1
|
Sarraf E. The drug titration paradox: a control engineering perspective. Curr Opin Anaesthesiol 2024; 37:362-370. [PMID: 38841991 DOI: 10.1097/aco.0000000000001396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
PURPOSE OF REVIEW The drug titration paradox describes that, from a population standpoint, drug doses appear to have a negative correlation with its clinical effect. This paradox is a relatively modern discovery in anesthetic pharmacology derived from large clinical data sets. This review will interpret the paradox using a control engineering perspective. RECENT FINDINGS Drug titration is a challenging endeavor, and the medication delivery systems used in everyday clinical practice, including infusion pumps and vaporizers, typically do not allow for rapid or robust titration of medication being delivered. In addition, clinicians may be reluctant to deviate from a predetermined plan or may be content to manage patients within fixed goal boundaries. SUMMARY This drug titration paradox describes the constraints of how the average clinician will dose a patient with an unknown clinical response. While our understanding of the paradox is still in its infancy, it remains unclear how alternative dosing schemes, such as through automation, may exceed the boundaries of the paradox and potentially affect its conclusions.
Collapse
Affiliation(s)
- Elie Sarraf
- Penn State College of Medicine, Hershey, Pennsylvania, USA
| |
Collapse
|
2
|
Hosseinirad S, van Heusden K, Dumont GA. Evaluating inter-individual variability captured by the Eleveld pharmacokinetics model. J Clin Monit Comput 2024; 38:505-518. [PMID: 37934309 DOI: 10.1007/s10877-023-01083-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 09/25/2023] [Indexed: 11/08/2023]
Abstract
Inter-individual variability in Pharmacokinetic (PK) and Pharmacodynamic (PD) models significantly affects the accuracy of Target Controlled Infusion and closed-loop control of anesthesia. We hypothesize that the novel Eleveld PK model captures more inter-individual variability relevant to both open-loop and closed-loop control design, resulting in reduced variability in PD models identified using the Eleveld PK model's plasma prediction compared to the Schuttler or Schnider PK model. We used a dataset of propofol infusion rates and Depth of Hypnosis measurements across three demographic groups: elderly, obese, and adult. PD models are identified based on plasma concentration prediction using three PK models (Schuttler, Schnider, and Eleveld). Validation methods are presented to confirm acceptable predictive performance and comparable PK-PD model variability within each demographic group. To test our hypothesis, we compared coefficient variations in step responses for open-loop control and multiplicative uncertainty of PD model sets for closed-loop control. Validated PKPD models using the Schuttler and Schnider PK model showed no significant differences in predictive response and multiplicative uncertainty compared to the Eleveld PK model. The coefficient variations in step responses of PD model sets and the frequency ranges, corresponding to uncertainty below one, were comparable for all three PK models. The comparison of the accumulated coefficient of variation in the step-response and the uncertainty of the PD model sets indicated that the Eleveld PK model does not offer any advantage for the design of open-loop or closed-loop control of anesthesia.
Collapse
Affiliation(s)
- Sara Hosseinirad
- Department of Electrical and Computer Engineering, The University of British Columbia, Vancouver, BC, V6T 1Z4, Canada.
| | - Klaske van Heusden
- School of Engineering, The University of British Columbia, Kelowna, BC, V1V 1V7, Canada
| | - Guy A Dumont
- Department of Electrical and Computer Engineering, The University of British Columbia, Vancouver, BC, V6T 1Z4, Canada
| |
Collapse
|
3
|
Ionescu CM, Copot D, Yumuk E, De Keyser R, Muresan C, Birs IR, Ben Othman G, Farbakhsh H, Ynineb AR, Neckebroek M. Development, Validation, and Comparison of a Novel Nociception/Anti-Nociception Monitor against Two Commercial Monitors in General Anesthesia. SENSORS (BASEL, SWITZERLAND) 2024; 24:2031. [PMID: 38610243 PMCID: PMC11013864 DOI: 10.3390/s24072031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/12/2024] [Accepted: 03/20/2024] [Indexed: 04/14/2024]
Abstract
In this paper, we present the development and the validation of a novel index of nociception/anti-nociception (N/AN) based on skin impedance measurement in time and frequency domain with our prototype AnspecPro device. The primary objective of the study was to compare the Anspec-PRO device with two other commercial devices (Medasense, Medstorm). This comparison was designed to be conducted under the same conditions for the three devices. This was carried out during total intravenous anesthesia (TIVA) by investigating its outcomes related to noxious stimulus. In a carefully designed clinical protocol during general anesthesia from induction until emergence, we extract data for estimating individualized causal dynamic models between drug infusion and their monitored effect variables. Specifically, these are Propofol hypnotic drug to Bispectral index of hypnosis level and Remifentanil opioid drug to each of the three aforementioned devices. When compared, statistical analysis of the regions before and during the standardized stimulus shows consistent difference between regions for all devices and for all indices. These results suggest that the proposed methodology for data extraction and processing for AnspecPro delivers the same information as the two commercial devices.
Collapse
Affiliation(s)
- Clara M. Ionescu
- Department of Electromechanics, System and Metal Engineering, Ghent University, 9052 Ghent, Belgium; (C.M.I.); (E.Y.); (R.D.K.); (I.R.B.); (G.B.O.); (H.F.); (A.R.Y.)
- Department of Automation, Technical University Cluj-Napoca, Memorandumului Street 20, 400114 Cluj, Romania;
| | - Dana Copot
- Department of Electromechanics, System and Metal Engineering, Ghent University, 9052 Ghent, Belgium; (C.M.I.); (E.Y.); (R.D.K.); (I.R.B.); (G.B.O.); (H.F.); (A.R.Y.)
| | - Erhan Yumuk
- Department of Electromechanics, System and Metal Engineering, Ghent University, 9052 Ghent, Belgium; (C.M.I.); (E.Y.); (R.D.K.); (I.R.B.); (G.B.O.); (H.F.); (A.R.Y.)
- Department of Control and Automation Engineering, Istanbul Technical University, Maslak, Istanbul 34469, Turkey
| | - Robin De Keyser
- Department of Electromechanics, System and Metal Engineering, Ghent University, 9052 Ghent, Belgium; (C.M.I.); (E.Y.); (R.D.K.); (I.R.B.); (G.B.O.); (H.F.); (A.R.Y.)
| | - Cristina Muresan
- Department of Automation, Technical University Cluj-Napoca, Memorandumului Street 20, 400114 Cluj, Romania;
| | - Isabela Roxana Birs
- Department of Electromechanics, System and Metal Engineering, Ghent University, 9052 Ghent, Belgium; (C.M.I.); (E.Y.); (R.D.K.); (I.R.B.); (G.B.O.); (H.F.); (A.R.Y.)
- Department of Automation, Technical University Cluj-Napoca, Memorandumului Street 20, 400114 Cluj, Romania;
| | - Ghada Ben Othman
- Department of Electromechanics, System and Metal Engineering, Ghent University, 9052 Ghent, Belgium; (C.M.I.); (E.Y.); (R.D.K.); (I.R.B.); (G.B.O.); (H.F.); (A.R.Y.)
| | - Hamed Farbakhsh
- Department of Electromechanics, System and Metal Engineering, Ghent University, 9052 Ghent, Belgium; (C.M.I.); (E.Y.); (R.D.K.); (I.R.B.); (G.B.O.); (H.F.); (A.R.Y.)
| | - Amani R. Ynineb
- Department of Electromechanics, System and Metal Engineering, Ghent University, 9052 Ghent, Belgium; (C.M.I.); (E.Y.); (R.D.K.); (I.R.B.); (G.B.O.); (H.F.); (A.R.Y.)
| | - Martine Neckebroek
- Department of Anesthesia, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium;
| |
Collapse
|
4
|
Hemmerling TM, Jeffries SD. Robotic Anesthesia: A Vision for 2050. Anesth Analg 2024; 138:239-251. [PMID: 38215704 DOI: 10.1213/ane.0000000000006835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024]
Abstract
The last 2 decades have brought important developments in anesthetic technology, including robotic anesthesia. Anesthesiologists titrate the administration of pharmacological agents to the patients' physiology and the needs of surgery, using a variety of sophisticated equipment (we use the term "pilots of the human biosphere"). In anesthesia, increased safety seems coupled with increased technology and innovation. This article gives an overview of the technological developments over the past decades, both in terms of pharmacological and mechanical robots, which have laid the groundwork for robotic anesthesia: target-controlled drug infusion systems, closed-loop administration of anesthesia and sedation, mechanical robots for intubation, and the latest development in the world of communication with the arrival of artificial intelligence (AI)-derived chatbots are presented.
Collapse
Affiliation(s)
- Thomas M Hemmerling
- From the Department of Experimental Surgery, McGill University Health Center, Montreal, Quebec, Canada
- Department of Anesthesia, McGill University, Montreal, Quebec, Canada
| | - Sean D Jeffries
- From the Department of Experimental Surgery, McGill University Health Center, Montreal, Quebec, Canada
| |
Collapse
|
5
|
Abstract
The monitoring of vital signs in patients undergoing anesthesia began with the very first case of anesthesia and has evolved alongside the development of anesthesiology ever since. Patient monitoring started out as a manually performed, intermittent, and qualitative assessment of the patient's general well-being in the operating room. In its evolution, patient monitoring development has responded to the clinical need, for example, when critical incident studies in the 1980s found that many anesthesia adverse events could be prevented by improved monitoring, especially respiratory monitoring. It also facilitated and perhaps even enabled increasingly complex surgeries in increasingly higher-risk patients. For example, it would be very challenging to perform and provide anesthesia care during some of the very complex cardiovascular surgeries that are almost routine today without being able to simultaneously and reliably monitor multiple pressures in a variety of places in the circulatory system. Of course, anesthesia patient monitoring itself is enabled by technological developments in the world outside of the operating room. Throughout its history, anesthesia patient monitoring has taken advantage of advancements in material science (when nonthrombogenic polymers allowed the design of intravascular catheters, for example), in electronics and transducers, in computers, in displays, in information technology, and so forth. Slower product life cycles in medical devices mean that by carefully observing technologies such as consumer electronics, including user interfaces, it is possible to peek ahead and estimate with confidence the foundational technologies that will be used by patient monitors in the near future. Just as the discipline of anesthesiology has, the patient monitoring that accompanies it has come a long way from its beginnings in the mid-19th century. Extrapolating from careful observations of the prevailing trends that have shaped anesthesia patient monitoring historically, patient monitoring in the future will use noncontact technologies, will predict the trajectory of a patient's vital signs, will add regional vital signs to the current systemic ones, and will facilitate directed and supervised anesthesia care over the broader scope that anesthesia will be responsible for.
Collapse
Affiliation(s)
- Kai Kuck
- From the Departments of Anesthesiology and Biomedical Engineering, University of Utah, Salt Lake City, Utah
| | | | | |
Collapse
|
6
|
Cochand L, Filipovic MG, Huber M, Luedi MM, Urman RD, Bello C. Systems Anesthesiology: Systems of Care Delivery and Optimization in the Operating Room. Anesthesiol Clin 2023; 41:847-861. [PMID: 37838388 DOI: 10.1016/j.anclin.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
Anesthesiology presents a challenge to a traditional simplifying approach given the ever-increasing amount of medical data and a more demanding environment. Systems anesthesiology is a modern approach to perioperative care, integrating the complexity of multifactorial knowledge and data to achieve a more adequate representation of reality, while including both patient-related medical aspects as well as economic and organizational challenges. We discuss the value of some innovative technologies such as the emergence of anesthesia information systems, the use of tele-medicine, predictive monitoring, or closed-loop systems as it pertains to the changes in the current standards of care in anesthesiology. Furthermore, we highlight the importance of systems anesthesiology in operating room planning, anesthesia research, and education.
Collapse
Affiliation(s)
- Laure Cochand
- Department of Anesthesiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mark G Filipovic
- Department of Anesthesiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Markus Huber
- Department of Anesthesiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Markus M Luedi
- Department of Anesthesiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Richard D Urman
- Department of Anesthesiology, The Ohio State University College of Medicine, OH, USA.
| | - Corina Bello
- Department of Anesthesiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| |
Collapse
|
7
|
Chakravarty S, Donoghue J, Waite AS, Mahnke M, Garwood IC, Gallo S, Miller EK, Brown EN. Closed-loop control of anesthetic state in nonhuman primates. PNAS NEXUS 2023; 2:pgad293. [PMID: 37920551 PMCID: PMC10619513 DOI: 10.1093/pnasnexus/pgad293] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 08/13/2023] [Accepted: 08/22/2023] [Indexed: 11/04/2023]
Abstract
Research in human volunteers and surgical patients has shown that unconsciousness under general anesthesia can be reliably tracked using real-time electroencephalogram processing. Hence, a closed-loop anesthesia delivery (CLAD) system that maintains precisely specified levels of unconsciousness is feasible and would greatly aid intraoperative patient management. The US Federal Drug Administration has approved no CLAD system for human use due partly to a lack of testing in appropriate animal models. To address this key roadblock, we implement a nonhuman primate (NHP) CLAD system that controls the level of unconsciousness using the anesthetic propofol. The key system components are a local field potential (LFP) recording system; propofol pharmacokinetics and pharmacodynamic models; the control variable (LFP power between 20 and 30 Hz), a programmable infusion system and a linear quadratic integral controller. Our CLAD system accurately controlled the level of unconsciousness along two different 125-min dynamic target trajectories for 18 h and 45 min in nine experiments in two NHPs. System performance measures were comparable or superior to those in previous CLAD reports. We demonstrate that an NHP CLAD system can reliably and accurately control in real-time unconsciousness maintained by anesthesia. Our findings establish critical steps for CLAD systems' design and testing prior to human testing.
Collapse
Affiliation(s)
- Sourish Chakravarty
- The Picower Institute for Learning and Memory, Massachusetts Institute of Technology (MIT), Cambridge, MA 02139, USA
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Jacob Donoghue
- The Picower Institute for Learning and Memory, Massachusetts Institute of Technology (MIT), Cambridge, MA 02139, USA
- Harvard-MIT Division of Health Sciences and Technology, MIT, Cambridge, MA 02139, USA
- Department of Brain and Cognitive Sciences, MIT, Cambridge, MA 02139, USA
| | - Ayan S Waite
- The Picower Institute for Learning and Memory, Massachusetts Institute of Technology (MIT), Cambridge, MA 02139, USA
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Meredith Mahnke
- The Picower Institute for Learning and Memory, Massachusetts Institute of Technology (MIT), Cambridge, MA 02139, USA
| | - Indie C Garwood
- The Picower Institute for Learning and Memory, Massachusetts Institute of Technology (MIT), Cambridge, MA 02139, USA
- Harvard-MIT Division of Health Sciences and Technology, MIT, Cambridge, MA 02139, USA
- Department of Brain and Cognitive Sciences, MIT, Cambridge, MA 02139, USA
| | - Sebastian Gallo
- The Picower Institute for Learning and Memory, Massachusetts Institute of Technology (MIT), Cambridge, MA 02139, USA
| | - Earl K Miller
- The Picower Institute for Learning and Memory, Massachusetts Institute of Technology (MIT), Cambridge, MA 02139, USA
- Department of Brain and Cognitive Sciences, MIT, Cambridge, MA 02139, USA
| | - Emery N Brown
- The Picower Institute for Learning and Memory, Massachusetts Institute of Technology (MIT), Cambridge, MA 02139, USA
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard-MIT Division of Health Sciences and Technology, MIT, Cambridge, MA 02139, USA
- Department of Brain and Cognitive Sciences, MIT, Cambridge, MA 02139, USA
- Institute for Medical Engineering and Sciences, MIT, Cambridge, MA 02139, USA
- Department of Anaesthesia, Harvard Medical School, Boston, MA 02115, USA
| |
Collapse
|
8
|
Bi X, Zhang Q, Ding D, Zhang T, Lu J, Wu Z, Li J, Ding F. Automated regional citrate anticoagulation based on online monitoring of ionized calcium concentration: Proof of concept. Artif Organs 2022; 46:2191-2200. [PMID: 35699387 DOI: 10.1111/aor.14335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/03/2022] [Accepted: 06/08/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Regional citrate anticoagulation (RCA), a complex and effective technique, is recommended as the anticoagulation of choice for continuous renal replacement therapy. One of its key objectives is to keep the ionized calcium in the targeted range. In this study, we aimed to develop an automated RCA based on online monitoring of the ionized calcium concentration and closed-loop feedback. METHODS We constructed calcium-selective electrodes with liquid inner contact, which measured a potentiometric signal as the output. We tested the responses, stability, and selectivity of the electrodes in flowing fluid containing calcium chloride. We compared the measurement accuracy between the electrodes and an i-STAT system in vivo. Moreover, we established closed-loop feedback using a proportional-integral-derivative controller model. We performed simulated automated RCA both in vivo and in vitro. RESULTS The electrode gave a Nernstian response to the variation of ionized calcium concentration. It showed high stability and a relatively short response time. Changes in the fluid flow rate, solution PH, and addition of metal ions including Mg2+ and K+ did not interfere with the measurements of ionized calcium. These measurements in whole blood by the electrode were very close to those assessed by the i-STAT system. The feedback control system responded quickly to an abnormal ionized calcium concentration and regulated the infusion rates of calcium or citrate to maintain the concentration of ionized calcium within the targeted range. CONCLUSIONS We successfully trialed automated RCA, which may help simplify the complexities of RCA in the future.
Collapse
Affiliation(s)
- Xiao Bi
- Division of Nephrology & Critical Care Nephrology Unit, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Tissue Engineering, Shanghai, China
| | - Qi Zhang
- Division of Nephrology & Critical Care Nephrology Unit, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Tissue Engineering, Shanghai, China
| | - Damin Ding
- School of Optical-Electrical and Computer Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Tao Zhang
- Shanghai Shuiyi Technology Co., Ltd., Shanghai, China
| | - Jianxin Lu
- Division of Nephrology & Critical Care Nephrology Unit, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Tissue Engineering, Shanghai, China
| | - Zhenkai Wu
- Division of Nephrology & Critical Care Nephrology Unit, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Tissue Engineering, Shanghai, China
| | - Jiaolun Li
- Division of Nephrology & Critical Care Nephrology Unit, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Tissue Engineering, Shanghai, China
| | - Feng Ding
- Division of Nephrology & Critical Care Nephrology Unit, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Tissue Engineering, Shanghai, China
| |
Collapse
|
9
|
Optimization of Propofol Dose Estimated During Anesthesia Through Artificial Intelligence by Genetic Algorithm: Design and Clinical Assessment. Neural Process Lett 2022. [DOI: 10.1007/s11063-022-10751-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
10
|
Schamberg G, Badgeley M, Meschede-Krasa B, Kwon O, Brown EN. Continuous action deep reinforcement learning for propofol dosing during general anesthesia. Artif Intell Med 2022; 123:102227. [PMID: 34998516 DOI: 10.1016/j.artmed.2021.102227] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 09/26/2021] [Accepted: 11/23/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE Anesthesiologists simultaneously manage several aspects of patient care during general anesthesia. Automating administration of hypnotic agents could enable more precise control of a patient's level of unconsciousness and enable anesthesiologists to focus on the most critical aspects of patient care. Reinforcement learning (RL) algorithms can be used to fit a mapping from patient state to a medication regimen. These algorithms can learn complex control policies that, when paired with modern techniques for promoting model interpretability, offer a promising approach for developing a clinically viable system for automated anesthestic drug delivery. METHODS We expand on our prior work applying deep RL to automated anesthetic dosing by now using a continuous-action model based on the actor-critic RL paradigm. The proposed RL agent is composed of a policy network that maps observed anesthetic states to a continuous probability density over propofol-infusion rates and a value network that estimates the favorability of observed states. We train and test three versions of the RL agent using varied reward functions. The agent is trained using simulated pharmacokinetic/pharmacodynamic models with randomized parameters to ensure robustness to patient variability. The model is tested on simulations and retrospectively on nine general anesthesia cases collected in the operating room. We utilize Shapley additive explanations to gain an understanding of the factors with the greatest influence over the agent's decision-making. RESULTS The deep RL agent significantly outperformed a proportional-integral-derivative controller (median episode median absolute performance error 1.9% ± 1.8 and 3.1% ± 1.1). The model that was rewarded for minimizing total doses performed the best across simulated patient demographics (median episode median performance error 1.1% ± 0.5). When run on real-world clinical datasets, the agent recommended doses that were consistent with those administered by the anesthesiologist. CONCLUSIONS The proposed approach marks the first fully continuous deep RL algorithm for automating anesthestic drug dosing. The reward function used by the RL training algorithm can be flexibly designed for desirable practices (e.g. use less anesthetic) and bolstered performances. Through careful analysis of the learned policies, techniques for interpreting dosing decisions, and testing on clinical data, we confirm that the agent's anesthetic dosing is consistent with our understanding of best-practices in anesthesia care.
Collapse
Affiliation(s)
- Gabriel Schamberg
- Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.
| | | | - Benyamin Meschede-Krasa
- Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Ohyoon Kwon
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Emery N Brown
- Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| |
Collapse
|
11
|
AIM in Anesthesiology. Artif Intell Med 2022. [DOI: 10.1007/978-3-030-64573-1_246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
12
|
On the Challenges of Anesthesia and Surgery during Interplanetary Spaceflight. Anesthesiology 2021; 135:155-163. [PMID: 33940633 DOI: 10.1097/aln.0000000000003789] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
13
|
Napoleone G, van Heusden K, Cooke E, West N, Görges M, Dumont GA, Ansermino JM, Merchant RN. The Effect of Low-Dose Intraoperative Ketamine on Closed-Loop-Controlled General Anesthesia: A Randomized Controlled Equivalence Trial. Anesth Analg 2021; 133:1215-1224. [PMID: 33560659 DOI: 10.1213/ane.0000000000005372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Closed-loop control of propofol-remifentanil anesthesia using the processed electroencephalography depth-of-hypnosis index provided by the NeuroSENSE monitor (WAVCNS) has been previously described. The purpose of this placebo-controlled study was to evaluate the performance (percentage time within ±10 units of the setpoint during the maintenance of anesthesia) of a closed-loop propofol-remifentanil controller during induction and maintenance of anesthesia in the presence of a low dose of ketamine. METHODS Following ethical approval and informed consent, American Society of Anesthesiologist (ASA) physical status I-II patients aged 19-54 years, scheduled for elective orthopedic surgery requiring general anesthesia for >60 minutes duration, were enrolled in a double-blind randomized, placebo-controlled, 2-group equivalence trial. Immediately before induction of anesthesia, participants in the ketamine group received a 0.25 mg·kg-1 bolus of intravenous ketamine over 60 seconds followed by a continuous 5 µg·kg-1·min-1 infusion for up to 45 minutes. Participants in the control group received an equivalent volume of normal saline. After the initial study drug bolus, closed-loop induction of anesthesia was initiated; propofol and remifentanil remained under closed-loop control until the anesthetic was tapered and turned off at the anesthesiologist's discretion. An equivalence range of ±8.99% was assumed for comparing controller performance. RESULTS Sixty patients participated: 41 males, 54 ASA physical status I, with a median (interquartile range [IQR]) age of 29 [23, 38] years and weight of 82 [71, 93] kg. Complete data were available from 29 cases in the ketamine group and 27 in the control group. Percentage time within ±10 units of the WAVCNS setpoint was median [IQR] 86.6% [79.7, 90.2] in the ketamine group and 86.4% [76.5, 89.8] in the control group (median difference, 1.0%; 95% confidence interval [CI] -3.6 to 5.0). Mean propofol dose during maintenance of anesthesia for the ketamine group was higher than for the control group (median difference, 24.9 µg·kg-1·min-1; 95% CI, 6.5-43.1; P = .005). CONCLUSIONS Because the 95% CI of the difference in controller performance lies entirely within the a priori equivalence range, we infer that this analgesic dose of ketamine did not alter controller performance. Further study is required to confirm the finding that mean propofol dosing was higher in the ketamine group, and to investigate the implication that this dose of ketamine may have affected the WAVCNS.
Collapse
Affiliation(s)
- Gabby Napoleone
- From the Department of Anesthesiology, Pharmacology and Therapeutics
| | - Klaske van Heusden
- Department of Electrical and Computer Engineering, University of British Columbia (UBC), Vancouver, British Columbia, Canada.,Research Institute, BC Children's Hospital, Vancouver, British Columbia, Canada; and
| | - Erin Cooke
- From the Department of Anesthesiology, Pharmacology and Therapeutics.,Research Institute, BC Children's Hospital, Vancouver, British Columbia, Canada; and
| | - Nicholas West
- From the Department of Anesthesiology, Pharmacology and Therapeutics
| | - Matthias Görges
- From the Department of Anesthesiology, Pharmacology and Therapeutics.,Research Institute, BC Children's Hospital, Vancouver, British Columbia, Canada; and
| | - Guy A Dumont
- Department of Electrical and Computer Engineering, University of British Columbia (UBC), Vancouver, British Columbia, Canada.,Research Institute, BC Children's Hospital, Vancouver, British Columbia, Canada; and
| | - J Mark Ansermino
- From the Department of Anesthesiology, Pharmacology and Therapeutics.,Research Institute, BC Children's Hospital, Vancouver, British Columbia, Canada; and
| | - Richard N Merchant
- From the Department of Anesthesiology, Pharmacology and Therapeutics.,Department of Anesthesia, Royal Columbian Hospital, Fraser Health Authority, New Westminster, British Columbia, Canada
| |
Collapse
|
14
|
Intelligent automated drug administration and therapy: future of healthcare. Drug Deliv Transl Res 2021; 11:1878-1902. [PMID: 33447941 DOI: 10.1007/s13346-020-00876-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2020] [Indexed: 12/13/2022]
Abstract
In the twenty-first century, the collaboration of control engineering and the healthcare sector has matured to some extent; however, the future will have promising opportunities, vast applications, and some challenges. Due to advancements in processing speed, the closed-loop administration of drugs has gained popularity for critically ill patients in intensive care units and routine life such as personalized drug delivery or implantable therapeutic devices. For developing a closed-loop drug delivery system, the control system works with a group of technologies like sensors, micromachining, wireless technologies, and pharmaceuticals. Recently, the integration of artificial intelligence techniques such as fuzzy logic, neural network, and reinforcement learning with the closed-loop drug delivery systems has brought their applications closer to fully intelligent automatic healthcare systems. This review's main objectives are to discuss the current developments, possibilities, and future visions in closed-loop drug delivery systems, for providing treatment to patients suffering from chronic diseases. It summarizes the present insight of closed-loop drug delivery/therapy for diabetes, gastrointestinal tract disease, cancer, anesthesia administration, cardiac ailments, and neurological disorders, from a perspective to show the research in the area of control theory.
Collapse
|
15
|
Komorowski M, Joosten A. AIM in Anesthesiology. Artif Intell Med 2021. [DOI: 10.1007/978-3-030-58080-3_246-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
16
|
Rinehart J, Lee S, Saugel B, Joosten A. Automated Blood Pressure Control. Semin Respir Crit Care Med 2020; 42:47-58. [PMID: 32746471 DOI: 10.1055/s-0040-1713083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Arterial pressure management is a crucial task in the operating room and intensive care unit. In high-risk surgical and in critically ill patients, sustained hypotension is managed with continuous infusion of vasopressor agents, which most commonly have direct α agonist activity like phenylephrine or norepinephrine. The current standard of care to guide vasopressor infusion is manual titration to an arterial pressure target range. This approach may be improved by using automated systems that titrate vasopressor infusions to maintain a target pressure. In this article, we review the evidence behind blood pressure management in the operating room and intensive care unit and discuss current and potential future applications of automated blood pressure control.
Collapse
Affiliation(s)
- Joseph Rinehart
- Department of Anesthesiology and Perioperative Care, University of California Irvine, Orange, California
| | - Sean Lee
- Department of Anesthesiology and Perioperative Care, University of California Irvine, Orange, California
| | - Bernd Saugel
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Outcomes Research Consortium, Cleveland, Ohio
| | - Alexandre Joosten
- Department of Anesthesiology, Erasme Hospital, Brussels, Belgium.,Department of Anesthesiology and Intensive Care, Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, Université Paris-Saclay, Hôpital De Bicêtre, Assistance Publique Hôpitaux de Paris (AP-HP), Le Kremlin-Bicêtre, France
| |
Collapse
|
17
|
Savoca A, van Heusden K, Manca D, Ansermino JM, Dumont GA. The effect of cardiac output on the pharmacokinetics and pharmacodynamics of propofol during closed-loop induction of anesthesia. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 192:105406. [PMID: 32155533 DOI: 10.1016/j.cmpb.2020.105406] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 01/31/2020] [Accepted: 02/17/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND OBJECTIVE Intraoperative hemodynamic stability is essential to safety and post-operative well-being of patients and should be optimized in closed-loop control of anesthesia. Cardiovascular changes inducing variations in pharmacokinetics may require dose modification. Rigorous investigational tools can strengthen current knowledge of the anesthesiologists and support clinical practice. We quantify the cardiovascular response of high-risk patients to closed-loop anesthesia and propose a new application of physiologically-based pharmacokinetic-pharmacodynamic (PBPK-PD) simulations to examine the effect of hemodynamic changes on the depth of hypnosis (DoH). METHODS We evaluate clinical hemodynamic changes in response to anesthesia induction in high-risk patients from a study on closed-loop anesthesia. We develop and validate a PBPK-PD model to simulate the effect of changes in cardiac output (CO) on plasma levels and DoH. The wavelet-based anesthetic value for central nervous system monitoring index (WAVCNS) is used as clinical end-point of propofol hypnotic effect. RESULTS The median (interquartile range, IQR) changes in CO and arterial pressure (AP), 3 min after induction of anesthesia, are 22.43 (14.82-36.0) % and 26.60 (22.39-35.33) % respectively. The decrease in heart rate (HR) is less marked, i.e. 8.82 (4.94-12.68) %. The cardiovascular response is comparable or less enhanced than in manual propofol induction studies. PBPK simulations show that the marked decrease in CO coincides with high predicted plasma levels and deep levels of hypnosis, i.e. WAVCNS < 40. PD model identification is improved using the PBPK model rather than a standard three-compartment PK model. PD simulations reveal that a 30% drop in CO can cause a 30% change in WAVCNS. CONCLUSIONS Significant CO drops produce increased predicted plasma concentrations corresponding to deeper anesthesia, which is potentially dangerous for elderly patients. PBPK-PD model simulations allow studying and quantifying these effects to improve clinical practice.
Collapse
Affiliation(s)
- A Savoca
- PSE-Lab, Process Systems Engineering Laboratory, Dipartimento di Chimica, Materiali e Ingegneria Chimica "Giulio Natta", Politecnico di Milano, Piazza Leonardo da Vinci 32, Milano 20133, Italy
| | - K van Heusden
- Department of Electrical & Computer Engineering, The University of British Columbia, Vancouver, British Columbia, Canada
| | - D Manca
- PSE-Lab, Process Systems Engineering Laboratory, Dipartimento di Chimica, Materiali e Ingegneria Chimica "Giulio Natta", Politecnico di Milano, Piazza Leonardo da Vinci 32, Milano 20133, Italy.
| | - J M Ansermino
- Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - G A Dumont
- Department of Electrical & Computer Engineering, The University of British Columbia, Vancouver, British Columbia, Canada; Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
18
|
The role of pharmacokinetics and pharmacodynamics in clinical anaesthesia practice. Curr Opin Anaesthesiol 2020; 33:483-489. [DOI: 10.1097/aco.0000000000000881] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
|
19
|
van Heusden K, Cooke E, Brodie S, West N, Görges M, Dumont GA, Ansermino JM, Merchant RN. Effect of ketamine on the NeuroSENSE WAV CNS during propofol anesthesia; a randomized feasibility trial. J Clin Monit Comput 2020; 35:557-567. [PMID: 32307624 DOI: 10.1007/s10877-020-00511-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 04/09/2020] [Indexed: 11/26/2022]
Abstract
Dose-dependent effects of ketamine on processed electroencephalographic depth-of-hypnosis indices have been reported. Limited data are available for the NeuroSENSE WAVCNS index. Our aim was to establish the feasibility of closed-loop propofol-remifentanil anesthesia guided by the WAVCNS index in the presence of an analgesic dose of ketamine. Thirty ASA I-II adults, 18-54 years, requiring general anesthesia for anterior cruciate ligament surgery were randomized to receive: full-dose [ketamine, 0.5 mg kg-1 initial bolus, 10 mcg kg-1 min-1 infusion] (recommended dose for postoperative pain management); half-dose [ketamine, 0.25 mg kg-1 bolus, 5 mcg kg-1 min-1 infusion]; or control [no ketamine]. After the ketamine bolus, patients received 1.0 mcg kg-1 remifentanil over 30 s, then 1.5 mg kg-1 propofol over 30 s, followed by manually-adjusted propofol-remifentanil anesthesia. The WAVCNS was > 60 for 7/9 patients in the full-dose group at 7 min after starting the propofol infusion. This was inconsistent with clinical observations of depth-of-hypnosis and significantly higher than control (median difference [MD] 17.0, 95% confidence interval [CI] 11.4-26.8). WAVCNS was median [interquartile range] 49.3 [42.2-62.6] in the half-dose group, and not different to control (MD 5.1, 95% CI - 4.9 to 17.9). During maintenance of anesthesia, the WAVCNS was higher in the full-dose group compared to control (MD 14.7, 95% CI 10.2-19.2) and in the half-dose group compared to control (MD 11.4, 95% CI 4.7-20.4). The full-dose of ketamine recommended for postoperative pain management had a significant effect on the WAVCNS. This effect should be considered when using the WAVCNS to guide propofol-remifentanil dosing.Trial Registration ClinicalTrails.gov No. NCT02908945.
Collapse
Affiliation(s)
- Klaske van Heusden
- Department of Electrical and Computer Engineering, UBC, Vancouver, BC, Canada.
- Research Institute, BC Children's Hospital, Vancouver, BC, Canada.
| | - Erin Cooke
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia (UBC), Vancouver, BC, Canada
- Research Institute, BC Children's Hospital, Vancouver, BC, Canada
| | - Sonia Brodie
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia (UBC), Vancouver, BC, Canada
| | - Nicholas West
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia (UBC), Vancouver, BC, Canada
| | - Matthias Görges
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia (UBC), Vancouver, BC, Canada
- Research Institute, BC Children's Hospital, Vancouver, BC, Canada
| | - Guy A Dumont
- Department of Electrical and Computer Engineering, UBC, Vancouver, BC, Canada
- Research Institute, BC Children's Hospital, Vancouver, BC, Canada
| | - J Mark Ansermino
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia (UBC), Vancouver, BC, Canada
- Research Institute, BC Children's Hospital, Vancouver, BC, Canada
| | - Richard N Merchant
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia (UBC), Vancouver, BC, Canada
- Department of Anesthesia, Royal Columbian Hospital, Fraser Health Authority, New Westminster, BC, Canada
| |
Collapse
|
20
|
Neckebroek M, Ghita M, Ghita M, Copot D, Ionescu CM. Pain Detection with Bioimpedance Methodology from 3-Dimensional Exploration of Nociception in a Postoperative Observational Trial. J Clin Med 2020; 9:E684. [PMID: 32143327 PMCID: PMC7141233 DOI: 10.3390/jcm9030684] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 02/13/2020] [Accepted: 02/29/2020] [Indexed: 12/21/2022] Open
Abstract
Although the measurement of dielectric properties of the skin is a long-known tool for assessing the changes caused by nociception, the frequency modulated response has not been considered yet. However, for a rigorous characterization of the biological tissue during noxious stimulation, the bioimpedance needs to be analyzed over time as well as over frequency. The 3-dimensional analysis of nociception, including bioimpedance, time, and frequency changes, is provided by ANSPEC-PRO device. The objective of this observational trial is the validation of the new pain monitor, named as ANSPEC-PRO. After ethics committee approval and informed consent, 26 patients were monitored during the postoperative recovery period: 13 patients with the in-house developed prototype ANSPEC-PRO and 13 with the commercial device MEDSTORM. At every 7 min, the pain intensity was measured using the index of Anspec-pro or Medstorm and the 0-10 numeric rating scale (NRS), pre-surgery for 14 min and post-anesthesia for 140 min. Non-significant differences were reported for specificity-sensitivity analysis between ANSPEC-PRO (AUC = 0.49) and MEDSTORM (AUC = 0.52) measured indexes. A statistically significant positive linear relationship was observed between Anspec-pro index and NRS (r2 = 0.15, p < 0.01). Hence, we have obtained a validation of the prototype Anspec-pro which performs equally well as the commercial device under similar conditions.
Collapse
Affiliation(s)
- Martine Neckebroek
- Department of Anesthesia, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium;
| | - Mihaela Ghita
- Research group of Dynamical Systems and Control, Ghent University, Tech Lane Science Park 125, 9052 Ghent, Belgium (D.C.); (C.M.I.)
- EEDT—Core Lab on Decision and Control, Flanders Make Consortium, Tech Lane Science Park 131, 9052 Ghent, Belgium
| | - Maria Ghita
- Research group of Dynamical Systems and Control, Ghent University, Tech Lane Science Park 125, 9052 Ghent, Belgium (D.C.); (C.M.I.)
- EEDT—Core Lab on Decision and Control, Flanders Make Consortium, Tech Lane Science Park 131, 9052 Ghent, Belgium
| | - Dana Copot
- Research group of Dynamical Systems and Control, Ghent University, Tech Lane Science Park 125, 9052 Ghent, Belgium (D.C.); (C.M.I.)
- EEDT—Core Lab on Decision and Control, Flanders Make Consortium, Tech Lane Science Park 131, 9052 Ghent, Belgium
| | - Clara M. Ionescu
- Research group of Dynamical Systems and Control, Ghent University, Tech Lane Science Park 125, 9052 Ghent, Belgium (D.C.); (C.M.I.)
- EEDT—Core Lab on Decision and Control, Flanders Make Consortium, Tech Lane Science Park 131, 9052 Ghent, Belgium
- Department of Automatic Control, Technical University of Cluj Napoca, Memorandumului 28, 400114 Cluj-Napoca, Romania
| |
Collapse
|
21
|
Görges M, West NC, Cooke EM, Pi S, Brant RF, Dumont GA, Ansermino JM, Merchant RN. Evaluating NeuroSENSE for assessing depth of hypnosis during desflurane anesthesia: an adaptive, randomized-controlled trial. Can J Anaesth 2020; 67:324-335. [PMID: 31691253 DOI: 10.1007/s12630-019-01522-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 08/12/2019] [Accepted: 10/28/2019] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Processed electroencephalography (EEG) monitors support depth-of-hypnosis assessment during anesthesia. This randomized-controlled trial investigated the performance of the NeuroSENSE electroencephalography (EEG) monitor to determine whether its wavelet anesthetic value for central nervous system (WAVCNS) index distinguishes consciousness from unconsciousness during induction of anesthesia (as assessed by the anesthesiologist) and emergence from anesthesia (indicated by patient responsiveness), and whether it correlates with changes in desflurane minimum alveolar concentration (MAC) during maintenance of anesthesia. METHODS EEG was collected using a fronto-temporal bilateral montage. The WAVCNS was continuously recorded by the NeuroSENSE monitor, to which the anesthesiologist was blinded. Anesthesia was induced with propofol/remifentanil and maintained with desflurane, with randomized changes of -0.4, 0, or +0.4 MAC every 7.5 min within the 0.8-1.6 MAC range, if clinically acceptable to the anesthesiologist. During emergence from anesthesia, desflurane was stepped down by 0.2 MAC every five minutes. RESULTS Data from 75 patients with a median [interquartile range] age of 41[35-52] yr were obtained. The WAVCNS distinguished consciousness from unconsciousness as assessed by the anesthesiologist, with area under the receiver operating characteristic curve of 99.5% (95% confidence interval [CI], 98.5 to 100.0) at loss of consciousness and 99.4% (95% CI, 98.5 to 100.0) at return of consciousness. Bilateral WAVCNS changes correlated with desflurane concentrations, with -8.0 and -8.6 WAVCNS units, respectively, per 1 MAC change in the 0.8-1.6 MAC range during maintenance of anesthesia and -10.0 and -10.5 WAVCNS units, respectively, in the 0.4-1.6 MAC range including emergence from anesthesia. CONCLUSION The NeuroSENSE monitor can reliably discriminate between consciousness and unconsciousness, as assessed by the anesthesiologist, during induction of anesthesia and with a lower level of reliability during emergence from anesthesia. The WAVCNS correlates with desflurane concentration but plateaus at higher concentrations, similar to other EEG monitors, which suggests limited utility to titrate higher concentrations of anesthetic vapour. TRIAL REGISTRATION clinicaltrials.gov, NCT02088671; registered 17 March, 2014.
Collapse
Affiliation(s)
- Matthias Görges
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, BC, Canada.
- BC Children's Hospital Research Institute, 950 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada.
| | - Nicholas C West
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Erin M Cooke
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, BC, Canada
- BC Children's Hospital Research Institute, 950 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada
| | - Shanshan Pi
- Department of Statistics, University of British Columbia, Vancouver, BC, Canada
| | - Rollin F Brant
- BC Children's Hospital Research Institute, 950 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada
- Department of Statistics, University of British Columbia, Vancouver, BC, Canada
| | - Guy A Dumont
- BC Children's Hospital Research Institute, 950 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada
- Department of Electrical Engineering, University of British Columbia, Vancouver, BC, Canada
| | - J Mark Ansermino
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, BC, Canada
- BC Children's Hospital Research Institute, 950 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada
| | - Richard N Merchant
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, BC, Canada
- Department of Anesthesia, Royal Columbian Hospital, Fraser Health Authority, New Westminster, BC, Canada
| |
Collapse
|
22
|
Eskandari N, van Heusden K, Dumont GA. Extended habituating model predictive control of propofol and remifentanil anesthesia. Biomed Signal Process Control 2020. [DOI: 10.1016/j.bspc.2019.101656] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
23
|
Di LL, Wang YX, Ma SX, Wu WH, Sun N, Wang ZC, Zhang YW, Huang LN. The effect of goal-directed fluid therapy combines closed-loop anesthesia management on postoperative rehabilitation of patients undergoing laparoscopic pancreaticoduodenectomy. J Clin Anesth 2019; 60:115-117. [PMID: 31669745 DOI: 10.1016/j.jclinane.2019.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 07/30/2019] [Accepted: 09/10/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Li-Li Di
- Department of Anesthesiology, Xingtai People's Hospital, No. 16, Hongxing Street, Qiaodong District, Xingtai 054000, PR China
| | - Yu-Xi Wang
- Department of Anesthesiology, The Second Hospital of Hebei Medical University, No. 215, Heping West Road, Xinhua District, Shijiazhuang 050000, PR China
| | - Shu-Xian Ma
- Department of Anesthesiology, The Second Hospital of Hebei Medical University, No. 215, Heping West Road, Xinhua District, Shijiazhuang 050000, PR China
| | - Wen-Hao Wu
- Department of Anesthesiology, The Second Hospital of Hebei Medical University, No. 215, Heping West Road, Xinhua District, Shijiazhuang 050000, PR China
| | - Na Sun
- Department of Anesthesiology, The Second Hospital of Hebei Medical University, No. 215, Heping West Road, Xinhua District, Shijiazhuang 050000, PR China
| | - Zi-Chen Wang
- Department of Anesthesiology, The Second Hospital of Hebei Medical University, No. 215, Heping West Road, Xinhua District, Shijiazhuang 050000, PR China
| | - Ya-Wen Zhang
- Department of Anesthesiology, The Second Hospital of Hebei Medical University, No. 215, Heping West Road, Xinhua District, Shijiazhuang 050000, PR China
| | - Li-Ning Huang
- Department of Anesthesiology, The Second Hospital of Hebei Medical University, No. 215, Heping West Road, Xinhua District, Shijiazhuang 050000, PR China.
| |
Collapse
|
24
|
van Heusden K, Soltesz K, Cooke E, Brodie S, West N, Gorges M, Ansermino JM, Dumont GA. Optimizing Robust PID Control of Propofol Anesthesia for Children: Design and Clinical Evaluation. IEEE Trans Biomed Eng 2019; 66:2918-2923. [PMID: 30763237 DOI: 10.1109/tbme.2019.2898194] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The goal of this paper was to optimize robust PID control for propofol anesthesia in children aged 5-10 years to improve performance, particularly to decrease the time of induction of anesthesia while maintaining robustness. METHODS We analyzed results of a previous study conducted by our group to identify opportunities for system improvement. Allometric scaling was introduced to reduce the interpatient variability and a new robust PID controller was designed using an optimization-based method. We evaluated this optimized design in a clinical study involving 16 new cases. RESULTS The optimized controller design achieved the performance predicted in simulation studies in the design stage. Time of induction of anesthesia was median [Q1, Q3] 3.7 [2.3, 4.1] min and the achieved global score was 13.4 [9.9, 16.8]. CONCLUSION Allometric scaling reduces the interpatient variability in this age group and allows for improved closed-loop performance. The uncertainty described by the model set, the predicted closed-loop responses, and the predicted robustness margins are realistic. The system meets the design objectives of improved speed of induction of anesthesia while maintaining robustness and improving clinically relevant system behavior. SIGNIFICANCE Control system optimization and ongoing system improvements are essential to the development of a clinically relevant commercial device. This paper demonstrates the validity of our approach, including system modeling, controller optimization, and pre-clinical testing in simulation.
Collapse
|
25
|
Heusden KV, Ansermino J, Dumont G. Performance of robust PID and Q-design controllers for propofol anesthesia. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.ifacol.2018.06.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|