Lessons learned from closed loops in engineering: towards a multivariable approach regulating depth of anaesthesia

J Clin Monit Comput. 2014 Dec;28(6):537-46. doi: 10.1007/s10877-013-9535-5. Epub 2013 Nov 23.

Abstract

In this paper is presented a brief state of art regarding the multivariable formulation for controlling the depth of anaesthesia by means of two intravenously administrated drugs, i.e. propofol and remifentanil. In a feasibility study of determining a suitable variable to quantify analgesia levels in patients undergoing cardiac surgery, the bispectral index and an electromyogram-based surrogate variable are proposed as the controlled variables. The study is carried on in the context of implementing a multivariable predictive control algorithm. The simulation results show that such a paradigm is feasible, although it does not guarantee perfect knowledge of the analgesia level-in other words, the variable is not validated against typical evaluations of the pain levels (e.g. clinical scores).

MeSH terms

  • Anesthetics, Intravenous / administration & dosage*
  • Anesthetics, Intravenous / blood
  • Anesthetics, Intravenous / pharmacokinetics*
  • Computer Simulation
  • Consciousness Monitors
  • Drug Monitoring / methods*
  • Drug Therapy, Computer-Assisted / methods*
  • Electroencephalography / drug effects*
  • Electromyography / drug effects*
  • Feedback, Physiological / physiology
  • Humans
  • Models, Biological*
  • Multivariate Analysis

Substances

  • Anesthetics, Intravenous