” said Xu Wenyue.

In addition to medical applications, Beijing Easymonitor Technology Co., Ltd. believes that brain function monitoring also has huge application space in the consumer market, and can be popularized from professional and expensive medical-grade applications to civilian use, just like genetic testing.

The civilian brain functional status monitor developed by Beijing Easymonitor Technology Co., Ltd. can complete a brain health check-up within 6 minutes, assessing brain status through 16 indicators to help warn against Alzheimer’s disease, evaluate brain development levels, sleep quality, and emotional states such as anxiety and depression.

Suitable for use in various scenarios, including health checkups, education, military applications, and HR.

In addition to its technological advantages, Beijing Easymonitor Technology Co.,Ltd. has established a nationwide sales network through years of marketing patient monitors and information systems. Its multifunctional combination patient monitors are widely used in Grade A tertiary hospitals, laying a solid foundation for the future sales of its products.

In the future, Beijing Easymonitor Technology Co., Ltd. will continue to promote the clinical trials and applications of anesthesia surgical robots and EEG monitors. To achieve this goal, in addition to reinvesting current sales profits, the company requires additional external financial support.

Beijing Easymonitor Technology Co.,Ltd. hopes to join hands with more like-minded partners to contribute to the advancement of brain science.

Reference: “Welcoming the Artificial Intelligence Era in Anesthesiology” – Xue Qingsheng, Yu Buwei, Department of Anesthesiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine

Auditory evoked potential index predicts the depth of sedation and movement in response to skin incision during sevoflurane anesthesia. Anesthesiology. 2001;95(2):364-70.