Theoretical basis of target controlled anaesthesia: history, concept and clinical perspectives

Individualizing propofol dosage: a multivariate linear model approach

In the last decades propofol became established as an intravenous agent for the induction and maintenance of both sedation and general anesthesia procedures. In order to achieve the desired clinical effects appropriate infusion rate strategies must be designed. Moreover, it is important to avoid or minimize associated side effects namely adverse cardiorespiratory effects and delayed recovery. Nowadays, to attain these purposes the continuous propofol delivery is usually performed through target-controlled infusion (TCI) systems whose algorithms rely on pharmacokinetic and pharmacodynamic models. This work presents statistical models to estimate both the infusion rate and the bolus administration. The modeling strategy relies on multivariate linear models, based on patient characteristics such as age, height, weight and gender along with the desired target concentration. A clinical database collected with a RugLoopII device on 84 patients undergoing ultrasonographic endoscopy under sedation-analgesia with propofol and remifentanil is used to estimate the models (training set with 74 cases) and assess their performance (test set with 10 cases). The results obtained in the test set comprising a broad range of characteristics are satisfactory since the models are able to predict bolus, infusion rates and the effect-site concentrations comparable to those of TCI. Furthermore, comparisons of the effect-site concentrations for dosages predicted by the proposed Linear model and the Marsh model for the same target concentration is achieved using Schnider model and a factorial design on the factors (patients characteristics). The results indicate that the Linear model predicts a dosage profile that is faster in leading to an effect-site concentration closer to the desired target concentration.

A target control Infusion method for neuromuscular blockade based on hybrid parameter estimation

The paper presents a new method for target control infusion (TCI) for neuromuscular blockade (NMB) level control of patients subject to general anaesthesia. The method combines an inversion of the pharmacokinetic/pharmacodynamic (PK/PD) model with a hybrid parameter estimation method that uses on-line data from the initial bolus response to estimate the model parameters. Although atracurium is considered as relaxant, the newly proposed method may be applied to other drugs for which the PK/PD model is available. Simulation results on a bank of 100 patient models are presented to demonstrate the achievable performance.

Model predictive control of depth of anaesthesia: guidelines for controller configuration

The paper presents a feasibility study on the use of Model based Predictive control (MPC) to regulate the level of Depth of Anaesthesia (DoA) when measured by the BIS index. Pharmacokinetic/pharmacodynamic nonlinear models of DoA when Propofol and Remifentanil are used as hypnotic and analgesic drugs are linearized around the desired working point for DoA in order to obtain a linear state-space model coupled with an extra integrator to include integral action in the control. This state-space model is then used in a MPC algorithm. The main contribution of the paper consists in the characterization of the influence of the different design parameters in the MPC performance when controlling DoA.