[Expert systems in medicine: possible uses in anesthesia].

The euphoric assumption that powerful computers fed with sophisticated software programmes may serve as a substitute for human knowledge and decision making has been replaced by a more realistic concept of how computers may help in collecting data and their interpretation on the basis of human knowledge and experience. The computer is now used as a dedicated tool to support man in overtaking cumbersome and monotonous processes and tedious calculations. Running 24 hours a day, a specific feature of the computer is that depending on unequivocal software programmes it does neither forget or alter commands and information. Computer programmes imitating human thinking and information processing are called expert or knowledge based systems. These are especially useful when multiple possible combinations of data make a given task very complex. This review presents several systems used in different medical disciplines to describe fundamental ideas, different problem-solving methods, techniques and possible working fields including anaesthesia. It is made clear why computers have found widespread use in all administrative areas. In contrast, no system comparable in potency has been developed for use in clinical medicine in spite of 25 years of research in expert systems. This review starts with a definition of expert knowledge and the appropriate transformation of this knowledge to the computer. In addition, a general survey about the structure of expert systems and a state of the art in some current problem solving methods is given. Additional aspects and restrictions including technical, psychological and legal problems which seem to be unimportant from the outside but are essential for the development of expert systems are presented.