A Multicenter Evaluation of a Closed-Loop Anesthesia Delivery System

Puri, Goverdhan D; Mathew, Preethy J; Biswas, Indranil; Dutta, Amitabh; Sood, Jayashree; Gombar, Satinder; Palta, Sanjeev; Morup, Tsering; Gautam, Parshotam Lal; Jayant, Aveek; Arora, Inderjeet; Bajaj, Vishal; Punia, T. S.; Singh, Gurjit

doi:10.1213/ane.0000000000000769

Cited by 80 publications

(49 citation statements)

References 18 publications

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“…In our study, maintenance time using the PSI TM between 20 and 50 was 92%. Puri G.D.et al in a multicenter clinical trial with 121 anesthetized patients with closed loop propofol and fentanyl and neuromonitoring with BIS TM , described a percentage of maintenance time in target BIS TM of 81.4% (76-89) (Puri et al, 2016). Hemmerling T.M.…”

Section: Discussionmentioning

confidence: 99%

Technical and clinical evaluation of a closed loop TIVA system with SEDLineTM spectral density monitoring: Multicentric prospective cohort study

et al. 2020

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Introduction: Closed loop total intravenous anesthesia is a technique in which the patient's hemodynamic and anesthetic depth variables are monitored, and based on this information, a computer controls the infusion rate of drugs to keep them within pre-established clinical parameters. Objective: To describe the technical and clinical performance of a closed loop system for total intravenous anesthesia with propofol and remifentanil, using the SEDLine TM monitor Design: Multicentric prospective cohort study Setting: Surgery room Patients: ASA I-II undergoing elective surgery Measurements: The authors designed a closed loop system that implements a control algorithm based on anesthetic depth monitoring and the Patient State Index (PSI TM ) of the SEDLine monitor for propofol, and on hemodynamic variables for remifentanil. The measurement of clinical performance was made based on the percentage of PSI TM maintenance time in the range 20-50. Precision analysis was evaluated by measuring median performance error (MDPE) can be defined as the median difference between actual and desired values, which refers to the degree of precision in which the controller is able to maintain the control variable within the objective set by the anesthesiologist; it represents the direction (over-prediction or underprediction) of performance error (PE) rather than size of errors, which is represented by MDAPE, median absolute percentage error, Wobble index, which is used for measuring the intrasubject variability in performance error. Results: Data were obtained from 93 patients in three healthcare centers. The percentage of PSI TM maintenance time in the 20-50 range was 92% (80.7-97.0). MDPE was 10.7 (− 11.0-18.0), MDAPE 21.0 (14.2-26.8) and wobble 10.7 (7.0-16.9). No adverse surgical or anesthetic events were found.

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Section: Discussionmentioning

confidence: 99%

Technical and clinical evaluation of a closed loop TIVA system with SEDLineTM spectral density monitoring: Multicentric prospective cohort study

et al. 2020

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“…Especially, the development of automated anaesthesia systems is progressing; for example, closed-loop feedback control of the bispectral index for stable control of hypnosis. Several meta-analyses have shown that automated anaesthesia delivery can be more effective than manually controlled anaesthesia by anaesthesiologists in attaining tight control with a speci ed range of target variables [27][28][29]. These systems also succeeded to reduce the doses of anaesthetics delivered and shorten the recovery time.…”

Section: Discussionmentioning

confidence: 99%

Development of an Automated Drug Delivery System for an Ultra-Short-acting β-Blocker, Landiolol, to Stably Reduce Myocardial Oxygen Consumption without Inducing Circulatory Collapse in a Canine Heart Failure Model

Nishikawa¹,

Uemura²,

Hayama³

et al. 2020

Preprint

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Background: Beta-blockers are well known to reduce myocardial oxygen consumption (MVO2) and improve the prognosis of heart failure (HF) patients. Although the use of β-blockers in the acute phase of HF can be expected to be beneficial, the negative chronotropic and inotropic effects limit their use due to the risk of circulatory collapse (cardiogenic shock, and/or pulmonary congestion). A safe method to administer β-blockers in the acute phase of HF is in great need. In this study, we developed an automated drug delivery system that controls the infusion of landiolol, an ultra-short-acting β-blocker, while preventing circulatory collapse. Method: We designed a system that simultaneously regulates cardiac function and volume status to control haemodynamics. The system monitors arterial pressure (AP), left atrial pressure (PLA), right atrial pressure, and cardiac output. Using negative feedback of haemodynamics, the system controls mean AP and mean PLA by administering landiolol, dextran, and furosemide. We applied the system for 60 min to 5 mongrel dogs with rapid pacing-induced HF, and assessed haemodynamics, MVO2 and lactate.Results: In all dogs, the system successfully adjusted delivery of the drugs resulting in accurate control of mean AP and mean PLA. From 15 to 60 min after the system was activated, median of absolute performance error (index of precision of control) was small for mean AP (median [interquartile range], 2.5 [2.1 – 3.7] %) and mean PLA (4.1 [1.8 – 6.2] %). Although the system decreased mean AP compared to baseline, mean and systolic AP were maintained not lower than 70 and 100 mmHg, respectively, and lactate did not increase. Furthermore, the system significantly decreased PLA and MVO2 (3.6 [3.3 – 4.0] to 2.7 [2.5 – 3.3] ml·min-1·100 g left ventricular weight-1) compared to baseline. Consequently, the automated drug delivery system successfully reduced MVO2 without inducing circulatory collapse.Conclusion: We developed an automated landiolol delivery system that achieved safe administration of landiolol in a canine model of acute HF. The system controlled AP and PLA accurately and stably, and reduced MVO2. With further development for clinical application, the automated drug delivery system may be the key tool to improve management of patients with HF.

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“…At present, with the increasing cesarean section rate in clinical practice, research is urgently required in order to determine how to reduce the impact of anesthetic drugs on mothers and neonates during cesarean deliveries. There have been advances in research and medical technology in recent years (9)(10)(11), from which the application of ropivacaine has evolved. Ropivacaine is a recently developed local anesthetic drug.…”

Section: Introductionmentioning

confidence: 99%

Ropivacaine vs. levobupivacaine: Analgesic effect of combined spinal‑epidural anesthesia during childbirth and effects on neonatal Apgar scores, as well as maternal vital signs

Cheng

Zhang

et al. 2019

Exp Ther Med

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The present study aimed to investigate and compare the analgesic effect and safety of ropivacaine or levobupivacaine in combined spinal-epidural anesthesia during childbirth and their effects on neonatal Apgar scores, as well as maternal and neonatal vital signs. A total of 615 maternal patients undergoing labor between April 2016 and March 2017 were divided into two groups according to the analgesic used for combined spinal-epidural anesthesia during childbirth: The ropivacaine group (n=318) and the levobupivacaine group (n=297). The onset time of analgesia in the two groups was determined and the pain score on the visual analog scale was assessed at the time of delivery (T3). At pre-analgesia, 30 min after analgesia (T2), at T3 and during maternal wound suturing (T4), the systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) were assessed. The cesarean section rate, neonatal 1-and 5-min Apgar scores and neonatal asphyxia at T4 were also determined. The onset time of analgesia in the ropivacaine group was significantly reduced compared with that in the levobupivacaine group (P<0.05). At T2 and T4, the SBP was significantly higher in the levobupivacaine group than that in the ropivacaine group (P<0.05). At T2, T3 and T4, the DBP was significantly lower in the levobupivacaine group compared with those in the ropivacaine group (P<0.05). At T2, the HR was significantly lower in the levobupivacaine group than that in the ropivacaine group (P<0.05). The cesarean section rate was significantly lower in the ropivacaine group compared with that in the levobupivacaine group [4.09% (n=13) vs. 22.89% (n=68); P<0.01]. In conclusion, the use of combined spinal-epidural anesthesia with ropivacaine or levobupivacaine has an excellent analgesic effect during childbirth. However, compared with levobupivacaine, ropivacaine for labor analgesia had a faster onset and a lesser impact on maternal vital signs, and was associated with a reduced maternal cesarean section rate among patients who did not opt for cesarean section in the beginning; therefore, it is useful in clinical practice.

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A Multicenter Evaluation of a Closed-Loop Anesthesia Delivery System

Cited by 80 publications

References 18 publications

Technical and clinical evaluation of a closed loop TIVA system with SEDLineTM spectral density monitoring: Multicentric prospective cohort study

Technical and clinical evaluation of a closed loop TIVA system with SEDLineTM spectral density monitoring: Multicentric prospective cohort study

Development of an Automated Drug Delivery System for an Ultra-Short-acting β-Blocker, Landiolol, to Stably Reduce Myocardial Oxygen Consumption without Inducing Circulatory Collapse in a Canine Heart Failure Model

Ropivacaine vs. levobupivacaine: Analgesic effect of combined spinal‑epidural anesthesia during childbirth and effects on neonatal Apgar scores, as well as maternal vital signs

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