Use of a smartwatch as a remote monitoring device during transport to, and inside, a computed tomography suite

A 32‐year‐old woman diagnosed with a diffuse infiltrating frontal glioma was scheduled to undergo computed tomography (CT) guided stereotactic biopsy. The plan was for awake surgery with dexmedetomidine sedation for patient comfort and scalp block for analgesia.

On the day of the procedure, standard vital signs monitoring was applied and the availability of backup resuscitation drugs and equipment was confirmed. A bilateral scalp block was performed with a mix of 6 mg.kg⁻¹ lignocaine 2% with adrenaline and 2 mg.kg⁻¹ of bupivacaine 0.5% to facilitate fixation of the stereotactic frame. The patient was then planned to be transported to the CT scan suite in a wheelchair. Due to the unavailability of a functional portable monitor with battery backup, a smartwatch (Boat^® Xtend, Imagine Marketing Limited, Guangzhou, China) capable of pulse rate and oxygen saturation monitoring, was applied on the patient's wrist (Fig. 1). This allowed us to monitor these parameters throughout the transport and scan on a smartphone (Samsung^® S9 plus, Samsung Electronics, Noida, India) linked to the watch via Bluetooth. The accompanying doctors were able to remain outside in the observation room and avoid exposure to ionising radiation. Visual clinical assessment of the patient was conducted regularly throughout. The patient was then transported back to the operating room for completion of the surgical procedure, under dexmedetomidine sedation. Monitoring in the operating room was with electrocardiography, pulse oximetry, invasive blood pressure measurement and capnography via a conventional monitor. The duration of transport, scan, and the operative procedure were smooth and uneventful.

Figure 1.

Patient inside the CT scanner with a smartwatch measuring pulse oximetry and heart rate, which were monitored by an anaesthesiologist outside the suite.

Wearable technology has the potential to be useful in clinical medicine. Commercially available products include tactile feedback, head‐mounted and wrist‐worn monitors [1]. A smartwatch connected to a wireless network may provide a cost‐efficient means for patient monitoring in remote scenarios or during transport. These devices can detect body motion, temperature, sleep patterns, physical exercise, heart rate, and oxygen saturation [2]. McFarlane et al. and Perez et al. have supported using smartwatches in critical care settings and to detect asymptomatic episodes of atrial fibrillation [3, 4], and utility in the early detection of COVID‐19 has also been described [5]. A recent meta‐analysis by Chan et al. suggests that wearable devices may offer acceptable accuracy and precision in monitoring, though high quality studies are still needed [6].

Limitations of smartwatch technology include a possible lag or interruption in detecting and transmitting data depending on network connectivity this could be affected by the presence of an electromagnetically noisy environment, such as in radiology suites. Also, the physical distance between the wearable device and a receiving device, such as a mobile phone or a tablet, may be a limiting factor if Bluetooth connectivity is required for data capture and transmission. It should also be noted that, with the exception of very narrow applications, most devices are not yet licensed for clinical monitoring. Nevertheless, in the absence of better alternatives, they may add value beyond clinical observation and assessment alone in low‐resource settings. Currently, commercially available wearables cannot be recommended to replace conventional clinical monitoring methods, but in the near future improvement in technology and validation through research may improve the credibility and reliability of this technology, which may be of particular utility in non‐operating room anaesthesia, during patient transport, and in resource‐limited environments.