Pharmacodynamic modelling of drug-induced ventilatory depression and automatic drug dosing in conscious sedation

Conf Proc IEEE Eng Med Biol Soc. 2006:2006:5029-32. doi: 10.1109/IEMBS.2006.260005.

Abstract

In conscious sedation (CS) procedures, the patient is sedated but retains the ability to breathe spontaneously. Drug-induced ventilatory depression represents a dangerous side effect of CS, possibly leading to hypoventilation and subsequent hypoxia. In this work, we propose a new pharmacodynamic model for drug-induced ventilatory depression. The model presents a parsimonious structure and shows good agreement with experimental data for different drugs. In addition, we explore the innovative idea of regulating drug infusion during CS by means of a feedback control system based on measurements of transcutaneous partial pressure of CO(2). In simulations, the controller proves able to maintain a predefined target of CO(2) despite pain, external disturbances and inter-patient variability in the sensibility to the drug. The implementation of the controller during CS procedures would improve clinical practice minimizing the occurrence of drug-induced ventilatory depression by tailoring drug infusion to patient's needs.

MeSH terms

  • Automation
  • Carbon Dioxide / metabolism
  • Chemistry, Pharmaceutical / methods
  • Computer Simulation
  • Conscious Sedation / methods*
  • Drug Delivery Systems
  • Equipment Design
  • Feedback
  • Humans
  • Hypnotics and Sedatives / administration & dosage*
  • Hypnotics and Sedatives / pharmacology*
  • Hypoxia
  • Infusions, Intravenous
  • Oxygen / metabolism
  • Pulmonary Gas Exchange / drug effects
  • Respiration / drug effects*

Substances

  • Hypnotics and Sedatives
  • Carbon Dioxide
  • Oxygen